右美托咪定复合罗哌卡因腹横肌平面阻滞对开腹胃手术术后镇痛效果的影响

Analgesia effect of adding dexmedetomidine to ropivacaine for transversus abdominis plane block (TAPB) after gastrectomy

目的腹横肌平面阻滞(transversus abdominis plane block,TAPB)常用于腹部手术后镇痛。右美托咪定常用作局部麻醉辅助药以延长区域麻醉的作用时间。该研究主要评估右美托咪定加入罗哌卡因中能否延长TAP阻滞的作用时间改善开腹胃手术的镇痛效果。方法择期行开腹胃手术患者90例,ASAⅠ或Ⅱ级随机分为三组,对照组(C组)、罗哌卡因组(R组)和罗哌卡因+右美托咪定组(RD组)。记录术后不同时间点视觉模拟疼痛评分(VAS评分)、恶心呕吐评分(PONV)、镇静评分、罗哌卡因血药浓度和曲马朵使用量以及术后第一次排气时间。结果R组和RD组患者术后2 h、4 h、12 h、24 h的静息和活动时VAS评分明显低于C组(P<0.05),但R组和RD组的VAS评分没有显著性差异。R组和RD组术后曲马朵需要量明显低于C组。术后2 h、12 h和24 h的PONV评分R组和RD组明显低于C组(P<0.05)。三组的镇静评分和第一次排气时间没有显著性差异(P>0.05)。R组和RD组罗哌卡因的血药浓度无显著性差异(P>0.05)。结论超声引导下TAP阻滞能够改善开腹胃手术后的镇痛质量,减少术后恶心呕吐,减少曲马朵消耗。局麻药中加入右美托咪定并没有影响罗哌卡因的血药浓度。

Objective Transversus abdominis plane block(TAPB)is analgesic technique.Adding dexmedetomidine can enhance regional anesthesia.The aim of this study is to evalaute wether dexmedetomidine prolong analgesic time of TAPB after gastrectomy.Methods Ninety ASA classⅠorⅡ patients scheduled for gastrectomy were randomly assgned to receive TAPB with ropivacaine(group R),ropivacaine and dexmedetomidine(group RD)or not to receive TAPB(group C).Vissual analogue scale(VAS)scores,postoperrative nausea and vomiting(PONY)scores,sedation scores,ropivacaine concentration,tramadol consumptiont and the first time of flatul were recorded.Results Group R and group RD had lower scores 2,4,12,and 24 h after surgery compared with group C(P<0.05).PONy scores were lower in group VAS R and group RD compared with group C after2,12,24,and 36 h(P<0.05).Group R and group RD required less tramadol than group C(P<0.05).The ropicaine blood drug level had no significant difference between group R and group RD(P>0.05).Sedation scores and the first time to flatul were similar between three groups(P>0.05).Conclution TAPB can provide analgesia and improve the quality of recovery.Adding dexmedetomidine does not effect the ropicaine blood drug level.