不同剂量右美托咪定混合罗哌卡因腹横肌平面阻滞对妇科腹腔镜术后镇痛效果的比较

Comparison of different doses of dexmedetomidine supplement with ropivacaine for ultrasound-guided transversus abdominis plane block on postoperative analgesia in patients undergoing laparoscopic gynecological surgery

目的比较不同剂量右美托咪定混合罗哌卡因超声引导下腹横肌平面(TAP)阻滞对妇科腹腔镜术后的镇痛效果。方法选择2017-01/2018-01期间在三峡大学人民医院择期全麻腹腔镜下妇科手术患者125例,年龄18～60岁, ASA分级Ⅰ或Ⅱ级。采用随机数字表法将患者分为C组(对照组):未行TAP阻滞(n=25); R组:仅用0.2%罗哌卡因TAP阻滞60 mL(n=25); D_1+R组、 D_2+R组、 D_3+R组:分别以0.25、 0.5、 1.0μg/kg右美托咪定混合0.2%罗哌卡因TAP阻滞60 mL(n=25)。比较术后1、 6、 12、 24 h时疼痛视觉模拟评分法(VAS)评分、 Ramsay镇静评分;术后24 h内补救镇痛药使用率、镇痛满意率及不良反应发生率。结果术后1 h时R组、 D_1+R组、 D_2+R组、 D_3+R组静息痛及运动痛VAS评分均低于C组(P<0.05);术后6、 12 h时D_2+R组、 D_3+R组静息痛VAS评分均低于C组、 R组,运动痛VAS评分均低于C组、 R组及D_1+R组(P<0.05)。D_2+R组、 D_3+R组术后24 h内补救镇痛药使用率均低于C组、 R组及D_1+R组,而镇痛满意率均增加(P<0.05)。术后1、 6、 12 h时D_3+R组Ramsay镇静评分、术后24 h内镇静过度及心动过缓发生率均高于C组、 R组及D_1+R组(P<0.05)。结论右美托咪定复合0.2%罗哌卡因超声引导下TAP阻滞能显著改善妇科腹腔镜手术后镇痛效果, 0.5μg/kg是较为适宜的佐剂剂量。

Objective To compare the efficacy of different doses of dexmedetomidine supplement with ropivacaine for ultrasound-guided transversus abdominis plane block on postoperative analgesia in patients undergoing laparoscopic gynecological surgery. Methods One hundred and twenty-five patients undergoing elective laparoscopic gynecological surgery under general anesthesia in the People s Hospital of China Three Gorges University from January2017 to January2018, aged18-60 years, ASA physical status Ⅰ or Ⅱ, were randomly divided into 5 groups, with25 cases in each group. Group C (control group): subjects received no transversus abdominis plane block;group R: subjects received transversus abdominis plane block with only 0.2% ropivacaine in total 60 mL volume;group D1+R, D2+R, D 3+R: subjects received transversus abdominis plane block with 0.2% ropivacaine supplement with 0.25, 0.5,1.0 μg/kg dexmedetomidine in total 60 mL volume, respectively. General anesthesia was induced and maintained after transversus abdominis plane block was successful. The [HJ2mm]visual analogue scale (VAS) and Ramsay sedation scores were applied to evaluate rest and movement pain, and sedation degrees at1, 6,12,24 h after surgery, respectively. The incidences of using rescue analgesic and the whole patient satisfaction for analgesia within24 h after surgery were analyzed. And postoperative adverse reactions were also record. Results Compared with group C, both rest pain and movement pain VAS scores were significantly decreased at1 h after surgery in group R and D1+R, D2+R, D 3+R ( P <0.05). The rest pain VAS scores at 6 and12 h in group D2+R, D 3+R were lower than those of group C and R;and the movement pain VAS scores at 6 and12 h in group D2+R, D 3+R were lower than those of group C, R and D1+R(P<0.05). Compared with group C, R, and D1+R, the incidences of using rescue analgesic in group D2+R, D 3+R were significantly decreased;however, the whole patient satisfaction for analgesia within24 h after surgery were significantly increased in group D2+R, D 3+R( P <0.05). The Ramsay sedation scores were higher at1, 6 and12 h after surgery;and both the incidences of drowsiness and bradycardia were also higher during the postoperative24 h in group D 3+R than those in group C, R and D1+R( P <0.05). Conclusion Dexmedetomidine supplement with 0.2% ropivacaine for ultrasound-guided TAP block significantly alleviate postoperative pain for patients undergoing laparoscopic gynecological surgery, and 0.5 μg/kg dexmedetomidine is a suitable dosage for adjuvant therapy.