帕瑞昔布钠超前镇痛联合右美托咪定复合局部麻醉在经皮椎间孔镜手术中的应用研究

Preemptive analgesia with parecoxib sodium to improve analgesic effect of dexmedetomidine combined with local anesthesia for percutaneous transforaminal surgery

目的研究帕瑞昔布钠超前镇痛联合右美托咪定复合局部麻醉用于经皮椎间孔镜手术的可行性。方法选择2016年1月至2018年6月于该院行局部麻醉下经皮椎间孔镜下腰椎髓核摘除术患者60例,按照随机数字表法分为A、B、C组,每组20例。A组术前静脉注射帕瑞昔布钠40mg;B组局部麻醉后术中泵注右美托咪定0.5μg/(kg·h);C组术前静脉注射帕瑞昔布钠40mg,局部麻醉后术中泵注右美托咪定0.5μg/(kg·h)。记录置入管道(T1)、打磨小关节(T2)、神经松解(T3)、术毕(T4)患者平均动脉压、心率、血氧饱和度、Ramsay镇静评分及数字疼痛评分(NRS评分)。若NRS评分大于4分,则追加使用芬太尼50mg。记录出现的不良反应及相应的例数。结果 A组患者各时间点血压、心率比较差异无统计学意义(P>0.05),B、C组T2、T3、T4时间点心率、血压较T1下降(P<0.05)。C组各时间点NRS评分低于A、B组,Ramsay评分高于A、B组(P<0.05)。3组患者均无明显的并发症反应。结论帕瑞昔布钠超前镇痛可提高右美托咪定复合局部麻醉用于经皮椎间孔镜手术的镇痛效果,减少芬太尼的使用。

Objective To explore the feasibility of preemptive analgesia with parecoxib sodium in improving the analgesia of dexmedetomidine combined with local anesthesia for percutaneous transforaminal surgery. Methods A total of 60 patients,receiving percutaneous lumbar discectomy under transforaminal endoscopes in this hospital from Jan.2016 to Jun.2018,were selected and randomly divided into group A,group B and group C,with 20 cases in each group.Group A received 40 mg of parecoxib sodium intravenously before surgery.Group B were continuously given 0.5 μg/(kg·h) dexmedetomidine infusion after local anesthesia.Group C received 40 mg of parecoxib sodium before surgery and 0.5 μg/(kg·h) of dexmedetomidine during surgery after local anesthesia.The mean arterial pressure,heart rate,pulse oximetry,Ramsay sedation score,and digital pain score (NRS score) were recorded at the beginning of surgery(T1),facet joint polishing(T2),neurolysis (T3) and at the end of surgery(T4).50 μg of fentanyl was used when NRS score was higher than 4.The adverse reactions and the number of related cases were recorded. Results The blood pressure and heart rate was not obviously changed in group A( P >0.05),but were decreased in group B and group C( P < 0.05 ).Compared with group A and group B,NRS score at T1,T2,T3 and T4 in group C were lower,while the Ramsay score at T1,T2,T3 and T4 in group C were higher( P <0.05).No obvious complication was found in all groups. Conclusion Preemptive analgesia with parecoxib sodium could significantly improve the analgesic effect of dexmedetomidine combined with local anesthesia for intervertebral foramen surgery and reduced the usage of fentanyl.