地塞米松对罗哌卡因行肋间神经阻滞效果的影响

Effect of dexamethasone added to ropivacaine on intercostal nerve block

目的探讨罗哌卡因中加入地塞米松对于肋间神经阻滞效果的影响。方法选取ASAⅠ~Ⅱ级择期在肋间神经阻滞下行单侧乳房肿块切除术的门诊患者390例,随机分为2组:实验组(A组,n=195)使用0.375%罗哌卡因24mL和5mg地塞米松1mL,对照组(B组,n=195)使用0.375%罗哌卡因24mL和0.9%生理盐水1mL。主要观察指标为触觉阻滞维持时间和疼痛阻滞维持时间;次要观察指标为起效时间、VAS评分、不良反应及患者满意度。结果触觉阻滞维持时间和疼痛阻滞维持时间:A组均显著长于B组(P<0.01);出现疼痛感知时VAS评分:A组低于B组(P<0.05);患者满意度:A组高于B组(P<0.05);2组起效时间、不良反应发生率差异均无统计学意义;2组均未发生延迟性神经损伤。结论0.375%罗哌卡因复合5mg地塞米松可安全用于肋间神经阻滞,具有延长镇痛时间、降低术后疼痛、提高患者满意度、改善麻醉效果等作用。

Objective To determine the effects of perineural dexamethasone added to ropivacaine on intercostal nerve block (INB). Methods In this trail,390 patients undergoing lumpectomy of breast with an INB were randomely devided into 2 groups:the experimrntal group (A,n =195) received 24 mL of 0.375% ropivacaine plus 5 mg dexamethasone,and the control group (B,n =195) received 24 mL of 0.375 % ropivacaine plus 1 mL of 0.9% saline.The primary outcome were the durations of tactile sensation block and pain sensation block.The secondary outcome were onset time,VAS score,INB complications and patient satisfaction. Results The durations of tactile sensation block and pain sensation block were significantly longer in group A compared with group B ( P <0.01).VAS score when first request for analgesic was lower in group A compared with group B ( P <0.05).Percentage of patient satisfaction was higher in group A compared with group B ( P <0.05).There was no statistically significant difference on onset time or INB complications between the two groups. Conclusions Perineural administration of 5 mg dexamethasone with 0.375% ropivacaine could be safely used for INB,which could significantly prolongs the duration of effective postoperative analgesia,improve patient satisfaction and ameliorate analgesic effect.