右美托咪定复合罗哌卡因骶管阻滞对前列腺电切术后镇痛效果评估

Postoperative pain control in elderly patients for transurethral resection of prostate surgery: evaluating the efficiency and safety of dexmedetomidine-ropivacaine combination for caudal block

目的探讨右美托咪定复合罗哌卡因单次骶管阻滞用于老年前列腺电切术患者术后镇痛的效果和安全性。方法纳入拟行择期经尿道前列腺等离子电切术的老年患者80名,随机分为R组和D组,每组各40例,均接受超声引导下的骶管阻滞和后续的全身麻醉。骶管用药R组为0.2%的罗哌卡因25ml,D组为含有0.5μg/kg盐酸右美托咪定注射液和0.2%盐酸罗哌卡因的混合液体25ml。记录两组不同时间点心率(HR)、平均动脉压(MAP)变化,记录感觉阻滞起效时间、最高感觉阻滞平面、感觉阻滞持续时间和最高运动阻滞(改良Bromage)评分。于术后1h(T1)、6h(T2)、12h(T3)、18h(T4)、24h(T5)、48h(T6)记录疼痛(NRS)评分和镇静(OAA/S)评分,记录第一次使用镇痛药物时间和48h内镇痛药物使用剂量以及麻醉相关不良事件发生情况。结果D组感觉阻滞起效时间短于R组,差异有统计学意义(P<0.05);感觉阻滞持续时间D组长于R组,差异有统计学意义(P<0.05);改良Bromage评分两组比较差异无统计学意义(P>0.05);术后T2、T3、T4时间点D组NRS评分低于R组(P<0.05);D组第一次使用镇痛药物的时间长于R组(P<0.05),D组术后镇痛药物使用量少于R组(P<0.05);两组患者T1~T6时间点的OAA/S评分组间比较,差异无统计学意义(P>0.05);骶管阻滞后两组HR、MAP均较之前有所下降,其中阻滞后15min时间点D组HR下降较R组明显,差异有统计学意义(P<0.05);D组患者出现心动过缓、低血压等与R组对比差异无统计学意义(P>0.05),两组患者48h内发生的其他麻醉不良事件发生率比较差异无统计学意义(P>0.05)。结论右美托咪定复合罗哌卡因单次骶管阻滞,可减轻老年患者前列腺术后疼痛,延长镇痛时间,减少镇痛药物使用,单次剂量0.5μg/kg右美托咪定骶管阻滞可出现一过性心动过缓和低血压,但不增加患者术后48h其他不良反应,是一种有效、安全的方法。

Objective To evaluate the efficacy and safety of dexmedetomidine-ropivacaine combination for caudal block in elderly patients which received transurethral resection of prostate surgeries.Methods This prospective,double-blind clinical trial included 80 patients of American Society of Anesthesiologist Grade Ⅰ and Ⅱ in the age group of 60-80 years which received selected transurethral resection of prostate surgeries.Patients were divided into ropivacaine group and dexmedetomidine-ropivacaine group.The ropivacaine group (Group R,n =40) was received 0.2% ropivacaine 25 ml.The dexmedetomidine-ropivacaine group (Group D,n =40) was received 0.2% ropivacaine 25 ml plus 0.5μg/kg dexmedetomidine.The hemodynamic changes,block characteristics which included time to onset of analgesia,maximum sensory analgesic level,time of sensory analgesia duration,and motor block scores (Bromage).Pain (NRS) and sedation (OAA/S) scores were documented at the 1th(T1),6th(T2),12th(T3),18th(T4),24th(T5) and 48th(T6) after the operation.Rescue analgesic consumption and time to the first dose of rescue analgesia for 48 h also were recorded.The other recordings included side-effects (nausea and vomiting,bradycardia,hypotension and shivering) during 48h after the operation.Results Significant differences were observed in relation to duration of sensory block (350.48+/-49.79 min in Group R and 433.85+/-51.65 min in Group D[ P <0.05]),duration of post-operative analgesia (385.63+/-60.09 min in Group R and 493.45+/-73.17 min in Group D[ P <0.05]) and consequently low doses of rescue analgesia in Group D (83.75+/-32.79) as compared to Group R (69.00+/-26.87)( P <0.05).No difference of Bromage scores between two groups was observed.After blocks,the HR and MAP of two groups decreased than before,especially the decrease of HR in group D compared with the group R( P <0.05).The NRS scores were lower in Group D from 6h to 18h after the operation( P <0.05).There was no difference in sedation scores between two groups (P> 0.05).The incidence of bradycardia and hypotension in two groups were not different significantly (12.5% in group R and 27.5% in group D) and (5.0% in group R and 17.5% in group D)(P 0.05).Conclusion These results suggest that,in elderly patients which receive transurethral resection of prostate surgeries,dexmedetomidine is an effective additive to ropivacaine for caudal block,which is associated with prolonged sensory block and postoperative analgesia,reduced demand for rescue analgesics when compared to plain Ropivacaine.The dose of 0.5 μg/kg is safe for elderly patients without hemodynamic and other adverse effect.