右美托咪定不同给药途径联合股神经阻滞用于膝关节镜日间手术后的镇痛

Different administration routes of dexmedetomidine combined with femoral nerve block for analgesia after arthroscopic daytime surgery

目的观察右美托咪定的不同给药途径复合相同浓度的罗哌卡因联合超声引导下的股神经阻滞对膝关节镜手术的术后镇痛效果。方法选择行日间膝关节镜检查的患者75例,随机分为A、B、C三组各25例。其中A组采用0.15%的罗哌卡因30 ml患侧股神经阻滞,50 ml生理盐水泵注;B组:0.15%的罗哌卡因+0.5μg/kg的右美托咪定共30 ml行单侧股神经阻滞,50 ml生理盐水泵注;C组:0.15%的罗哌卡因30 ml行患侧股神经阻滞,0.5μg/kg的右美托咪定50 ml泵注。均采用静推地佐辛5 mg/次作为术后镇痛的补救方法。记录手术持续时间以及患者苏醒时间,对患者的股四头肌肌力进行术前和术后的评估,记录术后2、5、9、12、16、20小时的VAS评分、Ramsay评分、不良反应发生例数、行镇痛补救例数。结果三组手术持续时间、患者苏醒时间、股四头肌肌力差异无统计学意义(P>0.05)。术后6、9、12、16、20小时的VAS评分、Ramsay评分,B、C组<A组,差异有统计学意义(P<0.05),B、C组间比较差异无统计学意义(P>0.05);B、C组需镇痛补救例数少于A组,三组不良反应发生例数差异无统计学意义。结论0.5μg/kg的右美托咪定静脉使用或者作为神经佐剂分别复合0.15%的罗哌卡因联合超声引导下的神股经阻滞应用于膝关节镜手术能有效并同等程度延长术后镇痛的持续时间。

Objective To observe the analgesic effect of dexmedetomidine combined with ropivacaine of the same concentration and femoral nerve block guided by ultrasound during knee arthroscopy.Methods Seventy-five patients undergoing knee arthroscopy were randomly divided into group A,B and C.The group A was given 30 ml femoral nerve block with 0.15%ropivacaine and 50 ml saline infusion.The group B was given 0.5μg/kg dexmedetomidine with 0.15%ropivacaine,30 ml femoral nerve block and 50 ml saline infusion.The group C was given 0.15%ropivacaine with 30 ml femoral nerve block and 50 ml 0.5μg/kg dexmedetomidine infusion.All patients received intravenous dezocine 5 mg/time as a remedy for postoperative analgesia.The duration of operation and recovery time were recorded.Quadriceps femoris muscle strength was evaluated before and after operation.VAS scores,Ramsay scores,adverse reactions and cases of pain relief were recorded at 2,5,9,12,16 and 20 hours after operation.Results There was no significant difference in operation duration,recovery time and quadriceps femoris muscle strength among the three groups(P>0.05).VAS score and Ramsay score at 6,9,12,16 and 20 hours after operation in the group B and C were significantly lower than those in the group A(P<0.05),but there was no significant difference between groups B and C(P>0.05).The number of cases requiring analgesic remedy in the group A was more than that in the group B and C,and there was no significant difference in the number of adverse reactions among the three groups.Conclusion The application of 0.5μg/kg dexmedetomidine intravenously or 0.15%ropivacaine combined with ultrasound-guided femoral nerve block as nerve adjuvant in knee arthroscopic surgery can effectively prolong the duration of postoperative analgesia.