右美托咪定联合罗哌卡因用于连续肋锁间隙臂丛神经阻滞对前臂或手部手术的术后镇痛效果

Postoperative analgestic effect of dexmedetomidine combined with ropivacaine for continuous costoclavicular space block in patients with forearm or hand surgery

目的研究右美托咪定联合罗哌卡因用于连续肋锁间隙臂丛神经阻滞(Costoclavicular space block,CCSB)对前臂或手部手术患者术后疼痛控制和身心健康的影响。方法采用队列对照的前瞻性研究方法,选取我院骨科2018年6月~2019年12月收治的60例前臂或手部手术骨折患者,随机分为罗哌卡因组(R组)和罗哌卡因+右美托咪定组(RD组),各30例,两组患者均在超声联合神经刺激仪引导下行CCSB并置管,R组予以单独罗哌卡因神经阻滞和术后持续镇痛,RD组予以罗哌卡因联合右美托咪定神经阻滞和术后持续镇痛。记录神经阻滞时间和起效时间、感觉和运动阻滞效率、静息VAS评分、自控镇痛次数、曲马多使用情况以及不良反应。评价患者睡眠节律和质量、焦虑程度(GAD-7)、躯体症状群(PHQ-15)和治疗满意度。结果所有患者CCSB穿刺和置管顺利,未出现阻滞相关并发症,两组神经阻滞操作时间和阻滞时间差异无统计学意义(P>0.05)。神经阻滞后30min RD组的运动阻滞评分2分占比明显高于R组,差异有统计学意义(P<0.05);但感觉阻滞评分两组间差异无统计学意义(P>0.05)。术后6、12、24和48h RD组静息VAS评分较R组明显降低,差异有统计学意义(P<0.05)。R组患者使用自控镇痛的次数以及使用曲马多的患者比例和剂量高于RD组,差异有统计学意义(P<0.05)。R组不良反应发生率、睡眠节律异常率、GAD-7评分和重度焦虑发生率、PHQ-15评分和重度躯体症状发生率高于RD组,差异有统计学意义(P<0.05)。RD组患者睡眠质量评分和满意度高于R组,差异有统计学意义(P<0.05)。结论连续肋锁间隙臂丛神经阻滞可为前臂或手部手术患者术后提供有效的疼痛控制,辅助使用右美托咪定有助于优化镇痛效果,改善患者心身健康,提升治疗满意度。

Objective To evaluate the effect of dexmedetomidine combined with ropivacaine in continuous costoclavicular space block(CCSB)on postoperative analgesia and psychosomatic health in patients with forearm or hand surgery.Methods Sixty patients with humeral fracture who underwent open reduction and internal fixation selected from Jun 2018 to Dec 2019 were enrolled into this study.They were randomly divided into ropivacaine group(R group,n=30)and ropivacaine+dexmedetomidine group(RD group,n=30).All patients received continuous CCSB analgesia guided by ultrasound and neurostimulator.Recorded CCSB operating and onset time,sensory and motor block efficiency,resting VAS score,self-controlled analgesia,rescue painkiller dose,adverse reactions,sleep rhythm and quality,degree of anxiety(GAD-7),somatic symptoms(PHQ-15),and treatment satisfaction.Results There was no significant difference in CCSB oprerating and onset time between the two groups(P>0.05).The proportion of motor block score of 2 in RD group 30min after CCSB significantly increased compared with R group(P<0.05),but there was no significant difference in sensory block score between the two groups(P>0.05).The resting VAS score at 6,12,24 and 48h after surgery significantly decreased in RD group compared with R group(P<0.05).RD group received fewer self-controlled analgesia and rescue painkillers compared with R group(P<0.05).Adverse reactions,abnormal sleep rhythm rate,GAD-7 score,severe anxiety rate,PHQ-15 score,and severe somatic symptoms rate significantly decreased in RD group compared with R group,and sleep quality improved distinctively in RD group(P<0.05).Patients'satisfaction obviously increased in RD group(P<0.05).Conclusion Continuous CCSB can effectively provide pain control for patients with forearm or hand surgery,and ropivacaine combined with dexmedetomidine can optimize analgesic effect,improve psychosomatic health and enhance treatment satisfaction.