右美托咪定复合罗哌卡因竖脊肌平面阻滞对腰椎手术后镇痛效果及睡眠质量的影响

Effect of dexmedetomidine combined with ropivacaine for erector spine plane block on postoperative analgesia and sleep quality in patients undergoing lumbar surgery

目的探讨右美托咪定(Dexmedetomidine,DEX)复合罗哌卡因竖脊肌平面(erector spine plane,ESP)阻滞对腰椎手术后镇痛效果及睡眠质量的影响。方法选择择期行腰椎后路手术患者40例,采用随机数字表法分为两组,每组20例:DEX复合罗哌卡因组(A组)和罗哌卡因组(B组)。全麻诱导前行双侧ESP阻滞,A组每侧注入含1μg/kg DEX的0.375%罗哌卡因20 mL,B组每侧注入0.375%罗哌卡因20 mL后全麻诱导。术后行自控静脉镇痛(PCIA)至术后48 h,若VAS≥4分,静脉给予地佐辛5 mg或帕瑞昔布钠40 mg或氟比洛芬酯50 mg补救镇痛。记录两组术后2、4、6、12、24和48 h时的BCS舒适度评分。记录术后48 h内PCIA有效按压次数(D 1)和实际按压次数(D 2),计算D 1/D 2比值及补救镇痛情况;记录ESP阻滞并发症(局麻药中毒、穿刺部位血肿、感染)及术后恶心呕吐、头晕、皮肤瘙痒、呼吸抑制等不良反应的发生情况;采用匹兹堡睡眠质量指数(PSQI)分别评估术前、术后1 d、2 d及出院前患者睡眠质量。结果与B组比较,A组术后2、4、6、12、24和48 h时BCS舒适度评分明显升高,D 1/D 2值明显升高,补救镇痛率明显减少,恶心呕吐发生率明显降低,术后1 d、2 d及出院前的PSQI评分明显降低(P<0.05)。两组术后头晕、皮肤瘙痒、呼吸抑制等发生情况差异无统计学意义(P>0.05),两组均未出现局麻药中毒、穿刺部位血肿、感染等并发症。结论1μg/kg DEX复合0.375%罗哌卡因用于ESP阻滞,可为腰椎后路手术患者提供更好的术后镇痛,改善术后睡眠质量。

Objective To evaluate the effect of dexmedetomidine(DEX)combined with ropivacaine for erector spine plane(ESP)block on postoperative analgesia and sleep quality in patients undergoing lumbar surgery.Methods Forty patients scheduled for elective lumbar surgery were randomly divided into two groups:DEX combined with ropivacaine group(group A)and ropivacaine group(group B),with 20 cases in each group.Bilateral ESP block was performed before general anesthesia induction.In group A,0.375%ropivacaine 20 mL with 1μg/kg DEX were injected into erector spine plane on each side.In group B,0.375%ropivacaine 20 mL was injected into erector spine plane on each side.Postoperative controlled intravenous analgesia(PCIA)was implemented until 48 h after surgery.When VAS scale≥4,dezocine 5 mg or parecoxib 40 mg or flurbiprofen 50 mg was selected and intravenously injected as rescue analgesic.Bruggrmann comfort scale(BCS)was evaluated at 2,4,6,12,24 and 48 h after operation.The requirement for rescue analgesia,the number of effective compressions(D 1)and actual compressions(D 2)of PCIA within 48 h after operation were recorded.The D 1/D 2 was calculated.The development of ESP block-related complications(local anesthetic poisoning,hematoma,infection)and adverse reactions such us postoperative nausea and vomiting,dizziness,itching of the skin,respiratory depression were also recorded.The sleep quality was assessed with Pittsburgh sleep quality index(PSQI)before operation,1 day,2 days after operation and before discharge.Results Compared with group B,BCS of group A was significantly increased at 2,4,6,12,24 and 48 h after operation,D 1/D 2 was significantly increased,the requirement for rescue analgesia and incidence of postoperative nausea and vomiting were significantly reduced,PSQI was significantly decreased at 1 d,2 d after operation and before discharge(P<0.05).There was no significant difference in the incidence of dizziness,itching of the skin,and respiratory depression between the two groups(P>0.05).There were no complications such as local anesthetic poisoning,hematoma and infection at the puncture site in both two groups.Conclusions 1μg/kg DEX combined with 0.375%ropivacaine for ESP block can provide better postoperative analgesia and improve postoperative sleep quality.