地塞米松和右美托咪定作为罗哌卡因佐剂对儿童前锯肌平面阻滞的影响

Effect of dexamethasone or dexmedetomidine as an adjuvant to ropivacaine on serratus anterior plane block in children

目的观察地塞米松和右美托咪定作为罗哌卡因佐剂对超声引导下儿童前锯肌平面阻滞镇痛效果的影响。方法选取90例择期行心脏直视手术的患儿,随机分为单纯罗哌卡因组(L组)、罗哌卡因+地塞米松组(LD组)和罗哌卡因+右美托咪定组(LY组),每组30例。L组在前锯肌浅面给予0.2%罗哌卡因3 mL/kg,LD组给予0.2%罗哌卡因3 mg/kg+地塞米松0.1 mg/kg,LY组给予0.2%罗哌卡因3 mg/kg+右美托咪定0.5μg/kg。在气管导管拔除后2 h、6 h、12 h、15 h、18 h、24 h进行FLACC镇痛评分,如果患儿镇痛评分>3分,则静脉给予舒芬太尼进行补救镇痛。记录患儿的舒芬太尼用量和镇痛相关并发症发生率。结果LD组和LY组拔管后2 h、6 h、12 h、18 h、24 h的FLACC评分与L组比较,差异均无统计学意义(P>0.05);LD组和LY组拔管后15 h的FLACC评分均低于L组(P<0.05)。LD组与LY组各时间点的FLACC评分比较,差异均无统计学意义(P>0.05)。LD组和LY组拔管后24 h内的舒芬太尼用量小于L组(P<0.05),但LD组与LY组比较,差异无统计学意义(P>0.05)。各组镇痛相关并发症发生率比较差异无统计学意义(P>0.05)。结论0.1 mg/kg地塞米松和0.5μg/kg右美托咪定可以有效延长罗哌卡因对儿童前锯肌平面阻滞的作用时间。

Objective To observe the effect of dexamethasone or dexmedetomidine as an adjuvant to ropivacaine on the analgesic effectiveness of ultrasound-guided serratus anterior plane block in children.Methods A total of 90 children who underwent elective congenital cardiac surgery were randomly divided into the ropivacaine group(L group),ropivacaine+dexamethasone group(LD group)and ropivacaine+dexmedetomidine group(LY group),with 30 cases in each group.children in L group received serratus anterior plane block with 3 mg/kg of 0.2%ropivacaine,children in LD group received serratus anterior plane block with 3 mg/kg of 0.2%ropivacaine+0.1 mg/kg of dexamethasone and children in LY group received serratus anterior plane block with 3 mg/kg of 0.2%ropivacaine+0.5μg/kg of dexmedetomidine.The FLACC(Face,Legs,Activity,Crying,Consolability)scoring was used to evaluated pains at 2,6,12,15,18,24 hours after extubation.Intravenous sufentanil was used for rescue analgesia when FLACC score was more than 3.The total consumption of sufentanil and analgesia related complications were recorded.Results There was no significant difference in FLACC scores at 2,6,12,18 and 24 hours after extubation among L group,LD group and LY group(P>0.05).The FLACC scores of LD group and LY group at 15 hours after extubation were significantly lower than that of the L group(P<0.05).There was no significant difference in the FLACC score at each time points between LD group and LY group.The consumption of sufentanil within 24 hours after extubation in LD group and LY group were less than that in L group(P<0.05),but no significant difference was found between LD group and LY group(P>0.05).There were no significantly differences in the incidence of analgesia related complications among three groups(P>0.05).Conclusion Both 0.1 mg/kg of dexamethasone and 0.5μg/kg of dexmedetomidine can effectively prolong the action time of 0.2%ropivacaine on ultrasound-guided serratus anterior plane block in children.