右美托咪定或地塞米松复合罗哌卡因对椎旁神经阻滞效果的影响

Effects of ropivacaine combined with dexmedetomidine or dexamethasone on paravertebral block

目的比较右美托咪定或地塞米松复合罗哌卡因对椎旁神经阻滞(PVB)效果的影响。方法择期行胸腔镜肺叶切除术患者128例,男43例,女85例,ASAⅠ或Ⅱ级,随机分为三组:对照组(C组)、右美托咪定组(D组)和地塞米松组(S组)。使用0.5%罗哌卡因共15 ml对C组患者行PVB,D组和S组分别使用0.5%罗哌卡因复合右美托咪定100μg共15 ml、0.5%罗哌卡因复合地塞米松10 mg共15 ml行PVB。记录阻滞后20 min的Ramsay镇静评分、口干评分以及术中阿片类药物用量、去氧肾上腺素用量、液体入量和尿量。测定PVB后0.5、1、2、3、24 h罗哌卡因血药浓度。记录术后24、48 h的VAS疼痛评分。记录术后首次镇痛泵按压时间。结果D组PVB阻滞后20 min的Ramsay镇静评分、口干评分明显高于C组,术中尿量明显多于C组(P<0.05)。C组、S组Ramsay镇静评分、口干评分以及术中尿量差异无统计学意义。三组术中舒芬太尼、去氧肾上腺素用量、液体入量差异无统计学意义。PVB后0.5、1、2、3、24 h三组罗哌卡因血药浓度差异无统计学意义。术后24、48 h三组不同状态下VAS疼痛评分差异无统计学意义。D组、S组术后首次镇痛泵按压时间明显长于C组(P<0.05),S组术后首次镇痛泵按压时间明显长于D组(P<0.05)。结论与0.5%罗哌卡因复合右美托咪定100μg比较,0.5%罗哌卡因复合地塞米松10 mg行PVB的镇痛时间更长,且患者无口干、镇静过深等不良反应。

Objective To explore the effect of ropivacaine combined with dexmedetomidine or dexamethasone on paravertebral nerve block(PVB).Methods A total of 128 patients scheduled for elective video-assisted thoracoscopic lobectomy,43 males and 85 females,ASA physical statusⅠorⅡ,were randomly assigned into three groups:dexmedetomidine group(group D),dexamethasone group(group S)and control group(group C).Group C received unilateral PVB with 0.5%ropivacaine 15 ml,group D received 0.5%ropivacaine 15 ml combined with dexmedetomidine 100μg,and group S received 0.5%ropivacaine 15 ml combined with dexamethasone 10 mg.The dry mouth score and Ramsay sedation score were evaluated 20 minutes after the block.The perioperative characteristics were recorded,such as intraoperative opioid,phenylephrine dosage,fluid intake,and urine volume.Blood concentrations of ropivacaine were measured 0.5,1,2,3,and 24 hours after PVB.VAS pain scores of resting and active conditions 24 and 48 hours after operation were recorded.The time of the patients'first controlled intravenous analgesia pump press was recorded.Results The Ramsay sedation score and dry mouth score of group D were significantly higher than those in group C,and the urine output was significantly higher than that in group C(P<0.05).There was no significant difference in Ramsay sedation score,dry mouth score,and urine output in groups C and S.There was no statistically significant difference in the amount of sufentanil,phenylephrine,and the amount of fluid in the three groups.There was no significant difference in the blood concentration of ropivacaine among groups C,D,and S at each time point.There was no significant difference in VAS pain scores among the three groups 24 and 48 hours after operation.The first analgesic pump compression time after operation in groups D and S was significantly longer than that in group C(P<0.05),and the first analgesic pump compression time after operation in group S was significantly longer than that in group D(P<0.05).Conclusion Compared with the addition of 100μg dexmedetomidine,0.5%ropivacaine combined with 10 mg dexamethasone provided longer analgesia time for PVB,and there were no adverse reactions such as dry mouth and deep sedation.