右美托咪定复合罗哌卡因Ⅱ型胸神经阻滞在乳腺癌改良根治术中的应用

Application of dexmedetomidine combined with ropivacaine in pectoral nerves blockⅡin modified radical mastectomy

目的探讨右美托咪定复合罗哌卡因Ⅱ型胸神经阻滞(PECSⅡ)对乳腺癌改良根治术后疼痛和炎症反应的影响。方法将拟行乳腺癌改良根治术的72例女性患者随机分为单用罗哌卡因组(R组)和右美托咪定复合罗哌卡因组(RD组),每组36例。2组麻醉诱导和维持方案相同。2组镇痛方法选择麻醉诱导前超声引导下PECSⅡ联合术后镇痛泵患者自控静脉镇痛(PCIA),R组PECSⅡ单用0.25%罗哌卡因30 mL,RD组PECSⅡ采用右美托咪定0.5μg·kg^(-1)复合0.25%罗哌卡因30 mL,2组术后镇痛泵配方相同,药液中含舒芬太尼100μg,均无持续给药剂量。以PECSⅡ起效至患者第一次按压镇痛泵给药键的时间为PECSⅡ有效镇痛时间,记录术中丙泊酚、瑞芬太尼以及术后48 h内舒芬太尼用量,术后6 h(T_(1))、12 h(T_(2))、24 h(T_(3))、48 h(T_(4))时静息状态下疼痛视觉模拟量表(VAS)评分。酶联免疫吸附(ELISA)法测定术前1 h(T_(0))、T_(1)、T_(2)、T_(3)、T_(4)时血清白细胞介素(IL)-6和前列腺素E2(PGE2)浓度,并观察不良反应发生情况。结果与R组相比,RD组PECSⅡ有效镇痛时间延长(P<0.05),术中丙泊酚、瑞芬太尼用量减少(P<0.05),术后48 h内舒芬太尼用量减少(P<0.05),T_(2)、T_(3)、T_(4)时VAS评分降低(P<0.05),T_(1)、T_(2)、T_(3)、T_(4)时血清IL-6、PGE_(2)浓度降低(P<0.05)。2组术中、术后不良反应发生率均无显著差异(P>0.05)。结论将右美托咪定0.5μg·kg^(-1)作为罗哌卡因的佐剂行PECSⅡ,可以延长PECSⅡ镇痛时间,减少术中、术后麻醉药的用量,还具有抗炎作用。

AIM To investigate the effects of dexmedetomidine combined with ropivacaine in pectoral nerve block(PECSⅡ)on pain and inflammatory reaction in modified radical mastectomy.METHODS Seventy-two female patients undergoing modified radical mastectomy were randomly divided into ropivacaine group(group R,n=36)and dexmetomidine combined with ropivacaine group(group RD,n=36).Anesthesia induction and maintenance were the same in two groups.Ultrasound-guided PECSⅡbefore anesthesia induction combined with patient-controlled intravenous analgesia(PCIA)were selected for analgesia in two groups.Group R was given 0.25%ropivacaine 30 mL in PECS,and group RD was given dexmedetomidine 0.5μg·kg^(-1) combined with 0.25%ropivacaine 30 mL.Postoperative analgesia pump contained sufentanil 100μg and there was no continuous dose.The time from PECSⅡtook effect to patient’s first pressing of the analgesic pump key was recorded as the effective analgesic time of PECSⅡ.The dosage of propofol and remifentanil during operation and the dosage of sufentanil in 48 hours after operation were recorded.VAS score of pain was scored at 6 h(T_(1)),12 h(T_(2)),24 h(T_(3))and 48 h(T_(4))after operation.The concentrations of serum interleukin(IL)-6 and prostaglandin E2(PGE_(2))were measured by ELISA at 1 h before operation(T_(0)),T_(1),T_(2),T_(3) and T_(4).The adverse reactions were observed.RESULTS Compared with the group R,the effective analgesia time was prolonged(P<0.05)in the group RD.The dosage of propofol,remifentanil and sufentanil in the group RD was significantly lower than that in the group R(P<0.05).The VAS score in the group RD was lower than that in the group R at T_(2),T_(3) and T_(4)(P<0.05),and the concentration of serum IL-6 and PGE_(2) in the group RD was lower than that in the group R at T_(1),T_(2),T_(3) and T_(4)(P<0.05).There was no difference in the incidence of intraoperative and postoperative adverse reactions between the two groups(P>0.05).CONCLUSION Dexmedetomidine 0.5μg·kg^(-1) combined with ropivacaine in PECSⅡcan prolong the time of analgesia,reduce the anesthetics of intraoperative and postoperative,and have the effect of anti-inflammation.