右美托咪定复合罗哌卡因股外侧皮神经阻滞对髋关节置换术后镇痛效果的影响

The effect of dexmedetomidine combined with ropivacaine for lateral femoral cutaneous nerve block on analgesia after hip replacement

目的:探讨右美托咪定复合罗哌卡因股外侧皮神经阻滞对髋关节置换术后镇痛效果的影响。方法:择期行全髋关节置换术患者50例,男27例,女23例,ASAⅠ~Ⅱ级。按照随机数字表法将其分为两组:右美托咪定复合罗哌卡因组(DR组)和罗哌卡因组(R组),每组25例。术前超声引导下行股外侧皮神经阻滞,DR组注射右美托咪定1μg/kg+0.375%罗哌卡因10 ml,R组注射0.375%罗哌卡因10 ml,15 min后测定阻滞范围。记录术后2 h、4 h、8 h、12 h、24 h和48 h静息和运动时VAS评分,记录术后首次镇痛泵按压时间及术后24 h内有效按压次数和术后48 h内追加镇静镇痛药物情况,记录术后48 h内发生恶心、呕吐等不良反应的情况,记录患者满意度。结果:术后12 h内静息和运动时DR组VAS评分明显低于R组,差异有统计学意义(P<0.05);DR组首次按压镇痛泵时间明显长于R组,术后24 h内有效按压次数明显少于R组,差异有统计学意义(P<0.05),术后48 h内追加镇痛镇静药物DR组明显少于R组,差异有统计学意义(P<0.05);术后恶心呕吐等不良反应发生率无统计学差异,术后患者满意度评分明显高于R组,差异有统计学意义(P<0.05)。结论:右美托咪定复合罗哌卡因应用于超声引导下股外侧皮神经阻滞,可以为髋关节置换术后早期提供更好的镇痛作用,减少术后镇痛镇静药物的使用,促进术后早期恢复,提高患者满意度。

Objective To investigate the effect of dexmedetomidine combined with ropivacaine for lateral femoral cutaneous nerve block on postoperative analgesia after hip replacement.Method 50 patients(27 males,23 females,ASAⅠ~Ⅱ)underwent selective total hip replacement.According to the random number table method,they were divided into two groups:Dexmedetomidine combined with ropivacaine group(DR group)and ropivacaine group(R group),25 cases in each group.Before the operation,the lateral femoral cutaneous nerve block was guided by ultrasound.In the DR group,dexmedetomidine 1 ug/kg+0.375%ropivacaine 10 ml was injected,and the R group was injected with 0.375%ropivacaine 10 ml.The block range was determined 15 minutes later.The VAS scores of 2,4,8,12,24 and 48 h after operation were recorded.The time of the first compression of analgesia pump,the times of effective compression within 24 h and the situation of adding sedative and analgesic drugs within 48 h after operation were recorded.The adverse reactions such as nausea and vomiting occurred within 48 h after operation were recorded.The satisfaction of patients was also recorded.Results The VAS score of DR group was significantly lower than that of R group(P<0.05).The first pressing time of analgesia pump in Dr group was significantly longer than that in R group,and the effective pressing times within 24 hours after operation in Dr group was significantly less than that in R group(P<0.05);The patients in Dr group were significantly less that those in R group(P<0.05).There was no significant difference in the incidence of postoperative nausea and vomiting and other adverse reactions,and the satisfaction score of patients was significantly higher than that of R group(P<0.05).Conclusion Dexmedetomidine combined with ropivacaine can provide better analgesic effect in the early stage of hip arthroplasty,reduce the use of analgesic and sedative drugs,promote the early recovery and improve patients'satisfaction.