右美托咪定复合罗哌卡因髂筋膜阻滞在老年全髋关节置换术中的镇痛效果观察

Application of dexmedetomidine combined with ropivacaine fascia iliaca compartment block in elderly total hip arthroplasty

目的探讨超声引导右美托咪定复合罗哌卡因髂筋膜阻滞(FICB)在老年患者全髋关节置换术(THA)围术期的镇痛效果。方法选取我院2020年1月—2021年6月因股骨颈骨折行THA患者60例,根据随机数字表法将其分为观察组与对照组,各30例。蛛网膜下腔麻醉前应用"领结征"法行超声引导FICB,对照组给予0.3%罗哌卡因40 mL,观察组给予1μg/Kg右美托咪定+0.3%罗哌卡因混合液共40 mL。记录FICB起效时间;记录蛛网膜下腔穿刺时(T_(1))、术后6 h(T_(2))、术后12 h(T_(3))、术后24 h(T_(4))、术后48 h(T_(5))患者视觉模拟评分(VAS);记录患者入手术室(T0)及T_(2)、T_(3)、T_(4)、T_(5)的平均动脉压(MAP)及HR;记录两组患者术后48h内首次按压镇痛泵时间及按压次数;记录FICB相关并发症及术后不良反应发生情况。结果观察组FICB起效时间短于对照组(P<0.05);T_(2)、T_(4)、T_(5)的VAS,观察组小于对照组(P均<0.05);T_(4)、T_(5)的MAP,观察组低于对照组(P均<0.05);T_(2)、T_(3)、T_(4)、T_(5)的HR,观察组低于对照组(P均<0.05);术后首次按压镇痛泵时间,观察组晚于对照组(P<0.01),按压镇痛泵次数,观察组少于对照组(P<0.01)。观察组术后出现心动过缓2例,无明显血流动力学波动;两组均未发现FICB相关并发症。结论超声引导右美托咪定复合罗哌卡因FICB对老年THA患者围术期的镇痛效果良好,能缩短FICB起效时间,显著延长镇痛时间。

Objective To explore the analgesic effect of ultrasound-guided dexmedetomidine combined with ropivacaine fascia iliaca compartment block(FICB)in perioperative total hip arthroplasty(THA)in elderly patients.Methods From January 2020 to June 2021,60 cases of THA due to femoral neck fracture in our hospital were selected and divided into observation group and control group,with 30 patients in each group,according to random number table method.Before subarachnoid anesthesia,"bow tie sign"method was used to guide FICB.Control group was given 40 mL of 0.3%ropivacaine,and observation group was given 40 mL of dexmedetomidine+0.3%ropivacaine mixture.The onset time of fascia iliaca compartment block,VAS of patients before subarachnoid puncture(T_(1))and 6 h(T_(2)),12 h(T_(3)),24 h(T_(4))and 48 h(T_(5))after operation were recorded.The HR and mean arterial pressure(MAP)of patients entering the room(T0)and T_(2),T_(3),T_(4),T_(5) were recorded.Record the time of first pressing and total PCA times of intravenous analgesia pump after operation in two groups.Incidence of postoperative adverse reactions and complications related to FICB.Results The onset time of fascia iliaca compartment block in observation group was shorter than that in control group(P<0.05),and the VAS scores at T_(2),T_(4) and T_(5) in observation group were lower than those in control group(all P<0.05).The MAP at T_(4) and T_(5) in the observation group was lower than that in the control group(all P<0.05).The HR of the observation group at T_(2),T_(3),T_(4) and T_(5) was lower than that of the control group(all P<0.05).After operation 48 hours,the time of pressing the analgesic pump for the first time in the observation group was less than that in the control group,and the number of pressing the analgesic pump was less than that in the control group(all P<0.01).In observation group,two cases of bradycardia occurred after operation,with no obvious hemodynamic fluctuations.No FICB-related complications were found in both groups.Conclusion Ultrasound-guided dexmedetomidine combined with ropivacaine is safe and effective in analgesia.It can shorten the onset time of fascia iliaca compartment block,prolong the analgesic time significantly.