髋关节置换术后右美托咪定增强罗哌卡因的镇痛效果

Dexmedetomidine enhances post-operative analgesic effect of ropivacaine after hip replacement

目的观察髋关节置换术中右美托咪定关节囊注射(JCI)是否可增强罗哌卡因镇痛效果。方法98例来自郴州市第一人民医院ASA(美国麻醉医师协会)Ⅱ~Ⅲ拟在全麻下行首次髋关节置换的患者,根据JCI情况分为3组:对照组(生理盐水),R组(罗哌卡因),RD组(罗哌卡因加右美托咪定)。手术结束前,根据分组不同,实施关节囊注射。手术时长、出血量、输液量、复苏室停留时间、病人自控止痛(PCA)次数等资料使用单因素方差分析,静态痛、动态痛、恶心感等的视觉模拟评分(VAS)使用重复测量的方差分析,并发症(嗜睡、呕吐)使用卡方检验分析。结果静息痛VAS评分3组之间差异均有统计学意义(F=17.62,P<0.05);与对照组比较,R组和RD组差异均有统计学意义(均为P<0.05);RD组比R组评分更低(P<0.05)。动态痛VAS评分3组差异有统计学意义(F=27.97,P<0.05);在不同时点R组和RD组均低于对照组(均为P<0.05);RD组比R组评分更低(P<0.05)。恶心痛VAS评分3组整体表现差异有统计学意义(F=63.3,P<0.05);在不同时间点,R组和RD组均低于对照组(均为P<0.05);T2至T4时间点的RD组和R组比较差异有统计学意义(均为P<0.05)。对照组、R组及RD组复苏室停留时间、嗜睡及呕吐病例占比差异无统计学意义(均为P>0.05)。结论髋关节置换手术中,右美托咪定关节囊周注射可以增强罗哌卡因的镇痛效果。

Objective To see whether dexmedetomidine joint-capsule-injection(JCI)could enhance ropivacaine analgesic effect in hip replacement.Methods Ninety-eight patients of American Society of Anesthesiologists(ASA)gradingⅡ-Ⅲfrom Chenzhou No.1 People’s Hospital were divided into three groups according to drugs of JCI:normal saline(the control group),ropivacaine(group R),ropivacaine plus dextrometeridine(group RD).According to the assignment of different groups,the injections were injected around the capsula-articularis before the end of the surgery.One way ANOVA was used to analyze the length of operation,the amount of bleeding,the amount of infusion,length of stay in post-anesthesia-care-unit(STPACU)and patient controlled anagesia(PCA)times.Repeated measurement analysis of variance was used to analyze visual analogue scale(VAS)of static pain,dynamic pain and nausea feeling,chi-square test was applied to analyze incidence of somnolence and vomiting.Results The overall difference in VAS score of static pain was statistically significant in the three groups(F=27.97,P<0.05).Comparing with the control group,VAS scores of static pain in group R and group RD were much lower(all P<0.05);the score of group RD was lower than group R(P<0.05).The three groups showed significantly statistical difference in VAS of dynamic pain(F=17.62,P<0.05).In VAS of dynamic pain,comparing with the control group,group R and group RD were much lower at different time points(all P<0.05);the score was lower in group RD than group R(P<0.05).The overall performance of the three groups was statistically different in VAS of nuausea(F=63.3,P<0.05).VAS scores of nausea in group R and group RD at different time points were lower than the control group(all P<0.05).The differences between group RD and group R at T2 to T4 were statistically significant(all P<0.05).There was no significant difference among the three groups of STPACU,the somnolence and vomiting incidences(all P>0.05).Conclusion In hip-replacement,JCI with ropivacaine plus dexmedetomidine will get better analgesic effects compareed with ropivacaine alone or normal saline.