罗哌卡因复合右美托咪定超声引导坐骨神经阻滞临床评价

Clinical Evaluation of Ultrasound-Guided Sciatic Nerve Block with Ropivacaine and Dexmedetomidine

目的探讨罗哌卡因复合右美托咪定超声引导坐骨神经阻滞的效果。方法选取医院2020年1月至2021年1月收治的小腿及足踝手术患者60例,均进行术中超声引导腘窝坐骨神经阻滞麻醉,根据麻醉方式的不同分为A组、B组、C组,各20例。A组患者静脉注射0.25%盐酸罗哌卡因注射液+0.5μg/kg盐酸右美托咪定注射液,B组患者静脉注射0.2%盐酸罗哌卡因注射液+0.5μg/kg盐酸右美托咪定注射液,C组患者静脉注射0.15%盐酸罗哌卡因注射液+0.5μg/kg盐酸右美托咪定注射液。结果C组患者神经阻滞即刻、切皮即刻、复位固定时、手术结束时、术后30 min的平均动脉压、心率多明显优于A组和B组(P<0.05),且波动性更小;术后4,12,24,48 h,3组患者的视觉模拟评分法评分及Ramsay镇静评分比较均无显著差异(P>0.05),C组Bromage评分均明显低于A组和B组(P<0.05);治疗期间,C组患者不良反应发生率明显低于A组和B组(P<0.05)。结论罗哌卡因复合右美托咪定用于超声引导腘窝坐骨神经阻滞麻醉效果良好,具有较强的镇痛、镇静效果,且小剂量罗哌卡因能减小血压和心率的波动,改善术后运动神经阻滞,降低不良反应发生率。

Objective To investigate the effect of ultrasound-guided sciatic nerve block with ropivacaine combined with dexmedetomidine.Methods A total of 60 patients with crus and ankle surgery admitted to the hospital from January 2020 to January 2021 were selected.All patients were anesthetized by ultrasound-guided popliteal sciatic nerve block,and they were divided into group A,group B and group C according to different anesthesia methods,with 20 cases in each group.The patients in group A were injected intravenously with 0.25%Ropivacaine Hydrochloride Injection+0.5μg/kg Dexmedetomidine Hydrochloride Injection,the patients in group B were injected intravenously with 0.2%Ropivacaine Hydrochloride Injection+0.5μg/kg Dexmedetomidine Hydrochloride Injection,and the patients in group C were injected intravenously with 0.15%Ropivacaine Hydrochloride Injection+0.5μg/kg Dexmedetomidine Hydrochloride Injection.Results The mean arterial pressure and heart rate in group C at the time points of immediately after nerve block,immediately after skin incision and fixation,the end of surgery and 30 min after surgery were mostly significantly better than those in group A and group B(P<0.05),with less fluctuation.At 4,12,24 and 48 h after surgery,there was no significant difference in visual analogue scale score and Ramsay sedation scale score among the three groups(P>0.05),while the Bromage score in group C was significantly lower than that in group A and group B(P<0.05).During the treatment period,the incidence of adverse reactions in group C was significantly lower than that in group A and group B(P<0.05).Conclusion The effect of ropivacaine combined with dexmedetomidine in ultrasound-guided popliteal sciatic nerve block anesthesia is good,with strong analgesic,sedative and motor block effects.The application of low-dose ropivacaine can reduce the fluctuation of blood pressure and heart rate,improve postoperative motor nerve block and reduce the incidence of adverse reactions.