右美托咪定复合罗哌卡因胸椎旁神经阻滞用于胸腔镜手术围术期安全性及镇痛效果的研究

Perioperative Safety and Analgesic Efficacy of Dexmedetomidine Combined with Ropivacaine for Thoracic Paravertebral Nerve Block in Thoracoscopic Surgery

目的:探讨右美托咪定复合罗哌卡因胸椎旁神经阻滞(TPVB)用于胸腔镜手术围术期的安全性及镇痛效果。方法:选取我院择期行胸腔镜手术的52例患者,随机分为两组,患者均在麻醉诱导前行T4/5间隙超声引导TPVB,DR组给予右美托咪定复合罗哌卡因,R组给予罗哌卡因。结果:两组患者术中血流动力学指标变化、全麻药物用量及苏醒时间差异均无统计学意义(均P>0.05);DR组患者术后12 h、24 h静息和咳嗽时VAS评分均明显低于R组(均P<0.05),12 h和24 h镇痛泵输注总量较R组明显减少(均P<0.05);两组术后48 h内补救镇痛药物使用率及恶心呕吐发生率差异无统计学意义(均P>0.05)。结论:超声引导右美托咪定复合罗哌卡因TPVB用于胸腔镜手术,患者术中血流动力学平稳,延长罗哌卡因术后镇痛时间,无明显不良反应,值得临床推广。

Objective: To investigate the perioperative safety and analgesic effect of dexmedetomidine combined with ropivacaine for thoracic paravertebral nerve block(TPVB) under ultrasound-guiding in thoracoscopic surgery. Methods: A total of 52 patients with thoracoscopic surgery in our hospital were randomly divided into two groups. Before the induction of anesthesia in both groups, T4 and T5 gaps were selected for ultrasound-guided TPVB. The DR group was given dexmedetomidine combined with ropivacaine, and the R group was given ropivacaine. Results: There were no significant differences in hemodynamic indexes, dosage of general anesthesia and recovery time between the two groups(all P>0.05). VAS scores of rest and cough at 12 h and 24 h after surgery in DR group were significantly lower than those in R group(all P<0.05). The total amount of analgesic pump infusion at 12 h and 24 h after surgery were significantly reduced compared with the R group(all P<0.05). There were no statistically differences in the use of rescue analgesic drugs and incidence of nausea and vomiting within 48 h between the two groups(all P>0.05). Conclusion: Ultrasound-guided TPVB using dexmedetomidine combined with ropivacaine for thoracoscopic surgery has stable hemodynamics and can significantly prolong the postoperative analgesia time of ropivacaine without obvious adverse reactions, which is worthy of clinical promotion.