右美托咪定联合罗哌卡因行连续性前锯肌平面阻滞在乳腺癌改良根治术术后镇痛的效果

The effect of postoperative analgesia with ropivacaine plus dexmedetomidine for continuous serratus anterior plane block after modified radical mastectomy

目的探讨右美托咪定联合罗哌卡因行连续性前锯肌平面(serratus anterior plane,SAP)阻滞在乳腺癌改良根治术术后镇痛的效果。方法选取2020年7月至2022年6月于温州市人民医院行全身麻醉下单侧乳腺癌改良根治术的40例患者为研究对象,所有患者术前行超声引导下SAP置管,术毕接患者自控镇痛泵。根据随机数字表法将患者分为Con组(罗哌卡因+生理盐水)与Dex组(罗哌卡因+右美托咪定),每组各20例。比较两组患者术后8h、12h、24h及48h的静态、动态数字分级评估量表(numerical rating scale,NRS)评分及Ramsay镇静评分、术后48h羟考酮用量、术后各种不良反应及相关并发症。结果Dex组患者不同时点的静态及动态NRS评分均显著低于Con组(P<0.05)。Dex组患者术后8h、12h及24h的Ramsay镇静评分显著高于Con组(P<0.05)。Dex组患者的术后羟考酮用量显著低于Con组(P<0.05)。Dex组患者的口干发生率显著高于Con组(P<0.05)。结论右美托咪定联合罗哌卡因可增强连续性SAP阻滞在乳腺癌改良根治术患者的术后镇痛效果,减少术后阿片类药物用量,且无明显不良反应。

Objective To explore the effect of postoperative analgesia with ropivacaine plus dexmedetomidine for continuous serratus anterior plane(SAP)block after modified radical mastectomy.Methods A total of 40 patients who underwent unilateral modified radical mastectomy under general anesthesia in Wenzhou People’s Hospital from July 2020 to June 2022 were selected as the study objects.All patients underwent SAP block under ultrasound guidance before surgery and received patient controlled analgesia pump after surgery.Patients were divided into Con group(ropivacaine+saline)and Dex group(ropivacaine+dexmedetomidine)according to random number table method,with 20 cases in each group.Numerical rating scale(NRS)scores and Ramsay sedation scores of patients 8h,12h,24h and 48h after surgery,dosage of oxycodone 48h after surgery,various postoperative adverse reactions and related complications were compared between the two groups.Results NRS scores of patients in Dex group at different static and dynamic time points were significantly lower than those in Con group(P<0.05).Ramsay sedation scores at 8h,12h and 24h in Dex group were significantly higher than those in Con group(P<0.05).Postoperative oxycodone dosage in Dex group was significantly lower than that in Con group(P<0.05).The incidence of dry mouth in Dex group was significantly higher than that in Con group(P<0.05).Conclusion Continuous SAP block with ropivacaine plus dexmedetomidine enhances the postoperative analgesic effect in patients undergoing modified radical mastectomy and reduces postoperative opioid consumption with no significant adverse effects.