右美托咪定复合罗哌卡因收肌管阻滞辅助全身麻醉在全膝关节置换术中的应用效果

Application effects of Dexmedetomidine combined with Ropivacaine adductor canal block-assisted general anesthesia in total knee arthroplasty

目的:探讨右美托咪定复合罗哌卡因收肌管阻滞辅助全身麻醉在全膝关节置换术(TKA)中的应用效果。方法:选取2019年3月至2020年3月于该院行TKA治疗的110例膝关节病患者进行前瞻性研究,按照随机数字表法将其分为观察组和对照组各55例。在全身麻醉基础上,对照组采用罗哌卡因行超声引导下收肌管阻滞,观察组采用右美托咪定复合罗哌卡因行收肌管阻滞。比较两组神经阻滞效果[感觉阻滞起效时间(OTSB)、运动阻滞起效时间(OTMB)、感觉阻滞持续时间(DSB)、运动阻滞持续时间(DMB)]、术中血流动力学指标[麻醉诱导完成后(T_(0))、切皮时(T_(1))、手术开始后30 min(T_(2))、术毕时(T_(3))的平均动脉压(MAP)和心率]水平、术后疼痛[视觉疼痛模拟评分法(VAS)]评分、麻醉药物用量、术后镇痛泵按压次数及不良反应发生率。结果:两组OTSB、OTMB比较,差异均无统计学意义(P>0.05);观察组DSB、DMB均长于对照组,差异有统计学意义(P<0.05);T_(1)、T_(2)、T_(3)时,观察组MAP、心率水平均低于对照组,差异有统计学意义(P<0.05);观察组术后12、24、48 h时的VAS评分均低于对照组,差异有统计学意义(P<0.05);观察组丙泊酚、舒芬太尼、瑞芬太尼用量及术后镇痛泵按压次数均少于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:右美托咪定复合罗哌卡因收肌管阻滞辅助全身麻醉用于TKA患者可缩短麻醉起效时间,延长神经阻滞持续时间,维持术中血流动力学稳定,提高术后疼痛效果,减少术中及术后麻醉药物用量,且不增加不良反应。

Objective:To observe application effects of Dexmedetomidine combined with Ropivacaine adductor canal block-assisted general anesthesia in patients undergoing total knee arthroplasty(TKA).Methods:A prospective study was conducted on 110 patients with knee joint disease who underwent TKA in the hospital from March 2019 to March 2020.They were divided into observation group and control group according to the random number table method,55 cases in each.On the basis of general anesthesia,the control group was treated with Ropivacaine for ultrasound-guided adductor canal block,while the observation group was treated with Dexmedetomidine combined with Ropivacaine for adductor canal block.The nerve block effect[onset time of sensory block(OTSB),onset time of motor block(OTMB),duration of sensory block(DSB),duration of motor block(DMB)],the intraoperative hemodynamic indexes[mean arterial pressure(MAP)and heart rate after anesthesia induction(T0),at skin incision(T_(1)),30 min after the surgery(T_(2))and at the end of operation(T_(3))]levels,the postoperative pain[visual analogue scale(VAS)]score,the anesthetic dosage,the postoperative analgesia pump pressing times,and the incidence of adverse reactions were compared between the two groups.Results:There were no significant differences in OTSB and OTMB between the two groups(P>0.05).The DSB and DMB in the observation group were longer than those in the control group,and the differences were statistically significant(P<0.05).At T_(1),T_(2) and T_(3),the levels of MAP and heart rate in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).The VAS scores of the observation group 12,24 and 48 h after the surgery were lower than those of the control group,and the differences were statistically significant(P<0.05).The dosage of Propofol,Sufentanil,Remifentanil and the number of pressing times of postoperative analgesia pump in the observation group were less than those in the control group,and the differences were statistically significant(P<0.05).However,there was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions:Dexmedetomidine combined with Ropivacaine adductor canal block-assisted general anesthesia for the TKA patients can shorten the onset time of anesthesia,prolong the duration of nerve block,maintain the intraoperative hemodynamic stability,improve the postoperative pain effects,and reduce the intraoperative and postoperative anesthetic dosages without increasing the incidence of adverse reactions.