超声引导下右美托咪定复合罗哌卡因行连续收肌管阻滞在膝关节镜手术中的应用

Application of ultrasound-guided dexmedetomidine combined with ropivacaine for continuous adductor canal block in arthroscopic knee surgery

目的 探讨超声引导下右美托咪定复合罗哌卡因行连续收肌管阻滞(adductor canal block,ACB)在膝关节镜手术患者中的应用效果。方法 选取膝关节镜手术患者85例作为研究对象,用随机数字表法分为复合组(43例)与单一组(42例),均于全身麻醉诱导后行超声引导下ACB,术毕开启ACB镇痛泵,单一组用罗哌卡因镇痛,复合组用右美托咪定复合罗哌卡因镇痛。用视觉模拟评分法(visual analogue score,VAS)评估术后6、12、24、48 h 2组患者静息与主动运动状态时的疼痛程度、膝关节主动屈曲角度,比较2组术前及术后24、48 h血清疼痛因子[P物质(substance P,SP)和前列环素(prostaglandin I2,PGI2)]的水平,比较2组患者首次下床活动时间、术后膝关节主动屈曲90°时间。结果 术后6、12、24、48 h静息与运动状态下复合组患者的VAS均低于单一组,且术后24、48 h复合组的血清SP、PGI2水平均低于单一组(P<0.05);术后6、12、24、48 h复合组膝关节主动屈曲角度大于单一组,复合组首次下床活动时间、术后膝关节主动屈曲90°时间均短于单一组(P<0.05)。结论 超声引导下右美托咪定复合罗哌卡因ACB应用于膝关节镜手术患者,可降低疼痛因子的表达水平,减轻患者的疼痛程度,促进患者术后膝功能的恢复。

Objective To explore the application effect of ultrasound-guided dexmedetomidine combined with ropivacaine for continuous adductor canal block(ACB)under ultrasound guidance in patients undergoing arthroscopic knee surgery.Methods A total of 85 patients undergoing arthroscopic knee surgery were randomly divided into compound group(43 cases)and single group(42 cases).All patients were treated with ultrasound-guided ACB after general anesthesia induction,and the ACB analgesia pump was turned on after operation.The single group was treated with ropivacaine for analgesia,and the compound group was treated with dexmedetomidine combined with ropivacaine for analgesia.Visual analogue scale(VAS)was used to evaluate the pain degree and the active flexion angle of knee joint between the 2 groups at 6,12,24 and 48 hours after operation.The levels of serum pain factor[substance P(SP)and prostaglandin I2(PGI2)]before operation and at 24,48 hours were compared between the 2 groups.The time of getting out of bed for the first time and the time of active knee flexion after operation were compared between the 2 groups.Results At 6,12,24,48 hours after the operation,the VAS of patients in the compound group were lower than those in the single group,and the serum SP and PGI2 levels in the compound group were lower than those in the single group at 24 and 48 hours after operation(P<0.05).At 6,12,24,48 hours after the operation,the active flexion angle of the knee joint in the compound group was greater than that in the single group,and the time of get out of bed for the first time and the time of active flexion of knee joint to 90°after operation in the compound group were shorter than that in the single group(P<0.05).Conclusion Ultrasound-guided dexmedetomidine combined with ropivacaine ACB in patients with knee arthroscopy can reduce the expression of pain factors,reduce the pain degree of patients,and promote the recovery of knee function in patients after surgery.