右美托咪定联合髋关节囊周围神经阻滞在老年髋关节置换术中的麻醉效果

Anesthetic effect of dexmedetomidine combined with pericapsular nerve group block for hip arthroplasty in the elderly

目的 探究右美托咪定联合罗哌卡因神经阻滞用于老年直接前方入路髋关节置换术(DAA-THA)的麻醉效果,并比较髋关节囊周围神经阻滞(PENGB)和腹股沟韧带上髂筋膜间隙阻滞(S-FICB)的镇痛效果及快速康复的影响。方法 选取2022年2~10月安徽医科大学附属六安医院择期下行单侧全髋关节置换术的患者90例,采用随机数字表法分为3组:A组(S-FICB组,n=30),单独使用罗哌卡因;B组(PENGB组,n=30),单独使用罗哌卡因;C组(PENGB组,n=30),使用右美托咪定联合罗哌卡因。记录患者入室时(T_(0))、体位摆放前即刻(T_(1))、体位摆放时(T_(2))静息时VAS疼痛评分和神经阻滞后6 h(T_(3))、12 h(T_(4))、24 h(T_(5))、48 h(T_(6))抬髋15°时VAS疼痛评分,神经阻滞后T_(3)~T_(6)的Ramsay镇静评分,T_(3)时股四头肌肌力分级,神经阻滞的操作时间和起效时间,患者镇痛满意度,术中血流动力学指标,不良反应的发生率,术后首次下床时间和术后住院天数。结果 T_(3)时B组和C组的股四头肌肌力明显高于A组(P<0.01)。T_(3)~T_(6)时C组的Ramsay镇静评分高于A组和B组(P<0.05)。T_(2)时B组和C组的VAS疼痛评分低于A组(P<0.05)。T_(4)~T_(6)时C组的VAS疼痛评分明显低于A组和B组(P<0.01)。B组、C组的操作时间低于A组(P<0.05)。C组患者麻醉后30 min的心率低于A组和B组(P<0.05)。结论 PENGB操作所需时间短、起效快,并且保留股四头肌的运动功能,右美托咪定作为佐剂联合罗哌卡因用于PENGB能够有效延长镇痛时间,为患者提供良好的术后镇静与镇痛,且无明显不良反应,有利于患者术后早期康复。

Objective To investigate the anesthetic effect of dexmedetomidine combined with ropivacaine nerve block for direct anterior approach for total hip arthroplasty(DAA-THA)in the elderly,and to compare the analgesic effect and rapid recovery from pericapsular nerve group block(PENGB)versus supra-inguinal fascia iliaca compartment block(S-FICB).Methods A total of 90 patients with an elective surgery of unilateral total hip arthroplasty in Lu’an Hospital of Anhui Medical University from February 2022 to October 2022 were selected.They were divided into three groups using a randomized numerical table method:group A(ropivacaine use for S-FICB,n=30),group B(ropivacaine use for PENGB,n=30),and group C(dexmedetomidine combined with ropivacaine for PENGB,n=30).The Visual Analogue Scale(VAS)scores inrest at the time points of admission(T_(0)),immediately before positioning(T_(1)),and at the time of positioning(T_(2)),and the VAS scores at 15°of hip lifting at 6h(T_(3)),12h(T_(4)),24h(T_(5)),and 48h(T_(6))after the nerve block were recorded.The Ramsay Sedation Scale(RASS)score at T3 and T6,muscle strength of the quadriceps at T_(3),operation time and onset time of nerve block,patients’satisfaction with analgesia,intraoperative hemodynamic indicators,incidence of adverse effects,time of the first postoperative off-bed activities,and postoperative length of stay were recorded.Results Muscle strength of the quadriceps at T3 was significantly greater in group B and C than that of group A(P<0.01).The RASS scores at T3-T6 were significantly higher in group C than those of group A and B(P<0.05).The VAS scores at T2 were significantly lower in group B and C than those of group A(P<0.05).The VAS scores at T4-T6 in group C were significantly lower than those of group A and group B(P<0.01).The operation time was significantly shorter in group B and C than that of group A(P<0.05).The heart rate at 30min of anesthesia was significantly less in group C than that of group A and group B(P<0.05).Conclusion PENGB procedure requires short time,fast onset of action,and preserves the motor function of the quadriceps muscle.Dexmedetomidine,as an adjuvant combined with ropivacaine for PENGB can effectively prolong the duration of analgesia and provide good postoperative sedation and analgesia without obvious adverse reactions,which is conducive to the early recovery of patients after surgery.