硬膜外腔加点这个药镇痛效果更好

右美托咪定联合罗哌卡因用于骶管阻滞镇痛的随机双盲临床研究

背景：

骶管阻滞镇痛是用于下腹手术后镇痛的常用方法之一，但有其自身的局限性。

目的：

观察右美托咪定联合罗哌卡因用于小儿下腹手术后硬膜外阻滞的镇痛效果及副作用。

方法：

采用随机双盲法，将46例3～6岁儿童随机分为两组，在全麻下行下腹手术后进行骶管阻滞镇痛。

对照组注射0.2%罗哌卡因1ml/kg，DR组注射右美托咪定2μg/kg+0.2%罗哌卡因1ml/kg。

在术后1小时、2小时和6小时评估两组的：

☝疼痛评分（改良CHEOPS评分）、

✌镇痛持续时间、

????镇痛药消耗量（静脉注射扑热息痛）、

????血流动力学变化和可能的不良反应。

结果：

????两组患者术后1h和2h疼痛评分无显著性差异（P>0.05）。

????而DR组术后第6小时疼痛评分明显降低，

????镇痛持续时间延长（P=0.001）。

????DR组的镇痛剂用量也较低（P=0.001）。

????收缩压和心率无显著性差异（P<0.05），舒张压有显著性差异（P<0.05），DR组低于R组。

????两组在手术时间、恢复时间和副作用方面无统计学差异（P<0.05）。

结论：

在本研究中，右美托咪定与罗哌卡因联合应用于硬膜外阻滞可改善小儿术后镇痛效果，且无明显不良反应。

关键词：骶管阻滞；右美托咪定；儿科；术后疼痛；罗哌卡因。

Evaluation of Adding Dexmedetomidine to Ropivacaine in Pediatric CaudalEpidural Block: A Randomized, Double-blinded Clinical Trial

Background: Caudal block is one of the methods of pain managementperformed following lower abdominal surgery, though having its own limitations.

Objectives: In the present study, the effects and side effects of addingdexmedetomidine to ropivacaine in the caudal epidural block were investigatedin children after lower abdominal surgery.

Methods: In this randomized, double-blinded clinical trial, 46 childrenaged three to six years were divided into two groups to perform a caudal blockfollowing lower abdominal surgery under general anesthesia. The injectablesolution contained ropivacaine in the R group (1 mL/kg ropivacaine 0.2%), asthe control group, and dexmedetomidine (2 µg/kg) and ropivacaine 0.2% (1 mL/kg)in the DR group. The pain score (modified CHEOPS score), duration of analgesia,amount of analgesia consumed (i.v. paracetamol), hemodynamic changes, andpossible adverse effects were assessed at one, two, and six hours in bothgroups.

Results: The pain score at one and two hours showed no significantdifference between the two study groups (P > 0.05). In the DR group,however, the pain score at the sixth hour was significantly lower, and theduration of analgesia was longer (P = 0.001). The amount of analgesicconsumption was also lower in the DR group (P = 0.001). However, there was nosignificant difference in systolic blood pressure and heart rate (P < 0.05),in the case of diastolic blood pressure, a significant difference (P < 0.05)was seen (DR group lower than the R group). There was no statisticallysignificant difference between the study groups in the duration of surgery,recovery time, and side effects (P < 0.05).

Conclusions: In the present study, the addition of dexmedetomidine toropivacaine in the caudal epidural blockade improved postoperative analgesiawithout significant adverse effects in pediatric patients.

Keywords: Caudal Block; Dexmedetomidine; Pediatric; Postoperative Pain;Ropivacaine.

原文：

Imani F, Farahmand Rad R, Salehi R, Alimian M, Mirbolook Jalali Z,Mansouri A, Nader ND. Evaluation of Adding Dexmedetomidine to Ropivacaine inPediatric Caudal Epidural Block: A Randomized, Double-blinded Clinical Trial.Anesth Pain Med. 2021 Feb 28;11(1):e112880. doi: 10.5812/aapm.112880. PMID:34221950; PMCID: PMC8241816.