【罂粟摘要】右美托咪定和地塞米松作为超声引导下肌间沟阻滞局麻药的辅助剂在关节镜下肩关节手术中的比较：一项双盲随机安慰对照研究

右美托咪定和地塞米松作为超声引导下肌间沟阻滞局麻药的辅助剂在关节镜下肩关节手术中的比较：一项双盲随机安慰对照研究

贵州医科大学 麻醉与心脏电生理课题组

翻译：安丽 编辑：潘志军 审校：曹莹

背景

臂丛肌间沟入路阻滞是减少关节镜下肩关节手术后疼痛和镇痛的常用方法之一。

目的

在超声引导下关节镜肩关节手术中，右美托咪定和地塞米松作为辅助药物与0.5%罗哌卡因用于关节镜肩关节手术的镇痛持续时间的比较。

方法

在这项对照试验中，将117例肩关节镜手术实施全身麻醉患者随机分为三组：罗哌卡因组(对照组)：给予0.5% 罗哌卡因20 mL，地塞米松组：给予0.5%罗哌卡因 20 mL加地塞米松4mg，右美托咪定组：给予0.5%罗哌卡因 20 mL加右美托咪定75ug, 三组患者术前均行超声引导下臂丛肌间沟入路阻滞法。监测指标为：测术后24小时和48小时感觉功能、运动功能,首次疼痛感觉恢复时间和阿片类药物用量的情况。

结果

三组在24小时内阿片类药物（吗啡）的平均用量分别为：罗哌卡因组(22.5 mg(10 - 30))、右美托咪定组(15 mg(0 - 30))、地塞米松组(15 mg(0 - 20.6))（P=0.130） 。三组在48小时内阿片类药物（吗啡）平均用量分别为：罗哌卡因组为40 mg（25-67.5），地塞米松组为30 mg（22-50.6），右美托咪定组为52.5 mg（30-75）（P=0.278）。24小时疼痛评分分别为：罗哌卡因对照组为6分(5 - 8)，地塞米松组为7分(5.5 - 8)，右美托咪定组为7 分(4 - 9)(P = 0.573)。

结论

右美托咪定、地塞米松和无辅助用药对术后24小时和48小时阿片类药物的消耗量无统计学差异。然而，与地塞米松和0.5%罗哌卡因相比，在术中右美托咪定组阿片类药物的使用量显著降低。当使用地塞米松可能是禁忌时，右美托咪定可成为外周神经阻滞的合理辅助选择。

原始文献来源 ????

Roman Margulis , Jacquelyn Francis, Bryan Tischenkel , Adam Bromberg, Domenic Pedulla , Karina Grtisenko , Elyse M. Cornett , Alan D. Kaye , Farnad Imani , Farsad Imani , Naum Shaparin and Amaresh Vydyanathan.Comparison of Dexmedetomidine and Dexamethasone as Adjuvants to Ultra-Sound Guided Interscalene Block in Arthroscopic Shoulder Surgery: A Double-Blinded Randomized Placebo-Controlled Study.Anesth Pain Med 2021 Jun;11(3).DOI：10.5812/aapm.117020

英文原文

Comparison of Dexmedetomidine and Dexamethasone as Adjuvants to Ultra-Sound Guided Interscalene Block in Arthroscopic Shoulder Surgery: A Double-Blinded Randomized Placebo-Controlled Study

Abstract

Background:Interscalene block is one of the popular methods for decreasing pain and analgesic consumption after shoulder arthroscopic surgeries.

Objectives:The objective is to compare the analgesic duration of effects of dexmedetomidine and dexamethasone as adjuvants to 0.5% ropivacaine in ultrasound-guided interscalene blocks for arthroscopic shoulder surgery in an ambulatory setting.

Methods:In this randomized controlled trial, 117 adult patients candidate for ambulatory arthroscopic shoulder surgery under general anesthesia were divided into three groups to perform an ultra-sound guided interscalene block before the surgery. The ropivacaine (control) group received ropivacaine 0.5% 20 mL, group Dexamethasone received ropivacaine 0.5% 20 mL plus 4mg dexamethasone, and group dexmedetomidine received ropivacaine 0.5% 20 mL plus 75 mcg of dexmedetomidine. Time to return of sensory function, of motor function, of first pain sensation, amount of opioid medication consumed at 24 hours and 48 hours post-operatively were measured.

Results:The 24-hour median (25th- 75th percentile) opioid consumption in morphine equivalents was similar between groups 22.5 mg (10 - 30), 15 mg (0 - 30), and 15 mg (0 - 20.6) in the ropivacaine, dexmedetomidine, and dexamethasone groups, respectively (P = 0.130). The median (25th- 75th percentile) 48 hours post-operatively, the median opioid consumption in morphine equivalents was 40 mg (25 - 67.5) in the ropivacaine group, 30 mg (22 - 50.6) in the dexamethasone group, and 52.5 mg (30 - 75) in the dexmedetomidine group (P = 0.278). The median 24-hour pain scores were 6 (5 - 8) in the ropivacaine control group, 7 (5.5 - 8) in the dexamethasone group, and 7 (4 - 9) in the dexmedetomidine group (P = 0.573).

Conclusions:There was no statistical difference in opioid consumption at 24 and 48 hours post-operatively when comparing dexmedetomidine, dexamethasone, and no adjuvant. However, intraoperative opioid use was significantly lower with dexmedetomidine compared to dexamethasone and plain 0.5% ropivacaine. The safe side effect profile of dexmedetomidine makes it a reasonable alternative as an adjuvant for peripheral nerve blockade when dexamethasone use may be contraindicated.

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