罗哌卡因与罗哌卡因联合右美托咪定行肋间神经阻滞在开胸术后镇痛

罗哌卡因与罗哌卡因联合右美托咪定行肋间神经阻滞在开胸术后镇痛的比较:一项随机临床试验

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

01   背景、目的

开胸手术是最疼痛的手术之一，如果术后镇痛不充分会有危险的后果。本研究旨在评价右美托咪定联合罗哌卡因在肋间神经阻滞中对开胸手术患者术后镇痛的作用。

02   方法

在本随机临床试验中，纳入74例年龄18 - 60岁，ASA I级或II级，BMI小于40kg/m2，无严重系统性疾病，需行开胸手术的患者，随机分为两组。R组：术后在超声引导下予0.25%罗哌卡因5ml行肋间神经阻滞组；RD组：术后在超声引导下0.25%罗哌卡因联合右美托咪定0.5µg/kg共5ml行肋间神经阻滞组。比较两组患者疼痛、阿片类药物总用量、ICU住院时间、首次使用镇痛药时间和下床活动时间。

03   结果

肋间阻滞显著减轻了两组患者的疼痛（P<0.0001）。从干预后6小时到干预后24小时，RD组的疼痛低于R组（P<0.001）。RD组在12小时需要抢救性镇痛的患者数量显著减少（P<0.05）。RD组的阿片类药物总量也较低并首次使用镇痛药的时间延长（P<0.01）。两组患者住院时间及下床活动时间比较，差异无统计学意义。

0 4  结论

右美托咪定作为罗哌卡因在ICB中的辅助用药是一种有效且安全的选择，并且在开胸术后与罗哌卡因联合使用可以延长镇痛时间。

0 5  原始文献来源

Kamran Mahmoudi, Mahboobeh Rashidi , Farhad Soltani , Mohsen Savaie, Ehsan Hedayati and Parisa Rashidi. Comparison of Intercostal Nerve Block with Ropivacaine and Ropivacaine-Dexmedetomidine for Postoperative Pain Control in Patients Undergoing Thoracotomy: A Randomized Clinical Trial.Anesth Pain Med. 2021 December; 11(6):e118667.

Doi: 10.5812/aapm.118667.

英文原文    

Comparison of Intercostal Nerve Block with Ropivacaine and

Ropivacaine-Dexmedetomidine for Postoperative Pain Control in Patients Undergoing Thoracotomy: A Randomized Clinical Trial

Abstract

Background: Thoracotomy is one of the most painful surgeries, and failure to alleviate patients’ pain can have dangerous consequences.

Objectives: This study aimed to evaluate the addition of dexmedetomidine to ropivacaine in the intercostal block for postoperative pain control in patients undergoing thoracotomy.

Methods: In this randomized clinical trial, 74 patients aged 18 to 60 years with ASA class I or II, BMI less than 40, and no severe systemic problems referred to a teaching hospital in Ahvaz to undergo thoracotomy were included in the study and randomly divided into two groups. After surgery, an ultrasound-guided intercostal block was done with ropivacaine (5 cc of 0.25% solution; group R) or ropivacaine (5 cc of 0.25% solution) plus dexmedetomidine (0.5 µg/kg; group RD) per dermatome. Two dermatomes above and two dermatomes below the level of surgical incision were used. Pain, total opioid consumption, length of ICU stays, time to fifirst rescue analgesic, and time to get out of bed were compared between the two groups.

Results: The intercostal block signifificantly reduced pain in both groups (P < 0.0001). The pain was lower in the RD group than in the R group from six hours after the intervention up to 24 hours after (P < 0.001). The number of patients who needed rescue analgesia at 12 hours was signifificantly lower in the RD group (P < 0.05). The RD group also had lower total opioid consumption and a longer time to receive the fifirst rescue analgesia (P < 0.01). There was no signifificant difffference between the two groups in the length of hospitalization and the time to get out of bed.

Conclusions: Dexmedetomidine is an effffective and safe choice to be used as an adjunct to ropivacaine in ICB, and it extends the duration of analgesia in combination with ropivacaine after thoracotomy.

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