右美托咪定复合罗哌卡因联合收肌管阻滞用于全膝关节置换后镇痛  

Analgesia efficacy of dexmedetomidine combined with ropivacaine for adductor canal block after total knee arthroplasty

作　　者：谭正玲[1] 陈郡兴[1] 苏志源[1] 刘先保[1] 陆晓勤 王簕[2] Tan Zhengling;Chen Junxing;Su Zhiyuan;Liu Xianbao;Lu Xiaoqin;Wang Le(Department of Anesthesiology, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China;Department of Orthopedics, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China)

机构地区：[1]广州医科大学附属第三医院麻醉科,广东省广州市510150 [2]广州医科大学附属第三医院骨科,广东省广州市510150

出　　处：《中国组织工程研究》2019年第24期3798-3804,共7页Chinese Journal of Tissue Engineering Research

基　　金：广东省自然科学基金(2017A030313137);项目负责人:王簕~~

摘　　要：背景:全膝关节置换后大部分患者会出现重度疼痛,对于这类患者如何缓解术后疼痛,减少术后并发症,是促进患者早期快速康复治疗的重点。目的:探讨B超定位下右美托咪定复合罗哌卡因用于收肌管阻滞在全膝关节置换术后的镇痛效果。方法:前瞻性观察2017年10月至2018年9月行单侧、初次全膝关节置换患者40例,随机分为2组,每组20例。罗哌卡因+右美托咪定组给予30 mL 0.375%罗哌卡因+1.5μg/kg右美托咪定,罗哌卡因组仅给予30m L0.375%罗哌卡因,2组均采用收肌管阻滞。治疗方案得到广州医科大学附属第三医院伦理委员会批准(医伦会审[2018]第170号,审批时间2018-10-31),且所有患者均签署知情同意书,手术科室和医生具有关节置换的资质及相关临床经验。2组患者术中均使用全身麻醉,记录手术时间及术中出血量;术后2,4,6,12,24,48 h测量平均动脉压、心率、血氧饱和度以及静息、运动状态下疼痛数字分级、镇痛评分;记录术后48 h内阿片类药物追加使用量、术后不良反应以及血清C-反应蛋白、白细胞介素6水平。结果与结论:①罗哌卡因+右美托咪定组术后2-48 h Ramsay镇静评分均显著高于罗哌卡因组(P <0.05);②在静息状态下2组疼痛数字评价量表评分均随术后时间延长而显著降低(P <0.05),且各时间点罗哌卡因+右美托咪定组疼痛数字评价量表评分较罗哌卡因组显著降低(P <0.05);③在运动状态下2组(12-48 h)疼痛数字评价量表评分均随术后时间延长而显著降低(P <0.05),且在12,24,48 h罗哌卡因+右美托咪定组疼痛数字评价量表评分较罗哌卡因组显著降低(P <0.05);④在心率方面罗哌卡因+右美托咪定组仅在术后48 h较罗哌卡因组显著降低(P <0.05);⑤术后24 h内追加盐酸哌替啶(100 mg/次)者,罗哌卡因组有6例,罗哌卡因+右美托咪定组有1例(P <0.05);术后24 h-48 h内追加者,罗哌卡因组有2例,罗哌卡因+右美托咪BACKGROUND: Most patients will suffer from severe pain after total knee arthroplasty. How to relieve postoperative pain and reduce postoperative complications is the key to promote early and rapid rehabilitation for patients. OBJECTIVE: To observe the analgesic effect of dexmedetomidine combined with ropivacaine for adductor canal block in patients undergoing arthroscopic total knee arthroplasty. METHODS: Forty patients who underwent primary unilateral total knee arthroplasty between October 2017 and September 2018 were randomly divided into two groups (n=20/group), followed by treated by 30 mL 0.375% ropivacaine, and 30 mL 0.375% ropivacaine + 1.5 μg/kg dexmedetomidine, respectively. Both groups received adductor canal block. The study was approved by the Ethics Committee of the Third Affiliated Hospital of Guangzhou Medical University on October 31, 2018, approval number:[2018]170. All patients signed the informed consents, and the surgical department and surgeons had the qualifications for arthroplasty. General anesthesia was conducted, and the operation time and intraoperative blood loss were recorded. The mean arterial pressure, heart rate, oxyhemoglobin saturation, and Ramsay score and numeric pain rating scale score at rest and in activity at 2, 4, 6, 12, 24, and 48 hours after surgery were detected. Opioids consumption, anesthesia related adverse effects, the expression levels of C-reactive protein and interleukin-6 in the serum were detected at 48 hours after surgery. RESULTS AND CONCLUSION:(1) The Ramsay score at postoperative 2-48 hours in the ropivacaine + dexmedetomidine group was significantly higher than that in the ropivacaine group (P < 0.05).(2) The postoperative numeric pain rating scale score at rest in both groups decreased with time (P < 0.05), and the score at each time point in the ropivacaine + dexmedetomidine group was significantly lower than that in the ropivacaine group (P < 0.05).(3) The postoperative numeric pain rating scale score in activity in both groups decreased with time (P

关 键 词：右美托咪定 罗哌卡因 收肌管阻滞 全膝关节置换 术后镇痛 

分 类 号：R459.9[医药卫生—治疗学]