术中输注小剂量纳洛酮联合外周神经阻滞对膝关节镜手术患者雷米芬太尼麻醉后痛觉过敏的影响  

Effect of low-dose naloxone infusion combined with peripheral nerve block on remifentanil-induced hyperalgesia after knee arthroscopy

作　　者：冯发美 高鸿 高巨 FENG Famei;GAO Hong;GAO Ju(School of Anesthesiology,Guizhou Medical University,Guiyang 550000,CHINA)

机构地区：[1]贵州医科大学麻醉学院,贵州贵阳550000 [2]江苏扬州大学临床医学院(苏北人民医院)麻醉科

出　　处：《江苏医药》2020年第6期601-603,607,共4页Jiangsu Medical Journal

基　　金：国家自然科学基金(81571936)。

摘　　要：目的观察术中静脉输注小剂量纳洛酮联合外周神经阻滞对膝关节镜手术患者雷米芬太尼麻醉后痛觉过敏的影响。方法择期静-吸复合麻醉行膝关节镜手术患者90例随机分为三组,每组30例。B组实施0.15%罗哌卡因收肌管阻滞(ACB)联合膝关节囊后间隙阻滞(KPSB);A组术中采用外周神经阻滞(ACB+KPSB)和静脉泵注小剂量纳洛酮0.05μg·kg-1·h-1;C组不用外周神经阻滞和纳洛酮。比较术后24 h内痛觉过敏发生率。评估术后1、3、6和24 h静息和运动VAS疼痛评分,计算术中雷米芬太尼用量,记录不良反应发生情况。结果 A、B、C组术后痛觉过敏发生率依次为A组(10%)<B组(37%)<C组(53%)(P<0.05)。A组和B组患者术后1、3、6 h的静息和活动状态VAS疼痛评分低于C组(P<0.05)。术后6 h和24 h时,A组静息和活动状态VAS疼痛评分均低于B组(P<0.05)。A组和B组术后恶心、呕吐、头晕、嗜睡等不良反应发生率低于C组(10%和17%vs.50%)(P<0.05)。结论术中小剂量纳洛酮静脉输注联合外周神经阻滞能明显降低雷米芬太尼麻醉术后痛觉过敏发生率。Objective To observe the effect of peripheral nerve block combined with low-dose naloxone infusion on postoperative remifentanil-induced hyperalgesia in the patients undergoing knee arthroscopy.Methods Ninety patients undergoing elective knee arthroscopy were randomly divided into three groups with 30 cases each.Adductor canal block(ACB) and knee posterior space block(KPSB) with 0.15% ropivacaine were performed in group B.The patients in group A were treated with peripheral nerve block(ACB+KPSB) and continuous infusion of naloxone 0.05 μg·kg-1·h-1 during anesthesia.The patients in group C were not given ACB,KPSB and an infusion of naloxone.The incidence rate of hyperalgesia within postoperative 24 hours was compared among the three groups.The VAS pain scores during rest and active status at the 1st,3rd,6th,and 24th hour after surgery were evaluated.Total consumption of intraoperative remifentanil was calculated and adverse responses were recorded.Results The incidence rate of hyperalgesia within postoperative 24 hours was in an order of group A(10%) < group B(37%) < group C(53%)(P<0.05).The VAS pain scores during rest and active status at the 1st,3rd and 6th hour after surgery were lower in groups of A and B than those in group C(P<0.05),which at the 6th and 24th hour after surgery were lower in group A than those in group B(P<0.05).The incidence of postoperative nausea,vomiting,dizziness and drowsiness in groups of A and B was lower than that in group C(10% and 17% vs.50%)(P<0.05).Conclusion Intraoperative infusion of low dose naloxone combined with peripheral nerve block can significantly reduce the incidence of hyperalgesia after remifentanil anesthesia.

关 键 词：纳洛酮 收肌管阻滞 膝关节囊后间隙阻滞 膝关节镜 

分 类 号：R614[医药卫生—麻醉学]