超声引导下罗哌卡因复合地塞米松腰方肌阻滞对全髋关节置换术患者术后镇痛的影响  

Effect of ropivacaine combined with dexamethasone in ultrasound-guided quadratus lumborum block on postoperative analgesia in patients with total hip arthroplasty

作　　者：戴鹏[1] 王汉兵[1] 刘洪珍[1] 邓启芬 周桥灵[1] 贺俭[1] 陈华艳[1] DAI Peng;WANG Hanbing;LIU Hongzhen;DENG Qifen;ZHOU Qiaoling;HE Jian;CHEN Huayan(Department of Anesthesia,First People′s Hospital of Foshan City,Foshan 528000,China)

机构地区：[1]佛山市第一人民医院麻醉科,528000

出　　处：《临床麻醉学杂志》2021年第11期1134-1138,共5页Journal of Clinical Anesthesiology

基　　金：佛山市卫生和健康局医学科研课题(20200209)。

摘　　要：目的研究超声引导下腰方肌阻滞中罗哌卡因复合地塞米松对全髋关节置换术后镇痛的疗效。方法选择2019年12月至2020年12月行全髋关节置换术的患者90例,男40例,女50例,年龄65~78岁,ASAⅠ或Ⅱ级。采用随机分组的方法分成罗哌卡因复合地塞米松组(D组),罗哌卡因组(Y组)和单纯静脉自控镇痛(PCIA)组(R组),每组30例。D组术后以罗哌卡因100 mg复合地塞米松0.1 mg/kg为药液行腰方肌阻滞同时联合PCIA作为术后镇痛,Y组术后以单纯罗哌卡因100 mg为药液行腰方肌阻滞并联合PCIA为术后镇痛,R组则采用单纯PCIA作为对照。记录三组术后4、6、12、24和48 h静息和活动时VAS疼痛评分以及术后48 h内镇痛泵按压次数及曲马多补救例数。同时记录术后48 h内恶心呕吐、呼吸抑制和术后谵妄等不良反应发生情况,记录患者对术后镇痛的满意度。结果术后4、6、12、24和48 h D组和Y组静息和活动时VAS疼痛评分明显低于R组(P<0.05),术后12、24 h D组的静息和活动时VAS疼痛评分明显低于Y组(P<0.05)。术后48 h D组和Y组内镇痛泵按压次数和曲马多补救例数明显少于R组(P<0.05),且D组明显少于Y组(P<0.05)。术后48 h内D组和Y组恶心呕吐发生率明显低于R组(P<0.05),且D组明显低于Y组(P<0.05)。三组均未发生呼吸抑制和术后谵妄。D组术后镇痛的满意度评分明显高于Y组和R组(P<0.05)。结论超声引导下罗哌卡因复合地塞米松腰方肌阻滞对全髋关节置换术患者术后镇痛的效果好,不良反应少,提高患者对术后镇痛的满意度。Objective To study the efficacy of ropivacaine combined with dexamethasone in ultrasound-guided quadratus lumborum block in patients with total hip arthroplasty.Methods Ninety patients,40 males and 50 females,aged 65-78 years,ASA physical statusⅠorⅡ,underwent total hip replacement from December 2019 to December 2020 were selected.The patients were randomly divided into ropivacaine combined with dexamethasone group(group D),ropivacaine group(group Y)and patient controlled intravenous analgesia(PCIA)group(group R),with 30 patients in each group.Patients in group D were treated with ropivacaine 100 mg combined with dexamethasone 0.1 mg/kg in quadratus lumborum block combined with PCIA as postoperative analgesia;patients in group Y were treated with ropivacaine 100 mg alone in quadratus lumborum block combined with PCIA as postoperative analgesia;patients in group R were treated with PCIA alone as control.VAS pain scores at rest and during exercise were recorded at 4,6,12,24 and 48 hours after surgery,as well as the number of pressure times of pain pump and the number of additional tramadol cases within 48 hours after surgery.The occurrence of adverse reactions such as nausea and vomiting,respiratory depression and postoperative delirium within 48 hours after surgery,as well as the satisfaction score of patients with postoperative analgesia were recorded.Results The VAS pain score of group D and Y at rest and during exercise 4,6,12,24 and 48 hours after operation was significantly lower than that of group R(P<0.05),and the VAS pain score of group D at rest and during exercise was significantly lower than that of group Y 12 and 24 hours after operation(P<0.05).48 hours after operation,the number of compression times of analgesic pump and the number of tramadol recovery cases in groups D and Y were significantly lower than those in group R(P<0.05),and group D was significantly lower than group Y(P<0.05).48 hours after operation,the incidence of nausea and vomiting in groups D and Y was significantly lower than that

关 键 词：腰方肌阻滞 地塞米松 全髋关节置换术 术后镇痛 

分 类 号：R614[医药卫生—麻醉学]