罗哌卡因复合右美托咪定ESPB对日间模式腹腔镜肾上腺切除术后镇痛和康复的影响  

Effect of ropivacaine combined with dexmedetomidine for erector spinae plane block on postoperative analgesia and recov⁃ery in patients undergoing daytime⁃pattern laparoscopic adrenalectomy

作　　者：黄陈彬 张云星 张建文[2] Huang Chenbin;Zhang Yunxing;Zhang Jianwen(College of Anesthesiology,Shanxi Medical University,Taiyuan 030001,China;Department of Anesthesiology,the Third Hospital of Shanxi Medical University(Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences,Tongji Shanxi Hospital),Taiyuan 030032,China)

机构地区：[1]山西医科大学麻醉学院,太原030001 [2]山西医科大学第三医院(山西白求恩医院,山西医学科学院,同济山西医院)麻醉科,太原030032

出　　处：《国际麻醉学与复苏杂志》2025年第2期162-167,共6页International Journal of Anesthesiology and Resuscitation

摘　　要：目的评价罗哌卡因复合右美托咪定竖脊肌平面阻滞(ESPB)对日间模式腹腔镜肾上腺切除术后镇痛和康复的影响。方法择期行腹腔镜肾上腺切除的日间手术患者57例,美国麻醉医师协会(ASA)分级Ⅰ、Ⅱ级,按随机数字表法将患者分为2组:罗哌卡因组(R组,28例)和罗哌卡因复合右美托咪定组(RD组,29例)。两组患者均在术毕拔管前行超声引导下单侧单次ESPB,R组注入0.5%罗哌卡因30 ml,RD组注入0.5%罗哌卡因30 ml配伍1μg/kg右美托咪定。记录两组患者术后48 h内镇痛泵内舒芬太尼消耗量,术后1、6、12、24、48 h静息及咳嗽视觉模拟评分法(VAS)疼痛评分,首次补救镇痛时间和氟比洛芬酯补救剂量,术前24 h及术后24、48 h恢复质量15项量表(QoR‑15)评分,术后12、24、48 h进食、恶心、呕吐、查体、症状持续时间评分系统(I‑FEED)评分,首次排气时间,首次排便时间及术后48 h内不良反应发生情况。结果RD组术后48 h内镇痛泵内舒芬太尼消耗量和氟比洛芬酯补救剂量低于R组(均P<0.05),首次补救镇痛时间长于R组(P<0.05),术后6、12、24、48 h静息VAS疼痛评分及术后6、12、24 h咳嗽VAS疼痛评分低于R组(均P<0.05),术后24、48 h QoR‑15评分高于R组(均P<0.05),术后12、24、48 h I‑FEED评分低于R组(均P<0.05),首次排气时间、首次排便时间早于R组(均P<0.05)。其他指标两组差异无统计学意义(均P>0.05)。结论罗哌卡因复合右美托咪定ESPB应用于腹腔镜肾上腺切除的日间手术患者,可减少术后舒芬太尼消耗量,延长术后首次补救镇痛时间,降低术后疼痛评分,改善术后胃肠功能和恢复质量,促进术后快速康复。Objective To evaluate the effect of ropivacaine combined with dexmedetomidine for erector spinae plane block(ESPB)on postoperative analgesia and recovery in patients undergoing daytime‑pattern laparoscopic adrenalectomy.Methods A total of 57 patients,American Society of Anesthesiologists(ASA)gradeⅠorⅡ,who underwent daytime‑pattern laparoscopic adrenalectomy under general anesthesia were selected.According to the random number table method,they were divided into two groups:a ropivacaine group(group R,n=28)and a ropivacaine combined with dexmedetomidine group(group RD,n=29).Patients in the two groups underwent unilateral and single ESPB under ultrasound guidance before extubation.Patients in group R were injected with 30 ml of 0.5%ropivacaine,while those in group RD were injected with 1μg/kg dexmedetomidine combined with 30 ml of 0.5%ropivacaine.The consumption of sufentanil in the analgesia pump within postoperative 48 h was recorded.The Visual Analogue Scale(VAS)score at rest and during coughing were evaluated at postoperative 1 h,6 h,12 h,24 h,and 48 h.The time to first rescue analgesia and rescue doses of flurbiprofen axetil were recorded.The Quality of Recovery‑15(QoR‑15)scores were recorded at preoperative 24 h and at postoperative 24 h and 48 h.The Intake,Feeling nauseated,Emesis,Exam,Duration of symptoms scoring system(I‑FEED)scores at postoperative 12 h,24 h,and 48 h were recorded.Moreover,the time to first flatus and first defecation and the incidence of adverse events within postoperative 48 h were also recorded.Results The consumption of sufentanil in the analgesia pump within postoperative 48 h and the rescue doses of flurbiprofen axetil in group RD were less than those in group R(all P<0.05),while the time to first rescue analgesia in group RD was longer than that in group R(P<0.05).The VAS scores at rest at postoperative 6 h,12 h,24 h,and 48 h and during coughing at postoperative 6 h,12 h,and 24 h in group RD were lower than those in group R(all P<0.05).The QoR‑15 scores at postopera

关 键 词：罗哌卡因 右美托咪定 竖脊肌平面阻滞 日间模式 腹腔镜肾上腺切除术 术后镇痛 恢复质量 

分 类 号：R614[医药卫生—麻醉学]