右美托咪定复合罗哌卡因腹横肌平面阻滞在结直肠癌手术围术期镇痛中的应用Application of dexmedetomidine combined with ropivacaine for transverse abdominis plane block in perioperative analgesia of colorectal cancer surgery
刘志英;董有静;李洋;
摘要(Abstract):
目的观察右美托咪定复合罗哌卡因腹横肌平面阻滞在结直肠癌根治术术中和术后的镇痛效果。方法将60例全麻下行开腹结直肠癌根治术患者随机分为2组。两组患者均在麻醉诱导后行超声引导下双侧腹横筋膜阻滞,分别注射0.25%罗哌卡因20 ml+右美托咪定1μg/kg(RD组)或等量0.9%氯化钠溶液(RN组)。记录两组患者切皮前后血压、心率变化,术后2、6、12、24、48 h VAS评分,术后镇痛药使用及不良反应情况。结果切皮后,两组患者MAP、HR比较差异有统计学意义(P<0.05)。RD组术后2、6、12 h VAS评分低于RN组(P<0.05),两组患者术后24 h、48 h VAS评分比较差异无统计学意义(P>0.05)。RD组曲马多用量少于RN组(P<0.05)。两组患者均无恶心、呕吐、皮肤瘙痒、胸闷等不良反应发生。结论右美托咪定复合罗哌卡因能够显著增强腹横肌平面阻滞的镇痛效果,减轻术后疼痛,减少术中和术后镇痛药的需要量。
关键词(KeyWords): 右美托咪定;腹横肌平面阻滞;围术期镇痛
基金项目(Foundation):
作者(Authors): 刘志英;董有静;李洋;
DOI: 10.14053/j.cnki.ppcr.201908010
参考文献(References):
- [1] O′Donnell BD,McDonnell JG,McShane AJ.The transversus abdominis plane (TAP) block in open retropubic prostatectomy[J].RegAnesth Pain Med,2006,31(1):91.
- [2] 马浩南,李恒林,车伟,等.超声引导腹横肌平面阻滞对全麻子宫切除术病人术后镇痛效果的影响[J].中华麻醉学杂志,2010,30(9):1025-1027.
- [3] Lin YN,Li Q,Yang RM,et al.Addition of dexmedetomidine to ropivacaine improves cervical plexus block[J].Acta Anaesthesiol Taiwan,2013,51(2):63-66.
- [4] McDonnell JG,O′Donnell BD,Farrell T,et al.Transversus abdominis plane block:a cadaveric and radiological evaluation[J].Reg Anesth Pain Med,2007,32(5):399-404.
- [5] Hebbard P,Fujiwara Y,Shibata Y,et al.Ultrasound-guided transversus abdominis plane (TAP) block[J].Anaesth Intensive Care,2007,35(4):616-617.
- [6] Urigel S,Molter J.Transversus abdominis plane (TAP) blocks[J].AANA J,2014,82(1):73-79.
- [7] McDermott G,Korba E,Mata U,et al.Should we stop doing blind transversus abdominis plane blocks[J].Br J Anaesth,2012,108(3):499-502.
- [8] Jankovic Z,Ahmad N,Ravishankar N,et al.Transversus abdominis plane block:how safe is it[J].Anesth Analg,2008,107(5):1758-1759.
- [9] Szumita PM,Baroletti SA,Anger KE,et al.Sedation and analgesia in the intensive care unit:evaluating the role of dexmedetomidine[J].Am J Health Syst Pharm,2007,64(1):37-44.
- [10] KeniyaVM,Ladi S,Naphade R.Dexmedetomidine attenuates sympathoadrenal response to tracheal intubation and reduces perioperative anaesthetic requirement[J].Indian J Anaesth,2011,55(4):352-357.
- [11] 李渭敏,仲吉英,李艳雪,等.右美托咪定骶管内注射用于小儿先天性心脏病手术镇痛的临床研究[J].中国医药,2018,13(1):39-43.
- [12] 潘春英,许旭东,张爱萍,等.关节腔内注射不同浓度右美托咪定复合罗哌卡因对老年骨科患者膝关节镜术后镇痛效果[J].实用医学杂志,2018,34(10):1702-1704.
- [13] 王美容,李志鹏,蒋群锰,等.右美托咪定配伍罗哌卡因单次坐骨神经阻滞对TKA术后股神经旁置管镇痛效果的影响[J].实用医学杂志,2017,33(7):1145-1148.
- [14] 王晓军,赵涛,胡芸,等.不同浓度右美托咪定联合罗哌卡因对膝关节镜术后镇痛效果影响[J].创伤与急危重病医学,2018,6(6):358-359.
- [15] Kwon Y,Hwang SM,Lee JJ,et al.The effect of dexmedetomidine as an adjuvant to ropivacaine on the bispectral index for supraclavicular brachial plexus block[J].Korean J Anesthesiol,2015,68(1):32-36.
- [16] Bergmans E,Jacobs A,Desai R,et al.Pain relief after transversus abdominis plane block for abdominal surgery in children:a service evaluation[J].Local Reg Anesth,2015,8:1-6.
- [17] 高志屹,程斌.超声引导下腹横肌平面阻滞用于下腹部手术术后镇痛的效果[J].临床麻醉学杂志,2014,22(12):1190-1192.
- [18] Chang H,Rimel BJ,Li AJ,et al.Ultrasound guided transversus abdominis plane (TAP) block utilization in multimodal pain management after open gynecologic surgery[J].Gynecol Oncol Rep,2018,26:75-77.
- [19] 李露,王晓林,周海滨,等.右美托咪定局部用药对罗哌卡因臂丛神经阻滞半数有效浓度的影响[J].中华麻醉学杂志,2013,33(3):328-330.
- [20] Sivakumar RK,Panneerselvam S,Cherian A,et al.Perineural vs.intravenous dexmedetomidine as an adjunct to bupivacaine in ultrasound guided fascia iliaca compartment block for femur surgeries:a randomised control trial[J].Indian J Anaesth,2018,62(11):851-857.
- [21] Marhofer D,Kettner SC,Marhofer P,et al.Dexmedetomidine as an adjuvant to ropivacaine prolongs peripheral nerve block:a volunteer study[J].Br J Anaesth,2013,110(3):438-442.
- [22] Esmaoglu A,Yegenolu F,Akin A,et al.Dexmedetomidine added to levobupivacaine prolongs axillary brachial plexus block[J].Anesth Analg,2010,111(6):1548-1551.
- [23] Aboelela MA,Kandeel AR,Elsayed U,et al.Dexmedetomidine in a surgically inserted catheter for transversus abdominis plane block in donor hepatectomy:a prospective randomized controlled study[J].Saudi J Anaesth,2018,12(2):297-303.
- [24] Wang L,Shen J,Ge L,et al.Dexmedetomidine for craniotomy under general anesthesia:a systematic review and meta-analysis of randomized clinical trials[J].J Clin Anesth,2019,54:114-125.