目的 探讨右美托咪定作为罗哌卡因佐剂用于腰方肌阻滞对腹腔镜全子宫切除术后镇痛的影响。 方法 选择2019年11月~ 2020年6月在本院行腹腔镜下全子宫切除手术患者66例，随机分为右美托咪定组（D组）和罗哌卡因组（R组），每组33例。两组均采用TIVA，在麻醉诱导前行双侧后路腰方肌阻滞，D组每侧注射加入0.50 μg/kg右美托咪定的0.2%罗哌卡因30 mL，R组每侧注射0.2%罗哌卡因30 mL。记录术后2、6、12、24、48h h的静息和运动疼痛VAS评分；首次按压镇痛泵时间；术后48 h内有效PCA次数、舒芬太尼总量、哌替啶镇痛例数、镇痛满意度。 结果 与R组比较，D组术后12 h、24 h、48 h的疼痛VAS评分和运动疼痛VAS评分明显降低（P<0.05），术后48 h按压镇痛泵总次数、舒芬太尼总量、需要哌替啶镇痛例数明显降低（P<0.05），首次按压镇痛泵时间、镇痛满意度明显升高（P<0.05）。 结论 右美托咪定复合罗哌卡因双侧后路腰方肌阻滞用于腹腔镜下全子宫切除术后镇痛安全有效，能降低患者疼痛评分，增强镇痛效果、延长镇痛时间，减少术后阿片类镇痛药用量，提高患者满意度，为多模式镇痛方案提供新选择，效果优于单独应用罗哌卡因。
Abstract
Objective To investigate the effect of dexmedetomidine as an adjuvant to ropivacaine in quadratus lumbar block for postoperative analgesia with laparoscopic total hysterectomy. Methods From November 2019 to June 2020, sixty-six cases of hysteromyoma were selected and scheduled to undergo laparoscopic hysterectomy. They were randomly divided into a dexmedetomidine group (group D) and a ropivacaine group (group R), thirty-three cases in each group. TIVA was adopted in both groups and bilateral posterior quadratus lumbar block (QLB) was performed before induction of anesthesia. In group D,0.2% ropivacaine with dexmedetomidine 0.50μg/kg(30 mL) were injected on each side, while in group R, 0.2% ropivacaine (30mL) was injected on each side. VAS scores of resting and exercise pain were recorded 2 h, 6 h, 12 h, 24 h and 48 h after surgery. The first postoperative pressing time of the analgesic pump, the total effective pressing times within 48 h after surgery, the total dose of sufentanil within 48h after surgery, the number of cases of apethidine for analgesia and the analgesia satisfaction degree were recorded. Results Compared with group R, the VAS scores of resting and exercise pain in group D significantly reduced at 12 h, 24h and 48h after surgery (P<0.05). The total times of pressing the analgesia pump, the total dose of sufentanil 48h after surgery and the number of cases requiring pethidine for analgesia significantly reduced in group D (P<0.05). The first pressing time of the analgesic pump, the degree of analgesic satisfaction significantly increased in group D (P<0.05). Conclusions Dexmedetomidine 0.5 g/kg combined with 0.2% ropivacaine for bilateral QLB can be safely and effectively used for postoperative analgesia in patients undergoing laparoscopic total hysterectomy, which enhance the analgesic effect, prolong the analgesic time, reduce the dose of postoperative opioid analgesics, improve the postoperative recovery quality, and patient satisfaction, and provide a new option for multimodal analgesia schemes. It is more effective than using 0.2% ropivacaine alone.
关键词
右美托咪定 /
罗哌卡因 /
腰方肌阻滞 /
腹腔镜下全子宫切除术 /
术后镇痛
Key words
Dexmedetomidine; /
/
Ropivacaine; /
/
Quadratus umbar block; /
/
Laparoscopic total hysterectomy; /
/
Postoperative analgesia
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