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

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.

Key words: Dexmedetomidine; ,  , Ropivacaine; ,  , Quadratus umbar block; ,  , Laparoscopic total hysterectomy; ,  , Postoperative analgesia