右美托咪定联合罗哌卡因用于胸椎旁神经阻滞对胆总管切开取石术后镇痛效果的影响

目的:探讨盐酸右美托咪定联合罗哌卡因用于胸椎旁神经阻滞对胆总管切开取石术后镇痛效果的影响。方法:选择择期行胆总管切开取石术的患者40例,性别不限,年龄22~72岁,ASA分级I或II级,采用电脑生成随机数字表法分为D组(n=20)和C组(n=20)。两组均于麻醉前左侧卧位超声引导下行右侧胸7平面椎旁神经阻滞并置管。麻醉苏醒后,D组给予0.5%罗哌卡因+1μg/kg右美托咪定20 mL,C组给予0.5%罗哌卡因20 mL。两组术毕均连接静脉自控镇痛泵(含舒芬太尼1.0μg/mL,地佐辛0.1 mg/mL,昂丹司琼16 mg,0.9%氯化钠稀释至100 mL),作为补充镇痛并用于爆发性疼痛时的补救镇痛。术后入PACU持续监测有创血压、心电图、呼吸、脉搏血氧饱和度。记录拔管后2,4,8,12 h的VAS及Ramsay评分,术后额外镇痛药使用情况及不良反应发生情况。结果:术后2,4,8 h D组VAS评分明显低于C组,术后4,8,12 h A组Ramsay评分明显低于B组(P<0.05);D组额外镇痛药使用次数少于C组(P<0.05);两组不良反应发生情况无明显差异(P>0.05)。结论:右美托咪定联合罗哌卡因胸椎旁神经阻滞用于胆总管切开取石术有较好的镇痛效果。

Effect of dexmedetomidine combined ropivacaine on ultrasound guided thoracic paravertebral block in choledocholithotomy

Objective:To investigate the analgesic effect of dexmedetomidine combined ropivacaine on ultrasound guided thoracic paravertebral block in choledocholithotomy.Methods:Forty patients undergoing choledocholithotomy were selected with the age of 22–72 years,ASA grade I or II regardless of sex and divided into 2 groups by random number table(n=20):D group and C group.The right ultrasound guided thoracic 7 plane paravertebral nerve block and catheterization were performed in left supine position in both groups before anesthesia induction.D group was given 0.5%ropivacaine+1μg/kg dexmedetomidine 20 mL after postoperative awake and extubated.C group was given 0.5%ropivacaine 20 mL at the same time.The two groups were connected with intravenous self-controlled analgesia pump(sufentanil 1.0μg/mL,dezocine 0.1 mg/mL,ondansetron 16 mg,0.9%sodium chloride diluted to 100 mL)as a remedy for pain relief.Invasive blood pressure,ECG,respiration,pulse oxygen saturation after admission to the PACU were continuously monitored.Compared the difference of VAS and Ramsay scores of postoperative 2,4,8,12 h between two groups,the use of additional analgesics and the incidence of adverse reactions.Results:After 2,4,8 h,VAS score in D group was significantly lower than that of group C,4,8,12 h after operation in D group Ramsay score was significantly lower in group C(P<0.05).Compared to group C,the use of additional analgesics was less in group D(P<0.05).And the adverse reactions of two groups have no obvious difference(P>0.05).Conclusion:Dexmedetomidine combined with ropivacaine can promote the anaesthesia effect of ultrasound guided thoracic paravertebral block in choledocholithotomy.