右美托咪定作为罗哌卡因佐剂用于髋部骨折手术关节囊周围神经阻滞的效果

目的评价右美托咪定作为罗哌卡因佐剂,对髋部骨折手术超声引导关节囊周围神经(PENG)阻滞之镇痛效果的影响。方法选择2021年1月至6月于南京医科大学第四附属医院择期行髋部骨折手术的老年患者63例,根据随机数字表法将患者分为3组:静脉泵注右美托咪定联合罗哌卡因行PENG阻滞组(VD组)、右美托咪定复合罗哌卡因行PENG阻滞组(RD组)、单纯罗哌卡因行PENG阻滞组(RC组),每组21例。3组均于蛛网膜下腔阻滞麻醉前行超声引导下PENG阻滞,术后行患者静脉自控镇痛(PCIA),维持疼痛视觉模拟评分法(VAS)评分≤3分;当VAS评分>3分时,静脉给予帕瑞昔布钠40 mg。主要观察指标:3组患者阻滞后4 h(T₁)、8 h(T₂)、12 h(T₃)、24 h(T₄)、48 h(T₅)的VAS评分,术后首次PCIA时间。次要观察指标:术后48 h内镇痛泵有效按压次数,术后48 h内镇痛满意度评分,补救镇痛例数,不良反应发生情况。结果最终纳入患者61例,其中RD组20例,VD组20例,RC组21例。RD组在T₃~T₅时刻VAS评分均明显低于VD组和RC组(P<0.05);与VD组和RC组比较,RD组术后首次PCIA时间推迟、48 h内镇痛泵按压次数减少、镇痛满意度提高(P<0.05)。各组均未出现穿刺部位感染、血肿、神经损伤;3组术后并发症(恶心、呕吐、心动过缓等情况)发生率差异无统计学意义(P>0.05)。结论右美托咪定作为罗哌卡因佐剂用于PENG阻滞,能够有效延长神经阻滞作用时间,提高患者髋部骨折手术术后镇痛满意度,且无明显不良反应。

Effect of dexmedetomidine as ropivacaine adjuvant on ultrasound-guided pericapsular nerve block for hip fracture surgery

Objective To evaluate dexmedetomidine as an adjuvant of ropivacaine on the analgesic effect of ultrasound-guided pericapsular nerve group(PENG)block for hip fracture surgery.Methods A total of 63 elderly patients underwent elective hip fracture surgery in the Fourth Affiliated Hospital of Nanjing Medical University from January to June 2021 were selected and were randomly divided into three groups:intravenous pump infusion of dexmedetomidine combined with ropivacaine for PENG block group(VD group),dexmedetomidine combined with ropivacaine for PENG block group(RD group)and ropivacaine alone for PENG block group(RC group),with 21 cases in each group.All the three groups underwent ultrasound-guided PENG block before anesthesia,patient-controlled intravenous analgesia(PCIA)after operation,and maintained the visual analogue scale(VAS)score≤3 points;When VAS score>3 points,parecoxib sodium 40 mg was given intravenously.Main outcome measures:VAS scores at 4 h(T₁),8 h(T₂),12 h(T₃),24 h(T₄)and 48 h(T₅)after block,and the first PCIA time after operation.Secondary outcome measures:effective pressing times of analgesic pump within 48 hours after operation;analgesic satisfaction score within 48 hours after operation;number of cases of remedial analgesia;occurrence of adverse reactions.Results Finally,61 patients were included,including 20 in RD group,20 in VD group and 21 in RC group.The VAS scores in RD group at T₃-T₅ were significantly lower than those in VD group and RC group(P<0.05).Compared with VD group and RC group,the first PCIA time was delayed,the number of pressing of analgesic pump was reduced within 48 hours,and the analgesic satisfaction was improved in RD group(P<0.05).There were no infection,hematoma and nerve injury at the puncture site in each group;There was no significant difference in the incidence of postoperative complications(nausea,vomiting,bradycardia,etc.)among three groups(P>0.05).Conclusion Dexmedetomidine,as an adjuvant of ropivacaine for PENG block,can effectively prolong the action time of nerve block and improve the satisfaction of postoperative analgesia without obvious adverse reactions.