复方倍他米松复合罗哌卡因胸椎旁阻滞用于胸腔镜术后镇痛的效果

目的 探讨超声引导下复方倍他米松复合罗哌卡因胸椎旁阻滞用于胸腔镜术后镇痛的效果。方法 选择行择期胸腔镜手术患者60例，男41例，女19例，年龄18～60岁，BMI 18～25 kg/m²,ASAⅠ或Ⅱ级。采用随机数字表法将患者分为两组：复方倍他米松复合罗哌卡因组(B组)和罗哌卡因组(R组),每组30例。两组在麻醉诱导前行超声引导下胸椎旁阻滞，B组注射药物为加入复方倍他米松0.5 ml的0.4%罗哌卡因25 ml, R组注射药物为0.4%罗哌卡因25 ml。两组均采用标准化的支气管插管静脉全麻方案，术后行PCA。记录阻滞起效时间、镇痛持续时间、PCA首次按压时间，术中舒芬太尼、瑞芬太尼、丙泊酚用量，术后2、4、8、12、24、48 h静息和活动时(咳嗽)VAS疼痛评分，术后48 h PCA总按压次数和舒芬太尼补救镇痛例数，术后48 h内呼吸抑制、恶心呕吐、穿刺部位感染、尿潴留等不良反应发生情况。结果 与R组比较，B组阻滞起效时间明显缩短(P<0.05),镇痛持续时间、PCA首次按压时间明显延长(P<0.05)。两组术中舒芬太尼、瑞芬太尼、丙泊酚用量差异均...

Effect of compound betamethasone combined with ropivacaine on the thoracic paravertebral block for analgesia after thoracoscopic surgery

Objective: To explore the analgesic effect of thoracic paravertebral block (TPVB) under ultrasound guidance using a compound solution of betamethasone and ropivacaine for post-thoracoscopic surgery analgesia.
Methods: Sixty patients scheduled for elective thoracoscopic surgery were selected, including 41 males and 19 females, aged 18-60 years, BMI 18-25 kg/m², and ASA physical status Ⅰ or Ⅱ. Patients were randomly divided into two groups: the betamethasone combined with ropivacaine group (group B) and the ropivacaine group (group R), 30 patients in each group. Before anesthesia induction, both groups received TPVB under ultrasound guidance, with group B receiving 0.4% ropivacaine 25 ml mixed with compound betamethasone 0.5 ml, and group R receiving 0.4% ropivacaine 25 ml. Both groups underwent a standardized general anesthesia protocol with bronchial intubation and PCA. The onset time of block, duration of analgesia, first PCA pressing time, intraoperative sufentanil, remifentanil, and propofol consumption, resting and activity (coughing) VAS pain scores at 2, 4, 8, 12, 24, and 48 hours postoperatively, total PCA pressings and sufentanil rescue analgesia cases within 48 hours postoperatively, and adverse reactions such as respiratory depression, nausea and vomiting, puncture site infection, and urinary retention within 48 hours postoperatively were recorded.
Results: Compared with group R, group B had significantly shorter onset time of block and longer duration of analgesia and first PCA pressing time (P < 0.05). There was no significant difference in intraoperative sufentanil, remifentanil, and propofol consumption between the two groups. Compared with group R, group B had significantly lower resting and activity VAS pain scores at 8, 12, and 24 hours postoperatively (P < 0.05), and significantly fewer total PCA pressings and cases of sufentanil rescue analgesia within 48 hours postoperatively (P < 0.05). There was no significant difference in the incidence of adverse reactions such as respiratory depression, nausea and vomiting, puncture site infection, and urinary retention within 48 hours postoperatively between the two groups.
Conclusion: Compared with ropivacaine alone, the use of compound betamethasone as an adjuvant to ropivacaine for ultrasound-guided TPVB in perioperative analgesia for thoracoscopic surgery can enhance the blocking and postaperative analgesic effects, and reduce the use of opioid analgesics.