右美托咪定复合罗哌卡因腹横肌平面阻滞对结直肠癌根治术后镇痛效果的观察

目的探讨右美托咪定复合罗哌卡因腹横肌平面阻滞对结直肠癌根治术后的镇痛效果。方法选取行择期手术开腹结直肠癌根治术的病人60例，随机分为单纯全麻组（G组）、罗哌卡因+全麻（R+G组）和右美托咪定复合罗哌卡因（DR+G组），各20例。G组采用全身麻醉，R+G组采用全身麻醉+0.25%罗哌卡因两侧各20 mL腹横肌平面阻滞，RD+G组采用全身麻醉+1 μg/kg右美托咪定复合0.25%罗哌卡因两侧各20 mL腹横肌平面阻滞，术后病人均采用舒芬太尼自控镇痛。观察3组病人手术时间、术中输液量和丙泊酚、瑞芬太尼的用量以及术后24 h舒芬太尼的用量。比较病人术后2 h（T₁）、6 h（T₂）、12 h（T₃）、24 h（T₄）时点静息疼痛视觉模拟量表（VAS）评分和咳嗽VAS评分，记录不良反应。结果3组术中丙泊酚、瑞芬太尼用量、术后舒芬太尼用量差异均有统计学意义（P < 0.05~P < 0.01）；DR+G组术中丙泊酚和瑞芬太尼用量均低于G组（P < 0.05）；DR+G组、R+G组、G组术后舒芬太尼用量逐渐增加，差异均有统计学意义（P < 0.05~P < 0.01）。在T₁、T₂、T₃时间点3组静息VAS和咳嗽VAS评分差异均无统计学意义（P>0.05）；在T₄时间点，DR+G组静息VAS和咳嗽VAS评分均低于R+G组、G组（P < 0.05~P < 0.01）。DR+G组皮肤瘙痒、恶心呕吐的发生率均低于G组（P < 0.05）。结论右美托咪定复合罗哌卡因腹横肌平面阻滞能减少术中、术后全麻药物用量，改善结直肠癌根治术后镇痛效果，减轻病人疼痛，降低不良反应。

Observation on the analgesic effect of transversus abdominis plane block with combination of dexmedetomidine and ropivacaine after radical resection of colorectal cancer

ObjectiveTo investigate the analgesic effect of transversus abdominis plane block with combination of dexmedetomidine and ropivacaine after radical resection of colorectal cancer.MethodsSixty patients undergoing elective open radical resection of colorectal cancer were randomly divided into general anesthesia group(group G), ropivacaine combined with general anesthesia group(group R+G) and dexmedetomidine combined with ropivacaine group(group DR+G), 20 cases in each group.Group G was given general anesthesia, group R+G was given general anesthesia combined with transversus abdominis plane block on both sides separately using 20 mL 0.25% ropivacaine, and group DR+G was given general anesthesia combined with transversus abdominis plane block on both sides separately using 20 mL 1 μg/kg dexmedetomidine and 0.25% ropivacaine.All patients received sufentanil via patient-controlled introvenous analgesia after operation.The operation time, intraoperative infusion volume, the dosage of propofol and remifentanil, and the dosage of sufentanil 24 h after operation in three groups were observed.The resting visual analog scale(VAS) score and cough VAS score were compared at 2 h(T₁), 6 h(T₂), 12 h(T₃), 24 h(T₄) after operation, and the adverse reactions were recorded.ResultsThere were significant differences in the dosage of propofol, remifentanil and sufentanil among the three groups(P < 0.05 to P < 0.01);the dosage of propofol and remifentanil in group DR+G was lower than that in group G(P < 0.05);the dosage of sufentanil in group DR+G, group R+G and group G increased gradually, and the difference of which was statistically significant(P < 0.05 to P < 0.01).At T₁, T₂ and T₃, there was no significant difference in the resting VAS score and cough VAS score among the three groups(P>0.05);at T₄, the resting VAS score and cough VAS score in group DR+G were lower than those in group R+G and group G(P < 0.05 to P < 0.01).The incidence of skin itching, nausea and vomiting in group DR+G was lower than that in group G(P < 0.05).ConclusionsTransversus abdominis plane block with combination of dexmedetomidine and ropivacaine can reduce the dosage of general anesthesia during and after operation, improve the analgesic effect after radical resection of colorectal cancer, relieve pain and reduce adverse reactions.