右美托咪定-罗哌卡因混合液颈神经根阻滞在肩关节镜术后镇痛中的应用

Application of dexmedetomidine combined with ropivacaine for cervical nerve root block in analgesia after shoulder arthroscopy

摘要:

目的 观察右美托咪定-罗哌卡因混合液选择性颈神经根阻滞对肩关节镜手术术后镇痛效果的影响及安全性分析。方法 选取厦门大学附属中山医院择期行肩关节镜手术患者60例，ASA Ⅰ或Ⅱ级，随机分为右美托咪定-罗哌卡因混合液组（DR组）和罗哌卡因组（R组），每组30例。两组均于术前30?min行C5、C6神经根阻滞，DR组每个神经根分别予以右美托咪定0.5?μg/kg复合0.5%罗哌卡因混合液共4?ml，R组每个神经根分别予以0.5%罗哌卡因4?ml。所有患者均复合喉罩全身麻醉。记录感觉、运动阻滞起效时间及感觉、运动阻滞持续时间；记录术后不同时间点的视觉模拟评分（VAS评分）；记录术后48?h纳布啡补救镇痛的用量；记录患者满意度和不良反应情况。结果 DR组感觉、运动阻滞起效时间短于R组（P?<0.05）；DR组感觉、运动阻滞持续时间较R组长（P?<0.05）；DR组术后12、18、24和36?h的VAS评分及术后48?h纳布啡用量较R组低（P?<0.05）；与R组比较，DR组术后满意度较高（P?<0.05）；DR组有2例发生心动过缓，两组呼吸困难、声音嘶哑等不良反应差异无统计学意义（P?>0.05）。结论 右美托咪定-罗哌卡因混合液颈神经根阻滞能明显缩短神经阻滞起效时间，延长肩关节镜手术术后镇痛时间，减少术后镇痛药物的用量，可在肩关节镜手术镇痛中安全运用。

Abstract:

Objective To observe the efficacy and safety of dexmedetomidine combined with ropivacaine during selective cervical nerve root block in postoperative analgesia of shoulder arthroscopic surgery. Methods Sixty patients, with ASA I-II, undergoing selective arthroscopic shoulder surgery, were enrolled. They were randomized to two groups. C5 and C6 nerve root were blocked separately with either 0.5?μg/kg dexmedetomidine combined with 4?ml 0.5% ropivacaine miscible liquids (group DR, n?=?30) or 4?ml 0.5% ropivacaine (group R, n?=?30) thirty minutes before surgery. All patients received laryngeal mask anesthesia. Sensory onset and duration, motor onset and duration were recorded. VAS of 4, 8, 12, 18, 24, 36 and 48?h after surgery were also recorded. The rescue dosages of nalbuphine, patient satisfactions and related complications were recorded, too. Results Compared with group R, sensory and motor block onset time in group DR were significantly shortened (P??0.05). Conclusions Dexmedetomidine as an adjuvant of ropivacaine in cervical nerve root block can shorten sensory and motor block onset time, prolong postoperative analgesia duration and reduce postoperative analgesic requirements, which can be used in arthroscopic shoulder surgery safely.