不同浓度右美托咪定联合罗哌卡因对膝关节镜术后镇痛效果的影响

Effect of intra-articular administration of Ropivacaine combined with Dexmedetomidine on postoperative analgesia post arthroscopic knee surgery

摘要:

目的观察关节腔内注射不同浓度右美托咪定复合罗哌卡因对膝关节镜术后镇痛的效果。方法选取80例择期行膝关节镜手术患者随机分为A 组（0.25%罗哌卡因+0.25μg/kg右美托咪定）；B 组（0.25%罗哌卡因+0.50μg/kg右美托咪定）；C 组（0.25%罗哌卡因+0.75μg/kg 右美托咪定）；D 组（0.25%罗哌卡因+1.00μg/kg 右美托咪定）。记录患者术中心率、平均动脉压等生命体征，术后24 h内的疼痛评分（VAS）、术后首次需要镇痛药时间、芬太尼用量及不良反应。结果4组患者术中生命体征变化差异无统计学意义（P <0.05）；术后<6h C和D组患者VAS 评分低于A、B 组，B 组低于A 组；C 和D 组比较差异无统计学意义（P >0.05），其他4 组时间差 异无统计学意义；术后首次需要镇痛药时间C、D组长于A、B组，B组长于A组，C和D组比较差异无统计学意义；术后<24 h芬太尼用量C、D组低于A、B组，B组低于A 组，C 和D组比较差异无统计学意义。A 和B 组未出现不良反应，C组出现低血压1 例、恶心呕吐1 例；D组出现心动过缓1 例、恶心呕吐1 例。结论关节腔内注射不同浓度右美托咪定复合罗哌卡因用于膝关节镜术后镇痛，其镇痛效果及不良反应呈浓度依赖性，综合考虑推荐其镇痛浓度为0.50 μg/kg。

Abstract:

Objective To assess the effect of intra-articular administration of Ropivacaine combined with Dexmedetomidine on postoperative analgesia after arthoscopic knee surgery. Methods A total of 80 patients receiving arthroscopic knee surgery were included in this study and were randomly assigned into 4 groups. Patients in group A received intra-articularly 0.25% Ropivacaine plus 0.25 μg/kg Dexmedetomidine; patients in group B received 0.25% ropivacaine plus 0.50 μg/kg Dexmedetomidine; patients in group C received 0.25%Ropivacaine plus 0.75 μg/kg Dexmedetomidine; patients in the group D received 0.25% ropivacaine plus 1.00 μg/kg Dexmedetomidine. Haemodynamic changes, visual analogue scale (VAS), time of duration for the first request of analgesia postoperatively, total fentanyl consumption, and adverse effects were recorded. Results No significant difference among groups were observed in terms of haemodynamic changes during the operation (P >0.05). The VAS scores at 6 hour post -operation in group C and D were significantly decreased when compared with group A and B (P < 0.05). The VAS scores at the 6th hour post-operation in group B were significantly decreased when compared with group A (P < 0.05). No significant difference was observed between group C and D. Time of duration for the first request of analgesia postoperatively in group C and group D were dramatically prolonged when compared with group A and group B (P < 0.05). Time of duration for the first request of analgesia postoperatively in group B was dramatically prolonged when compared with group A (P < 0.05). No significant difference was observed between group C and D. Postoperative consumption of fentanyl was decreased significantly in group C and group D when compared with group A and B.Postoperative consumption of fentanyl was decreased significantly in group B when compared with group A. No significant difference in fentanyl consumption was observed between group C and D. In aspect of adverse advents, one patient experienced hypotension and one patient developed nausea and vomiting in both group C and group D. No adverse effect was observed in group A and B. Conclusions Intra-articular injection of Dexmedetomidine and ropivacaine for postoperative analgesia after arthroscopic knee surgery exerts desirable analgesia while unnecessary dose of Dexmedetomidine causes side effects. Thus, the recommended analgesic dose of Dexmedetomidine is 0.50 μg/kg in addition to Ropivacaine.