右美托咪定联合罗哌卡因对上肢骨折手术术后神经阻滞消退期爆发痛的影响

Effect of dexmedetomidine combined with ropivacaine on rebound pain during the regression phase of nerve block in upper limb fracture surgery

摘要:

目的 探讨右美托咪定（DEX）联合罗哌卡因对上肢骨折手术术后神经阻滞消退期爆发痛的影响。方法 选取2021年1月—2023年10月温州市中心医院收治的68例行上肢骨折切开复位内固定术患者，按照随机数字表法将其分为对照组和观察组，每组34例。对照组采用0.375%罗哌卡因+0.9%生理盐水混合液30 mL行神经阻滞；观察组采用0.375%罗哌卡因+50 μg DEX混合液30 mL行神经阻滞。所有患者回病房后采用疼痛强度数字分级评分法（NRS）自行记录NRS评分并进行相应镇痛治疗，12 h后比较两组患者不同等级疼痛持续时间、手术时间、镇痛药物使用剂量、不同时间段疼痛程度、不良反应及满意度情况。结果 观察组镇痛持续时间、首次出现疼痛至NRS评分≥4的时间、NRS评分>4至NRS评分>7（爆发痛）的时间均长于对照组（P <0.05），开始进行吗啡滴定至患者NRS评分<4的时间短于对照组（P <0.05）。两组手术时间比较，差异无统计学意义（P >0.05）。观察组吗啡滴定用量、滴定次数、按压次数、吗啡总消耗量均少于对照组（P <0.05）。观察组与对照组T₁、T₂、T₃、T₄、T₅、T₆、T₇、T₈的NRS评分比较，结果 ①不同时间点的NRS评分比较，差异有统计学意义（P <0.05）；②观察组与对照组的NRS评分比较，差异有统计学意义（P <0.05），观察组NRS评分较对照组低，镇痛效果较好；③观察组与对照组的NRS评分变化趋势比较，差异有统计学意义（P <0.05）。观察组患者术后不良反应发生率低于对照组（P <0.05），术后患者满意度高于对照组（P <0.05）。两组爆发痛的发生率比较，差异无统计学意义（P >0.05）。结论 上肢骨折手术患者采取DEX联合罗哌卡因行神经阻滞，虽然未能抑制爆发痛的发生率，但可延长患者术后镇痛时间，延缓爆发痛的发生时间，减轻爆发痛的疼痛程度，减少术后阿片类药物的用量，降低术后不良反应，提高患者满意度，值得推广。

Abstract:

Objective To investigate the effect of dexmedetomidine (DEX) combined with ropivacaine on outburst pain during nerve block resolution after upper limb fracture surgery. Medthods A total of 68 patients who underwent open reduction and internal fixation of upper limb fractures in Wenzhou Central Hospital from January 2021 to October 2023 were selected and divided into two groups by random number table method, with 34 cases in each group. The control group was treated with0.375% ropivacaine +0.9% normal saline mixture 30ml for nerve block. In the observation group, 0.375% ropivacaine +50 μg DEX 30 mL was used for nerve block. The patients in the two groups were self-recorded the NRS score of pain intensity after returning to the ward and received corresponding analgesic treatment. After 12 hours, the duration of different grades of pain, operation time, analgesic dose, pain degree at different time periods, adverse reactions and satisfaction of the two groups were compared.Results The observation group had a longer duration of analgesia, time from initial pain onset to NRS ≥4, and time from NRS >4 to NRS >7 (rebound pain) compared to the control group (P <0.05). The time to achieve NRS <4 after morphine titration was shorter in the observation group (P <0.05). No significant difference in operation time was observed between the two groups (P >0.05). The observation group had lower morphine titration dosage, fewer titration attempts, fewer patient-controlled analgesia presses, and lower total morphine consumption than the control group (P <0.05). The NRS scores at different time points (T₁-T₈) were significantly lower in the observation group, indicating better analgesic effects (P <0.05). The incidence of adverse reactions was lower, and patient satisfaction was higher in the observation group (P <0.05). There was no significant difference in the incidence of rebound pain between the two groups (P >0.05).Conclusion Patients with upper limb fracture surgery adopt DEX combined with ropivacaine neural blockage. Although the incidence of explosive pain is not inhibited,it can prolong the patient's postoperative analgesic time, delay the time of explosive pain,and reduce the degree of pain in rebound pain. Reduce the amount of opioids after surgery, reduce adverse reactions after surgery, and improve patient satisfaction, which is worth promoting.