不同浓度右美托咪定混合罗哌卡因连续腰丛神经阻滞用于老年患者髋关节置换术后镇痛效果的比较被引量：112

Comparison of continuous lumbar plexus block with different concentrations of dexmedetomidine added to ropivacaine for postoperative analgesia in elderly patients undergoing hip replacement

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摘要目的比较不同浓度右美托咪定混合罗哌卡因连续腰丛神经阻滞用于老年患者髋关节置换术后镇痛的效果.方法择期行全髋关节置换术老年患者60例,性别不限,年龄65 ～ 85岁,体重50～71 kg,ASA分级Ⅱ或Ⅲ级,采用随机数字表法分为2组（n=30）：0.5、1.0 μg/ml右美托咪定混合0.1％罗哌卡因组（D1组、D2组）.麻醉方式采用腰丛-骶丛神经阻滞联合全麻.术毕时开启连续腰丛神经阻滞镇痛泵,背景输注速率8 ml/h,PCA剂量4 ml,锁时30 min.D1组镇痛药液配方为0.5 μg/ml右美托咪定＋0.1％罗哌卡因;D2组镇痛药液配方为1.0μg/ml右美托咪定＋0.1％罗哌卡因,持续镇痛48 h,维持VAS评分≤3分.接自控静脉镇痛泵（含吗啡50 mg,0.9％氯化钠稀释至50 ml）作为爆发疼痛时的补救镇痛药,PCA剂量1 mg,锁时5 min,无背景输注.术后VAS评分＞3分时,由患者自控优先使用神经阻滞泵,若15 min后无效则自控吗啡泵.记录镇痛有效例数及不良反应的发生情况.结果与D1组比较,D2组镇痛有效率升高、恶心呕吐及瘙痒发生率降低（P＜0.05）,2组均未见心动过缓、低血压、镇静过度、呼吸抑制、尿潴留和局部皮肤感染的发生.结论 1.0 μg/ml右美托咪定混合0.1％罗哌卡因连续腰丛神经阻滞用于老年患者髋关节置换术后镇痛效果较好. Objective To compare the efficacy of continuous lumbar plexus block （LPB） with different concentrations of dexmedetomidine added to ropivacaine for postoperative analgesia in elderly patients undergoing hip replacement.Methods Sixty elderly patients of both sexes,aged 65-85 yr,weighing 50-71 kg,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,scheduled for elective total hip replacement,were divided into 2 groups （n =30 each） using a random number table：0.5 μg/ml dexmedetomidine＋0.1% ropivacaine group （group D1） and 1.0 μg/ml dexmedetomidine ＋ 0.1% ropivacaine group （group D2）.Lumbarsacral plexus block combined with general anesthesia was used.At the end of operation,LPB pump was started and set up to deliver a 4 ml bolus dose with a 30 min lockout interval and background infusion at a rate of 8 ml/h.The analgesia solution contained 0.5 μg/ml dexmedetomidine and 0.1% ropivacaine in group D1 and 1.0 μg/ml dexmedetomidine and 0.1% ropivacaine in group D2.Postoperative analgesia lasted for 48 h,and the visual analogue scale score was maintained ≤ 3.Patientcontrolled intravenous analgesia （PCIA） pump was connected when break-through pain happened.PCIA solution contained morphine 50 mg diluted to 50 ml in 0.9% sodium chloride.PCIA pump was set up to deliver a 1 ml bolus dose with a 5 min lockout interval and no background infusion.When the visual analogue scale score 〉3,the patient-controlled LPB pump was used first,and 15 min later if analgesia was still ineffective,PCIA pump was applied.The number of patients in whom analgesia was effective and occurrence of adverse reactions were recorded.Results Compared with group D1,the rate of effective analgesia was significantly increased,and the incidence of nausea,vomiting and pruritus was decreased in group D2 （P〈 0.05）.No bradycardia,hypotension,over-sedation,respiratory depression,urinary retention or local skin infection was found in the two groups.Conclusion Continuous LPB with 1.0 μg/ml dexmedetomidine added to 0.1% ropivacaine provides better efficacy for postoperative analgesia in elderly patients undergoing hip replacement.