【原】布比卡因联合右美托咪定行超声引导胸椎旁阻滞在上腹部手术后疼痛管理：一项双盲随机对照试验

罂粟花anesthGH 2022-05-30 发布于贵州

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布比卡因联合右美托咪定行超声引导胸椎旁阻滞在上腹部手术后疼痛管理：一项双盲随机对照试验

贵州医科大学麻醉与心脏电生理课题组

翻译：安丽编辑：陈锐审校：曹莹

背景

椎旁阻滞是腹部手术后疼痛处理方式之一。局麻药的佐剂剂，包括α-激动剂，已被证明能更好地缓解疼痛并延长镇痛时间。

目的

本研究的目的是研究在超声引导下，布比卡因联合右美托咪定进行椎旁阻滞对剖腹手术术后镇痛的影响

方法

在这项双盲、随机对照试验(RCT)中，我们纳入了计划在剖腹手术后使用T6至T8胸椎旁阻滞（TPVB）进行镇痛的42例患者。将患者随机分为两组，BD组（布比卡2.5mg/mL 加右美托咪定100µg的溶液20ml）和B组(布比卡因2.5mg/mL 的溶液20mL)。术后开始静脉注射芬太尼病人自控镇痛。比较两组患者前48小时内的疼痛、镇静评分、止痛药总用量、首次镇痛所需时间、不良反应(如恶心、呕吐)、呼吸抑制、患者满意度的数值评定量表(NRS)。

结果

BD组患者前48小时的疼痛评分和平均镇痛药总消耗量均显著低于B组(P = 0.03和P <分别为0.001)。BD组患者前48小时的疼痛评分和平均镇痛药总消耗量显著低于B组（分别为P=0.03和P<0.001）。BD组首次镇痛时间明显延长（P<0.001）。镇静评分和副作用两组间无显著差异。

结论

剖腹术后在布比卡因中加入右美托咪定用于TPVB，其术后疼痛处理效果更好，没有明显的并发症。

原始文献来源

Mahzad Alimian , Farnad Imani , Poupak Rahimzadeh , Seyed Hamid Reza Faiz , Leila Bahari-Sejahrood, and Arthur C. Hertling .Adding Dexmedetomidine to Bupivacaine in Ultrasound-guided Thoracic Paravertebral Block for Pain Management after Upper Abdominal Surgery: A Double-blind Randomized Controlled Trial.Anesth Pain Med. 2021 December; 11(6):e120787.

英文原文

Adding Dexmedetomidine to Bupivacaine in Ultrasound-guided Thoracic Paravertebral Block for Pain Management after Upper Abdominal Surgery: A Double-blind Randomized Controlled Trial

Abstract

Background: Paravertebral blocks are one of the possible postoperative pain management modalities after laparotomy. Adjuvants to local anesthetics, including alpha agonists, have been shown to lead to better pain relief and increased duration of analgesia.

Objectives: The aim of this study is to examine the effect of adding dexmedetomidine to bupivacaine for ultrasound-guided paravertebral blocks in laparotomy.

Methods: In this double-blind, randomized controlled trial (RCT), we enrolled 42 patients scheduled for T6 to T8 thoracic paravertebral block (TPVB) for analgesia after laparotomy. The patients were randomly assigned into two groups of BD (bupivacaine 2.5 mg/mL 20 mL plus dexmedetomidine 100 µg) and B (bupivacaine 20 mL alone). Following surgery, intravenous fentanyl patientcontrolled analgesia was initiated. The numerical rating scale (NRS) for pain, sedation score, total analgesic consumption, time to first analgesic requirement, side effects (such as nausea and vomiting), respiratory depression, and patients’ satisfaction during the first 48 hours of evaluation were compared in the two groups.

Results: Pain scores andmean total analgesic consumption at the first 48 hours in the BD group were significantly lower than Group B (P = 0.03 and P < 0.001, respectively). The time of first analgesic request was significantly longer in BD group (P < 0.001). Sedation scores and side effects did not differ significantly between the two groups.

Conclusions: Adding dexmedetomidine to bupivacaine for TPVB after laparotomy yielded better postoperative pain management without significant complications.