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右美托咪定联合布比卡因和单独使用布比卡因在竖脊肌平面阻滞中用于后路腰骶椎体固定术术后疼痛的比较：一项随机对照试验
贵州医科大学 麻醉与电生理课题组 翻译：宋雨婷 编辑：杨荣峰 审校：曹莹 后路腰骶椎体固定术是较为常见的脊柱手术，由于不同原因，患者术后多伴有中至重度疼痛，因此应为这类患者找到有效的术后镇痛方案。本研究旨在观察右美托咪定联合布比卡因与单独使用布比卡因对竖脊肌平面阻滞ESPB对后路腰骶椎体固定术术后疼痛的镇痛效果。 这项随机双盲对照试验共纳入90名患者并随机分为3组（每组30名）：右美托咪定联合布比卡因（DB 组）、布比卡因（B 组）和生理盐水（对照）（S 组）。3组患者术前均行超声引导下双侧ESPB，术后均接受自控镇痛，每8小时给予吗啡和1gm对乙酰氨基酚静脉注射。主要结局指标是术后前24小时每2小时测量一次主动（活动时）和被动（静止时）视觉模拟量表 （VAS） 疼痛评分、阿片类药物消耗量（PCA 按压次数）和补救镇痛需求。其他结局指标包括第二个24小时每4小时测量一次主动和被动VAS疼痛评分、阿片类药物消耗、补救镇痛需求、术后阿片类药物副作用以及术中右美托咪定的副作用，如心动过缓和低血压。 与其他组（B 组和S组）相比，DB组的主动和被动VAS疼痛评分、术后阿片类药物消耗、补救镇痛需求和术后阿片类药物副作用显著降低。术中无额外的右美托咪定副作用发生，如心动过缓和低血压。估计效应量r为-0.58，Cohen's d为-1.46。
在ESPB中加入0.25%的布比卡因复合右美托咪定用于后路腰骶椎体固定术患者的术后疼痛，术后患者主动和被动 VAS 疼痛评分降低，术后阿片类药物消耗、补救镇痛需求和术后阿片类药物副作用减少，且无额外的术中右美托咪定副作用发生。 原始文献来源：Abu El Hassan SHA, Wahsh EA, Mousa AM, Ibrahim ARN, Mohammed EL. Comparative Study Between Dexmedetomidine with Bupivacaine and Bupivacaine Alone in Erector Spinae Plane Block for Postoperative Pain Control of Posterior Lumbosacral Spine Fixation Surgeries: A Randomized Controlled Trial. Drug Des Devel Ther. 2024;18:351-363. Published 2024 Feb 7. 英文原文 Comparative Study Between Dexmedetomidine with Bupivacaine and Bupivacaine Alone in Erector Spinae Plane Block for Postoperative Pain Control of Posterior Lumbosacral Spine Fixation Surgeries: A Randomized Controlled Trial Background: As posterior lumbosacral spine fixation surgeries are common spine procedures done nowadays due to different causes and mostly accompanied with moderate-to-severe postoperative pain, so should find effective postoperative analgesia for these patients. This study aimed to observe analgesic effect of dexmedetomidine combined with bupivacaine versus bupivacaine alone for erector spinae plane block ESPB for postoperative pain control of posterior lumbosacral spine fixation surgeries. Methods: Double-blind randomized controlled study including 90 patients who were randomly allocated into 3 groups (30 patients for each): Dexmedetomidine combined with bupivacaine (DB group), bupivacaine (B group), and saline (control) (S group). US-guided ESPB was performed preoperatively bilaterally in all patients of the 3 groups. All patients received intravenous patient-controlled postoperative analgesia with morphine and 1 gm intravenous paracetamol every 8 hours. Primary clinical outcomes were active (while mobilization) and passive (at rest) visual analog scale (VAS) pain score at first 24 hours measured every 2 hours, opioid consumption (number of PCA presses), and need for rescue analgesia. Other clinical outcomes included active and passive VAS pain score at second 24 hours, measured every 4 hours, opioid consumption, need for rescue analgesia, postoperative opioid side effects, and intraoperative dexmedetomidine side effects as bradycardia and hypotension. Results: Active and passive VAS pain scores, postoperative opioid consumption, need for rescue analgesia, and postoperative opioid side effects were significantly lower in DB group when compared to other groups (B and S groups). There were no additional intraoperative dexmedetomidine side effects as bradycardia and hypotension. The estimated effect-size r was −0.58 and Cohen’s d was −1.46. Conclusion: Addition of dexmedetomidine to bupivacaine 0.25% in ESPB for postoperative pain control in patients of posterior lumbosacral spine fixation surgeries resulted in lower active and passive VAS pain scores, decreased postoperative opioid consumption, need for rescue analgesia and postoperative opioid side effects without additional intraoperative dexmedetomidine side effects. |
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来自： 罂粟花anesthGH > 《待分类》
