超声引导罗哌卡因复合右美托咪定腰方肌阻滞在老年髋关节置换术中的应用

目的评估超声引导罗哌卡因复合右美托咪定腰方肌阻滞在老年病人髋关节置换术中的围术期镇痛效果。方法选取行喉罩全麻下行单侧全髋关节置换术病人90例，随机分为3组，每组30例，分别为单纯喉罩全麻组（对照组，C组）、罗哌卡因阻滞组（R组）、复合药物阻滞组（RD组）。R组和RD组病人入室前30min于麻醉监护室中行术侧腰方肌阻滞，R组注射0.25%罗哌卡因20 mL，RD组注射含1 μg/kg右美托咪定的0.25%罗哌卡因20mL，3组病人术后均行静脉自控镇痛。记录诱导前、置入喉罩时、切皮时、扩髓腔时、拔除喉罩时病人的心率（HR）和平均动脉压（MAP）；记录所有病人术中瑞芬太尼、丙泊酚使用量、拔管时间；记录病人术后舒芬太尼镇痛使用量、帕瑞昔布补救性镇痛情况；记录病人术后不良反应；评估病人术后4、8、12、24、36、48h的静息VAS疼痛评分及术后24、36、48h的运动VAS疼痛评分；评估术后24、36、48 h髋关节的最大屈曲度及外展活动度。结果T0时，3组病人的MAP、HR差异均无统计学意义（P>0.05），T1和T4时，3组病人的MAP差异均无统计学意义（P>0.05），T2和T3时，R组和RD组的MAP低于C组（P < 0.01），R组与RD组差异无统计学意义（P>0.05）；T1~T4，R组和RD组的HR低于C组（P < 0.01），R组与RD组差异无统计学意义（P>0.05）；术中瑞芬太尼使用量、丙泊酚使用量、术后舒芬太尼使用量、补救性镇痛例数，各时间点的静息及运动VAS评分，C组> R组>RD组，差异均有统计学意义（P < 0.05~P < 0.01）；各时间点的髋关节最大屈曲度和髋关节外展活动度:C组 < R组 < RD组，差异均有统计学意义（P < 0.05~P < 0.01）；恶心呕吐、补救镇痛发生率:R组、RD组均低于C组（P < 0.05~P < 0.01），RD组与R组差异无统计学意义（P>0.05）。结论超声引导罗哌卡因复合右美托咪定腰方肌阻滞在老年病人髋关节置换围术期镇痛中效果理想，有利于病人术后康复。

Application of ropivacaine combined with dexmedetomidine guided by ultrasound in quadratus lumborum block in elderly hip replacement

ObjectiveTo evaluate the perioperative analgesic effects of ropivacaine combined with dexmedetomidine guided by ultrasound in quadratus lumborum block in elderly hip replacement.MethodsA total of 90 patients treated with unilateral total hip replacement under general anesthesia of laryngeal mask was randomly divided into the control group(group C, laryngeal mask general anesthesia group), group R(ropivacaine block group) and group RD(compound drug block group)(30 cases in each group).The quadratus lumborum block in group R and group RD were performed in the anesthetic intensive care unit before 30 min of admission, and the group R and group RD were injected with 20mL of 0.25% ropivacaine, and 20 mL of 0.25% ropivacaine containing 1 μg/kg dexmedetomidine, respectively.The heart rate(HR) and mean arterial pressure(MAP) in three groups were recorded before induction, laryngeal mask airway(LMA) insertion, dermectomy, reaming and removal of LMA.The amount of intraoperative remifentanil and propofol, extubation time, postoperative analgesia of sufentanil and parecoxib were recorded in three groups.The postoperative adverse reactions in all cases were recorded.The rest VAS scores after 4, 8, 12, 24, 36 and 48h of operation, movement VAS scores after 24, 36 and 48h of operation, and maximum flexion and abduction range of hip joint after 24, 36 and 48h of operation were evaluated in three groups.ResultsAt T0, there was no statistical significance in MAP and HR among three groups(P>0.05).At T1 and T4, there was no statistical significance in MAP among three groups(P>0.05).At T2 and T3, the MAP in group R and group RD was lower than that in group C(P < 0.01), and there was no statistical significance in the MAP between group R and group RD(P>0.05).At T1-T4, the HR in group R and group RD was lower than that in group C(P < 0.01), and there was no statistical significance in the MAP and HR between group R and group RD(P>0.05).The intraoperative usage amount of remifentanil and propofol, postoperative usage amount of sufentanil, number of cases of remedial analgesia, VAS scores of rest and movement in group C, group R and group RD gradually decreased at each time point, and the differences of those among three groups were statistically significant (P < 0.05 to P < 0.01).The maximum flexion and abduction range of hip joint in group C, group R and group RD gradually increased at each time point, and the differences of those among three groups were statistically significant(P < 0.05 to P < 0.01).The incidence rates of nausea and vomiting, and remedial analgesia in group R and group RD were lower than those in group C(P < 0.05 to P < 0.01), and the difference of which between group RD and group R was not statistically significant(P>0.05).ConclusionsThe perioperative analgesic effect of ropivacaine combined with dexmedetomidine guided by ultrasound in quadratus lumborum block in elderly hip replacement is ideal, which is conducive to postoperative rehabilitation.