单孔胸腔镜术后罗哌卡因复合右美托咪啶前锯肌平面阻滞联合静脉镇痛效果

 目的 观察超声引导下罗哌卡因复合右美托咪啶前锯肌平面阻滞(serratus anterior plane block,SAPB)联合静脉镇痛在单孔胸腔镜术后镇痛中的应用效果。方法 选择2019-01至2020-04医院择期行单孔胸腔镜肺叶切除术患者150例,采用随机数字表法分为,罗哌卡因复合右美托咪啶SAPB联合静脉镇痛组(RD组)、罗哌卡因SAPB联合静脉镇痛组(R组)和静脉镇痛组(对照组,C组),每组50例。手术结束后均在超声引导下行前锯肌平面穿刺,RD组注射(0.375%罗哌卡因+右美托咪啶0.5 μg/kg)20 ml,R组注射0.375%罗哌卡因20 ml,C组注射生理盐水20 ml。采用静脉自控镇痛(patient controlled intravenous analgesia,PCIA),记录并对比三组术后2、 6、12、24及48 h的视觉模拟评分(visual analogue scales,VAS)、PCIA镇痛泵有效按压次数及恶心、呕吐、瘙痒、心动过缓和呼吸抑制等不良反应发生情况。结果 RD组和R组术后2、6、12及24 h的VAS评分显著低于C组,差异有统计学意义(P＜0.05);且RD组术后2、6、12 h的VAS评分显著低于R组(P＜0.05),三组术后48 h的VAS评分差异无统计学意义。RD组和R组2、6、12 h的PCIA镇痛泵有效按压次数显著少于C组,差异有统计学意义(P＜0.05);且RD组术后2、6、12及24 h 的PCIA镇痛泵有效按压次数明显少于R组(P＜0.05)。RD组和R组不良反应发生率显著低于C组,差异有统计学意义(P＜0.05)。结论 0.375%罗哌卡因复合0.5 μg/kg右美托咪啶SAPB联合静脉镇痛用于单孔胸腔镜术后镇痛效果更完善,阿片类药物用量更少,不良反应少,值得临床推广及应用。

Effects of ropivacaine combined with dexmedetomidine on postoperative analgesia in patients undergoing single-hole thoracoscopic lobectomy under ultrasound-guided anterior serratus plane blocking

Objective To observe the effect of ultrasound-guided anterior serratus plane blocking by ropivacaine combined with dexmedetomidine on postoperative analgesia in patients undergoing single-hole thoracoscopic lobectomy.Methods A total of 150 patients undergoing single-hole thoracoscopic lobectomy in our hospital between January 2019 and April 2020 were randomly divided into three groups:group R,group RD,and group C(control group) ,with 50 cases in each.After surgery,patients in group R underwent ultrasound-guided anterior serratus plane blocking with 0.375% ropivacaine 20 ml,patients in group RD with 0.375% ropivacaine and 0.5 μg/kg dexmedetomidine 20ml,and group C with NS 20 ml.The three groups of patients were given intravenous analgesia pumps postoperatively.VAS scores and the number of effective presses at the analgesic pump were calculated before surgery,2 ,6,12,24,and 48 h after surgery.The incidence of adverse reactions such as nausea and vomiting,itching,hypotension,bradycardia and respiratory depression with 48 h of surgery was also recorded.Results VAS scores and effective numbers of presses at the analgesic pump were lower in group R than in group C at 2,6 and 12 h after surgery(P<0.05).VAS scores and effective numbers of presses at the analgesic pump in group RD were lower than in group C at 2,6,12 and 24 h after surgery(P<0.05).VAS scores and effective numbers of presses at the analgesic pump in group RD were lower than in group R at the above time points(P<0.05).The total incidence rate of adverse reactions in the three groups was 14%,16% and 42% respectively,while that of adverse reactions in group RD and group R was significantly lower than that of group C(P<0.05).Conclusions Ropivacaine combined with dexmedetomidine for SAPB can significantly reduce postoperative pain of patients undergoing single-hole thoracoscopic lobectomy,reduce the usage of opioid and incidence rate of postoperative nausea,vomiting and hypotension,which should be made more accessible.