右美托咪定复合罗哌卡因连续收肌管阻滞用于全膝关节置换术后镇痛的效果
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摘要
目的观察右美托咪定复合罗哌卡因行连续收肌管阻滞(adductor canal block, ACB)对单侧全膝关节置换术(total knee arthroplasty, TKA)患者术后镇痛及早期功能康复的影响。方法择期拟行单侧TKA患者40例,男21例,女19例,年龄60～75岁,ASAⅠ—Ⅲ级,采用随机数字表法分为两组:右美托咪定复合罗哌卡因组(DR组)和罗哌卡因组(R组),每组20例。术中采用全凭静脉麻醉,麻醉诱导前分别对两组患者行超声引导下ACB,并放置神经周围导管。术毕实施患者自控持续周围神经阻滞镇痛48 h, R组给予0.2%罗哌卡因,DR组给予0.2%罗哌卡因+右美托咪定1.0μg/ml。采用视觉模拟评分(VAS)法评估术后4、8、12、18、36、48 h静息和被动运动(膝关节被动屈曲45°)时疼痛程度;记录术后首次下床活动时间及术后膝关节主动屈曲90°时间;术后48 h内补救用药例数;不良反应发生情况。结果与R组比较,DR组术后不同时点被动运动VAS评分明显降低,术后首次下床活动时间明显缩短,补救镇痛药物应用人次明显减少(P<0.05)。两组恶心呕吐、低血压发生率差异无统计学意义。结论右美托咪定复合罗哌卡因连续收肌管阻滞用于老年患者单侧全膝关节置换术术后镇痛效果好,并能促进关节早期功能修复,不增加不良反应程度。
Objective To investigate the efficacy of dexmedetomidine combined with ropivacaine in continuous adductor canal blocks for postoperative analgesia in elderly patients undergoing total knee arthroplasty. Methods Forty patients, 21 males and 19 females, aged 60-75 years, ASA physical status Ⅰ-Ⅲ, scheduled for elective total knee arthroplasty were divided into 2 groups(n=20) by using a random number table:1.0 μg/ml dexmedetomidine+0.2% ropivacaine group(group DR) and 0.2%ropivacaine group(group R). Continuous adductor canal blocks combined with general anesthesia was used in the operation. Postoperative analgesia pump was applied for 48 h. VAS was used to evaluate the degree of pain at rest and passive motion(passive knee flexion of 45 degrees) at different time points after operation.The first time of out-of-bed activity and the complications after the operation were all recorded. Results The VAS score of passive movement at different time points in group DR was significantly lower than that in group R(P<0.05). The first time of out-of-bed activity was shorter in group DR(P<0.05) and the number of people using remedial analgesics was significantly less than that in group R(P<0.05). There was no significant difference in the incidence of nausea, vomiting and hypotension between the two groups. Conclusion ACB with dexmedetomidine unite ropivacaine is more effective in relieving the postoperative pain of the knee joint, shortening the passive movement time and promoting the patients' knees recovery.
Objective To investigate the efficacy of dexmedetomidine combined with ropivacaine in continuous adductor canal blocks for postoperative analgesia in elderly patients undergoing total knee arthroplasty. Methods Forty patients, 21 males and 19 females, aged 60-75 years, ASA physical status Ⅰ-Ⅲ, scheduled for elective total knee arthroplasty were divided into 2 groups(n=20) by using a random number table:1.0 μg/ml dexmedetomidine+0.2% ropivacaine group(group DR) and 0.2%ropivacaine group(group R). Continuous adductor canal blocks combined with general anesthesia was used in the operation. Postoperative analgesia pump was applied for 48 h. VAS was used to evaluate the degree of pain at rest and passive motion(passive knee flexion of 45 degrees) at different time points after operation.The first time of out-of-bed activity and the complications after the operation were all recorded. Results The VAS score of passive movement at different time points in group DR was significantly lower than that in group R(P<0.05). The first time of out-of-bed activity was shorter in group DR(P<0.05) and the number of people using remedial analgesics was significantly less than that in group R(P<0.05). There was no significant difference in the incidence of nausea, vomiting and hypotension between the two groups. Conclusion ACB with dexmedetomidine unite ropivacaine is more effective in relieving the postoperative pain of the knee joint, shortening the passive movement time and promoting the patients' knees recovery.
引文
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[4] Bangera A,Manasa M,Kfishna P.Comparison of effects of ropivacaine with and without dexmedetomidine in axillary brachial plexus block:a prospective randomized double blinded clinical trial.Saudi J Anaesth,2016,10(1):38-44.
[5] 张佳雷,韩元福,张文斌,等.超声引导下连续收肌管阻滞联合关节周围浸润镇痛对全膝关节置换术后镇痛的效果.实用疼痛学杂志,2017,13(3):180-184.
[6] Labraca NS,Castro-Sánchez AM,Matarán-Peňarrocha GA,et al.Benefits of starting rehabilitation within 24 hours of primary total kneearthroplasty:randomized clinical trial.Clin Rehabil,2011,25(6):557-566.
[7] Wasserstein D,Fdinger C,Brull R,et al.Advanced age,obesity and continuous femoral nerve blockade are independent risk factors for inpatient falls after primary total knee arthroplasty.J Arthroplasty,2013,28(7):1121-1124.
[8] Jenstrup MT,Jaeger P,Lund J,et al.Effects of adductor-canal-blockade on pain and ambulation after total knee arthroplasty:a randomized study.Acta Anaesthesiol Scand,2012,56:357-364.
[9] Kathuria S,Gupta S,Dhawan I.Dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block.Saudi J Anaesth,2015,9(2):148-154.
[10] Yoshitomi T,Kohjitani A,Macda S,et al.Dexmedetomidine enhances the local anesthetic action of lidocaine via analpha-2A adrenoceptor.Anesth Analg,2008,107(1):96-101.
[11] Brummett CM,Hong EK,Janda AM,et al.Perineural dexmedetomidine added to ropivacaine for sciatic nerve block in rats prolongs the duration of analgesia by blocking the hyperpolarization-activated cation current.Anesthesiology,2011,115(4):836-843.
[12] 曾德亮,章放香,余相地,等.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.中华麻醉学杂志,2017,37(1):84-87.
[2] Burns LC,Ritvo SE,Ferguson MK,et al.Pain catastrophizing as a risk factor for chronic pain after total kneearthroplasty:a systematic review.J Pain Res,2015,8:21-32.
[3] Marhofer P,Brummett CM.Safety and efficiency of dexmedetomidine as adjuvant to local anesthetics.Current Opinion in Anesthesiology,2016,29 (5):632-637.
[4] Bangera A,Manasa M,Kfishna P.Comparison of effects of ropivacaine with and without dexmedetomidine in axillary brachial plexus block:a prospective randomized double blinded clinical trial.Saudi J Anaesth,2016,10(1):38-44.
[5] 张佳雷,韩元福,张文斌,等.超声引导下连续收肌管阻滞联合关节周围浸润镇痛对全膝关节置换术后镇痛的效果.实用疼痛学杂志,2017,13(3):180-184.
[6] Labraca NS,Castro-Sánchez AM,Matarán-Peňarrocha GA,et al.Benefits of starting rehabilitation within 24 hours of primary total kneearthroplasty:randomized clinical trial.Clin Rehabil,2011,25(6):557-566.
[7] Wasserstein D,Fdinger C,Brull R,et al.Advanced age,obesity and continuous femoral nerve blockade are independent risk factors for inpatient falls after primary total knee arthroplasty.J Arthroplasty,2013,28(7):1121-1124.
[8] Jenstrup MT,Jaeger P,Lund J,et al.Effects of adductor-canal-blockade on pain and ambulation after total knee arthroplasty:a randomized study.Acta Anaesthesiol Scand,2012,56:357-364.
[9] Kathuria S,Gupta S,Dhawan I.Dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block.Saudi J Anaesth,2015,9(2):148-154.
[10] Yoshitomi T,Kohjitani A,Macda S,et al.Dexmedetomidine enhances the local anesthetic action of lidocaine via analpha-2A adrenoceptor.Anesth Analg,2008,107(1):96-101.
[11] Brummett CM,Hong EK,Janda AM,et al.Perineural dexmedetomidine added to ropivacaine for sciatic nerve block in rats prolongs the duration of analgesia by blocking the hyperpolarization-activated cation current.Anesthesiology,2011,115(4):836-843.
[12] 曾德亮,章放香,余相地,等.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.中华麻醉学杂志,2017,37(1):84-87.