目的 观察右美托咪定辅助联合罗哌卡因进行超声引导下竖脊肌阻滞(ESPB)在经皮内镜下椎间孔椎间盘摘除术(PELD)中的麻醉效果及术后镇痛效果.方法 将期间择期进行椎间孔镜下椎间盘摘除术的患者随机分为局部麻醉组(C组)、单纯罗哌卡因组(R组)和罗哌卡因+盐酸右美托咪定组(DR组).C组用0.375％罗哌卡因20 mL进行局部浸润麻醉;R组用0.375％罗哌卡因20 mL进行双侧ESPB;DR组用0.375％罗哌卡因+1μg·kg-1右美托咪定混合溶液20 mL进行双侧ESPB.观察3组患者插入通道前后3 min平均动脉压(MAP)和心率(HR)的变化;术前(T0)、穿刺针定位时(T1)、工作通道置入时(T2)、纤维环操作时(T3)、术毕即刻(T4)、术后4 h(T5)、8 h(T6)、12 h(T,)和24 h(T8)的视觉模拟量表(VAS)评分.观察静脉镇痛药物、血管活性药物用量及术中药物不良反应的发生情况.结果 C组30例,R组29例,DR组30例.插入通道后3 min,C组、R组和DR组的HR分别为(83.23±5.61)、(78.18±4.71)和(77.31±5.13)beat·min-1,MAP 分别为(85.97±3.89)、(76.13±4.70)和(74.21±3.12)mmHg,在统计学上差异均有统计学意义(均P＜0.05).T2时 C 组、R 组和 DR 组 VAS 分别为(5.80±0.85)、(2.38±0.68)和(1.73±0.95)分,T3 时 VAS 分别为(4.43±0.57)、(2.55±0.57)和(1.63±0.56)分,T7 时 VAS 分别 为(4.66±0.66)、(3.55±0.63)和(3.03±0.66)分,T8时 VAS 分别为(5.53±0.68)、(4.07±0.46)和(3.23±0.57)分,在统计学上差异均有统计学意义(均P＜0.05).C组术中舒芬太尼追加例数17例,R组5例,DR组3例,R组和DR组均显著少于C组(均P＜0.05).3组患者药物不良反应比较,在统计学上差异均无统计学意义(均P＞0.05).结论 右美托咪定联合罗哌卡因进行ESPB可显著减轻PELD手术患者术中和术后疼痛,减少术中阿片类药物的使用,且无明显药物不良反应发生.
Objective To evaluate the anesthetic and postoperative analgesic effects of ultrasound-guided erector spinae plane block(ESPB)with dexmedetomidine combined with ropivacaine in percutaneous endoscopic lumbar discectomy(PELD).Method Patients underwent endoscopic discectomy were randomly divided into local infiltrative anesthesia group(group C),ropivacaine group(group R)and dexmedetomidine combined with ropivacaine group(group DR).Group C received local infiltration anesthesia with 0.375％ropivacaine 20 mL;in group R,the anesthesiologist used 0.375％ropivacaine 20 mL to perform bilateral ESPB.In DR group,0.375％ropivacaine+1 μg·kg-1 dexmedetomidine mixed solution 20 mL was used for bilateral ESPB.The changes of mean arterial pressure(MAP)and heart rate(HR)at 3 min before and after insertion of the channel were observed.The visual analogue scale(VAS)were recorded before operation(T0),at the time of needle positioning(T1),working channel placement(T2),annulus fibrosus operation(T3),at the end of operation(T4),at 4 h(T5),8 h(T6),12 h(T7)and 24 h(T8)after operation were observed.The dosage of intravenous analgesics,vasoactive drugs,and the occurrence of intraoperative adverse drug reactions were observed.Results There were 30 patients in group C,29 patients in group R and 30 patients in group DR.At 3 min after insertion into the channel,HR of group C,group R and group DR were(83.23±5.61),(78.18±4.71)and(77.31±5.13)beat·min-1;MAP were(85.97±3.89),(76.13±4.70)and(74.21±3.12)mmHg;with statistically significant difference(all P＜0.05).The VAS of group C,group R and group DR at T2were(5.80±0.85),(2.38±0.68)and(1.73±0.95)points;at T3 were(4.43±0.57),(2.55±0.57)and(1.63±0.56)points;at T7 were(4.66±0.66),(3.55±0.63)and(3.03±0.66)points;at T8 were(5.53±0.68),(4.07±0.46)and(3.23±0.57)points,all with significant difference(all P＜0.05).The number of additional cases of sufentanil in group C was 17 cases,and in group R was 5 cases,and in group DR was 3 cases,the number of additional cases of sufentanil in group R and DR was significantly less than that in group C(all P＜0.05).There was no significant difference in the incidence of adverse drug reactions among the three groups(all P＞0.05).Conclusion ESPB with dexmedetomidine combined with ropivacaine can significantly reduce intraoperative and postoperative pain,reduce intraoperative opioid use,and has no obvious adverse reactions in patients undergoing PELD.
吴靓;宋致静;赵盼盼;徐海龙
徐州市第一人民医院麻醉科,江苏徐州 221000徐州市肿瘤医院麻醉科,江苏徐州 221000
药学
竖脊肌平面阻滞;右美托咪定;椎间孔镜下椎间盘摘除术;疼痛
erector spinae plane block;dexmetomidine;percutaneous endoscopic lumbar discectomy;pain
《中国临床药理学杂志》 2024 (008)
1106-1110 / 5
10.13699/j.cnki.1001-6821.2024.08.004
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