中国组织工程研究

中国组织工程研究 ›› 2019, Vol. 23 ›› Issue (24): 3798-3804.doi: 10.3969/j.issn.2095-4344.1289

• 人工假体 artificial prosthesis • 上一篇    下一篇

右美托咪定复合罗哌卡因联合收肌管阻滞用于全膝关节置换后镇痛

谭正玲1，陈郡兴1，苏志源1，刘先保1，陆晓勤1，王  簕2   

  1. 广州医科大学附属第三医院，1麻醉科，2骨科，广东省广州市  510150
  • 出版日期:2019-08-28 发布日期:2019-08-28
  • 通讯作者: 刘先保，副主任医师，广州医科大学附属第三医院麻醉科，广东省广州市 510150
  • 作者简介:谭正玲，女，1982年生，湖南省邵阳市人，汉族，2010年广州医科大学毕业，硕士，主治医师，主要从事骨科麻醉及产科麻醉方面的研究。
  • 基金资助:
    广东省自然科学基金(2017A030313137)，项目负责人：王簕

Analgesia efficacy of dexmedetomidine combined with ropivacaine for adductor canal block after total knee arthroplasty  

Tan Zhengling1, Chen Junxing1, Su Zhiyuan1, Liu Xianbao1, Lu Xiaoqin1, Wang Le2
  

  1. 1Department of Anesthesiology, 2Department of Orthopedics, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China
  • Online:2019-08-28 Published:2019-08-28
  • Contact: Liu Xianbao, Associate chief physician, Department of Anesthesiology, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China
  • About author:Tan Zhengling, Master, Attending physician, Department of Anesthesiology, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China
  • Supported by:
    the Natural Science Foundation of Guangdong Province, No. 2017A030313137 (to WL)

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摘要：

文章快速阅读：
 
文题释义：
右美托咪定：右美托咪定皮下或肌肉注射后快速吸收，达峰时间为1 h，分布半衰期约为6 min，稳态分布容积约为118 L。消除半衰期为2 h，清除期约2 h，清除期约为39 L/h。是一类新型α2受体激动药，右美托咪定联合局麻药使用可显著延长神经阻滞时间，加快局麻药的起效时间，减少局麻药使用剂量，提高镇痛效果，减少局麻药用量。
收肌管阻滞：高频超声探头引导下在术侧大腿中间(即髌骨上侧边界至腹股沟韧带连线中点)偏内侧，股动脉外侧的缝匠肌深面垂直探头进针，见针尖抵至近三角形高回声区域内后，推注1.0-2.0 mL局部麻醉药。可有效缓解全膝关节置换患者术后疼痛，且对股四头肌影响小，有助于患者术后早期锻炼。
 
摘要
背景：全膝关节置换后大部分患者会出现重度疼痛，对于这类患者如何缓解术后疼痛，减少术后并发症，是促进患者早期快速康复治疗的重点。
目的：探讨B超定位下右美托咪定复合罗哌卡因用于收肌管阻滞在全膝关节置换术后的镇痛效果。
方法：前瞻性观察2017年10月至2018年9月行单侧、初次全膝关节置换患者40例，随机分为2组，每组20例。罗哌卡因+右美托咪定组给予30 mL 0.375%罗哌卡因+1.5 µg/kg右美托咪定，罗哌卡因组仅给予30 mL 0.375%罗哌卡因，2组均采用收肌管阻滞。治疗方案得到广州医科大学附属第三医院伦理委员会批准(医伦会审[2018]第170号，审批时间2018-10-31)，且所有患者均签署知情同意书，手术科室和医生具有关节置换的资质及相关临床经验。2组患者术中均使用全身麻醉，记录手术时间及术中出血量；术后2，4，6，12，24，48 h测量平均动脉压、心率、血氧饱和度以及静息、运动状态下疼痛数字分级、镇痛评分；记录术后48 h内阿片类药物追加使用量、术后不良反应以及血清C-反应蛋白、白细胞介素6水平。
结果与结论：①罗哌卡因+右美托咪定组术后2-48 h Ramsay镇静评分均显著高于罗哌卡因组(P < 0.05)；②在静息状态下2组疼痛数字评价量表评分均随术后时间延长而显著降低(P < 0.05)，且各时间点罗哌卡因+右美托咪定组疼痛数字评价量表评分较罗哌卡因组显著降低(P < 0.05)；③在运动状态下2组(12-48 h)疼痛数字评价量表评分均随术后时间延长而显著降低(P < 0.05)，且在12，24，48 h罗哌卡因+右美托咪定组疼痛数字评价量表评分较罗哌卡因组显著降低(P < 0.05)；④在心率方面罗哌卡因+右美托咪定组仅在术后48 h较罗哌卡因组显著降低(P < 0.05)；⑤术后24 h内追加盐酸哌替啶(100 mg/次)者，罗哌卡因组有6例，罗哌卡因+右美托咪定组有1例(P < 0.05)；术后24 h-48 h内追加者，罗哌卡因组有2例，罗哌卡因+右美托咪定组有3例(P > 0.05)，所有追加均为1次；⑥在术后不良反应方面，罗哌卡因组患者有1例出现术后恶心，另有2例出现口干；罗哌卡因+右美托咪定组有2例出现恶心及口干，另有1例出现心动过缓(心率= 49次/min)；⑦右美托咪定组术后血清C-反应蛋白水平显著低于罗哌卡因组(P < 0.05)，而血清白细胞介素6水平2组间差异无显著性意义(P > 0.05)；⑧提示右美托咪定复合罗哌卡因用于收肌管阻滞对全膝关节置换术后的镇痛效果明显优于单独使用罗哌卡因，且不良反应少。

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
ORCID: 0000-0003-2242-1722(刘先保)

关键词: 右美托咪定, 罗哌卡因, 收肌管阻滞, 全膝关节置换, 术后镇痛

Abstract:

BACKGROUND: Most patients will suffer from severe pain after total knee arthroplasty. How to relieve postoperative pain and reduce postoperative complications is the key to promote early and rapid rehabilitation for patients.
OBJECTIVE: To observe the analgesic effect of dexmedetomidine combined with ropivacaine for adductor canal block in patients undergoing arthroscopic total knee arthroplasty.  
METHODS: Forty patients who underwent primary unilateral total knee arthroplasty between October 2017 and September 2018 were randomly divided into two groups (n=20/group), followed by treated by 30 mL 0.375% ropivacaine, and 30 mL 0.375% ropivacaine + 1.5 µg/kg dexmedetomidine, respectively. Both groups received adductor canal block. The study was approved by the Ethics Committee of the Third Affiliated Hospital of Guangzhou Medical University on October 31, 2018, approval number: [2018]170. All patients signed the informed consents, and the surgical department and surgeons had the qualifications for arthroplasty. General anesthesia was conducted, and the operation time and intraoperative blood loss were recorded. The mean arterial pressure, heart rate, oxyhemoglobin saturation, and Ramsay score and numeric pain rating scale score at rest and in activity at 2, 4, 6, 12, 24, and 48 hours after surgery were detected. Opioids consumption, anesthesia related adverse effects, the expression levels of C-reactive protein and interleukin-6 in the serum were detected at 48 hours after surgery.
RESULTS AND CONCLUSION: (1) The Ramsay score at postoperative 2-48 hours in the ropivacaine + dexmedetomidine group was significantly higher than that in the ropivacaine group (P < 0.05). (2) The postoperative numeric pain rating scale score at rest in both groups decreased with time (P < 0.05), and the score at each time point in the ropivacaine + dexmedetomidine group was significantly lower than that in the ropivacaine group (P < 0.05). (3) The postoperative numeric pain rating scale score in activity in both groups decreased with time (P < 0.05), and the score at 12, 24 and 48 hours in the ropivacaine + dexmedetomidine group was significantly lower than that in the ropivacaine group (P < 0.05). (4) The heart rate at postoperative 24 hours in the ropivacaine + dexmedetomidine group was decreased significantly compared with the ropivacaine group (P < 0.05). (5) Six patients in the ropivacaine group and one patient in the ropivacaine + dexmedetomidine group acquired additional use of dolantin (100 mg/times) within postoperative 24 hours (P < 0.05). Two patients in the ropivacaine group and three patients in the ropivacaine + dexmedetomidine group acquired additional use of dolantin once within postoperative 48 hours (P > 0.05). (6) There was one patient who suffered nausea in the ropivacaine group, and two who reported xerostomia. Two patients in the ropivacaine + dexmedetomidine group experienced nausea and xerostomia, and one patient suffered sinus bradycardia (heart rate=49 beats/min). (7) The postoperative expression level of serum C-reactive protein in the ropivacaine + dexmedetomidine group was significantly lower than that in the ropivacaine group (P < 0.05), and there was no significant difference in the interleukin-6 level between two groups (P > 0.05). (8) To conclude, the analgesic effect of dexmedetomidine combined with ropivacaine on adductor canal block after total knee arthroplasty is significantly better than that of ropivacaine alone, and no significant adverse reactions are observed.

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