罗哌卡因加右美托咪定腹横肌平面阻滞用于腹腔镜术后镇痛的效果研究*

Postoperative analgesia of Ropivacaine combined Dexmedetomidine for transversus abdominis plane block in laparoscopic surgery*

摘要:

目的 观察罗哌卡因复合右美托咪定腹横肌平面阻滞（TAP）用于腹腔镜疝修补手术患者术后镇 痛的效果。方法 择期行腹腔镜疝修补手术患者60 例，常规气管插管全麻下行手术，手术结束行超声引导下 双侧TAP，随机分为两组：罗哌卡因+ 右美托咪定组（Rpd 组）：腹横肌平面内注射右美托咪定1.0μg/kg+ 0.4% 罗哌卡因30 ml ；罗哌卡因组（R 组）：腹横肌平面内注射生理盐水1 ml+0.4% 罗哌卡因30 ml。观察两 组患者手术切皮、术中1 h、出手术室时的血压、心率（HR）；术后即刻、4、6、8、12 和24 h 视觉模拟疼 痛评分（VAS）；记录两组患者腹部感觉阻滞时间，及术后恶心、呕吐不良反应发生率。结果 两组患者术中 及术后各时间点的血流动力学指标无差异（P >0.05），Rpd 组术后6、8 和12 h Rpd 组的VAS 评分低于R 组 （P <0.05），术后即刻、4 和24 h VAS 评分无差异（P >0.05），腹部感觉阻滞时间Rpd 组明显长于R 组（P <0.05）， 术后恶心呕吐发生率两组患者无差异（P >0.05）。结论 罗哌卡因复合右美托咪定TAP 用于腹腔镜疝修补手 术患者，可以显著延长术后镇痛时间。

Abstract:

Objective To observe the effect of postoperative analgesia of Ropivacaine combined Dexmedetomidine for transversus abdominis plane (TAP) block in laparoscopic surgery. Methods 60 patients underwent selective laparoscopic hernia repair were randomly divided into two groups: Ropivacine plus Dexmedetomidine group (Rpd group): Dexmedetomidine 1.0 μg/kg + 0.4% Ropivacine 30 ml was injected into bilateral TAP, and Ropivacine group (R group): saline 1 ml+0.4% Ropivacine 30 ml was injected into bilateral TAP. Blood pressure and heart rate on beginning of the surgery, 1 h during surgery and leaving the operating room, VAS of immediate postoperative period, 4 h, 6 h, 8 h, 12 h, 24 h after the surgery, analgesic duration and incidence of nausea and vomiting of the two groups were recorded. Results Two groups have no difference in blood pressure and heart rate in all time points (P > 0.05), VAS score of 6 h, 8 h, 12 h after surgery in Rpd group were lower than in R group (P < 0.05), and VAS score of postoperative period, 4 h, 24 h after the surgery had no difference between the two groups (P > 0.05). Sensory block duration in Rpd group was longer than in R group (P < 0.05). Incidence of nausea and vomiting of the two groups had no difference in two groups (P > 0.05). Conclusions Ropivacaine combined Dexmedetomidine for Transversus Abdominis Plane block in laparoscopy patients can significantly prolong the analgesic duration