右美托咪定联合罗哌卡因行竖脊肌平面阻滞用于椎间孔镜手术的临床研究

Dexmedetomidine combined with ropivacaine for erector spinae plane block in percutaneous transforaminal endoscopic discectomy surgery

摘要:

目的 探讨右美托咪定联合罗哌卡因行竖脊肌平面阻滞（ESPB）在骨科椎间孔镜手术中的临床应用。方法 选择在该院行经皮腰椎间孔镜手术的患者40例，采用随机分组法将患者分为右美托咪定联合罗哌卡因行ESPB组（DR组，n = 20）和单纯罗哌卡因行ESPB组（R组，n = 20）。DR组应用0.5 μg/kg右美托咪定联合0.5%罗哌卡因行超声引导下ESPB，R组单纯用0.5%罗哌卡因行超声引导下ESPB。分别记录切皮时（T₁）、分离肌肉时（T₂）、椎间孔成形时（T₃）、神经根减压时（T₄）和缝皮时（T₅）的平均动脉压（MAP）、心率（HR）、经皮动脉血氧饱和度（SpO₂）和视觉模拟评分法（VAS）评分，记录术中补救使用静脉镇痛药情况，以及术后4、8、24和48 h VAS评分，并记录术后48 h内补救使用静脉镇痛药情况。术后随访患者满意度以及不良反应的发生情况（如恶心呕吐、头晕、嗜睡、穿刺部位血肿和神经损伤等）。结果 与R组比较，DR组T₁～T₃时点VAS和MAP较低，HR较慢；DR组术后4和8 h的VAS评分较R组低；DR组术中和术后48 h内补救静脉镇痛药物使用次数和总量均较R组少；DR组术后随访患者满意度较R组高。两组患者T₄和T₅时点的VAS、MAP和HR比较，差异均无统计学意义（P > 0.05）；两组患者术后24和48 h的VAS、各时点SpO₂和术后不良反应发生情况比较，差异均无统计学意义（P > 0.05）。结论 ESPB作为一种辅助镇痛技术已广泛应用于临床。在骨科椎间孔镜手术时，右美托咪定联合罗哌卡因行ESPB可在术中和术后给患者带来良好的镇痛和镇静作用，减少围手术期静脉镇痛药的使用量，并且可以维持术中血流动力学稳定，提高患者满意度。

Abstract:

Objective To investigate the clinical application of dexmedetomidine combined with ropivacaine for erector spinae plane block (ESPB) in orthopedic percutaneous transforaminal endoscopic discectomy.Methods Select 40 patients who underwent percutaneous transforaminal endoscopic discectomy surgery and divided them into 2 groups by randomization: dexmedetomidine combined with ropivacaine for ESPB group (group DR, n = 20) and Ropivacaine alone for ESPB group (group R, n = 20). The DR group was treated with 0.5 μg/kg dexmedetomidine combined with 0.5% ropivacaine for ultrasound-guided ESPB, while in the R group, 0.5% ropivacaine alone was used for ultrasound-guided ESPB. The mean arterial pressure (MAP), heart rate (HR), percutaneous arterial oxygen saturation (SpO₂) and visual analogue scale (VAS) were recorded at the time of skin incision (T₁), muscle separation (T₂), intervertebral foramen plasty (T₃), nerve root decompression (T₄) and skin suture (T₅), and the use of intravenous analgesics during operation. The VAS were recorded at 4, 8, 24 and 48 h after surgery, the remedial use of intravenous analgesics within 48 h after surgery was recorded. Patients’ satisfaction and adverse reactions (such as nausea and vomiting, dizziness, drowsiness, puncture site hematoma and nerve injury) were followed up after operation.Results The VAS and MAP at T₁~T₃ and the VAS at 4 and 8 h after operation in group DR were lower than those in group R; The HR in group DR at T₁~T₃ was slower than that in group R. The number and total amount of remedial intravenous analgesic drugs used in group DR was less than that in group R in operation and 48 h after operation. Patients’ satisfaction after operation in group DR was higher than that in group R. The VAS, MAP and HR at T₄ and T₅ has not significant difference between the two groups (P > 0.05); The VAS at 24 and 48 h after operation, the SpO₂ at each time point and the incidence of postoperative adverse reactions between the two groups have not significant difference (P > 0.05).Conclusion As an auxiliary analgesic technique, ESPB has been widely used in clinical practice. In orthopedic percutaneous transforaminal endoscopic discectomy surgery, dexmedetomidine combined with ropivacaine for ESPB can provide better analgesia and sedation during perioperative period, maintain intraoperative hemodynamic stability and improve patient satisfaction.