Kida K, Ohtani N, Shoji K, Yasui Y, Masaki E
Jikei University School of Medicine, Department of Anesthesiology, Tokyo.
Eur J Anaesthesiol. 2008 Nov;25(11):869-75. doi: 10.1017/S0265021508004493.
To determine whether intraoperative systemic dexmedetomidine improves postoperative pain and interacts with epidural neostigmine to produce analgesic effects.
Sixty patients undergoing gynaecological surgery were randomly divided into four groups to receive epidural neostigmine and/or systemic dexmedetomidine: control (Group C), epidural neostigmine (Group N), systemic dexmedetomidine (Group D) and co-administered neostigmine and dexmedetomidine (Group ND). Epidural neostigmine (0.3 mg) was administered with 10 mL of 0.75% ropivacaine before the induction of general anaesthesia. Systemic dexmedetomidine (loading dose of 1 mug kg-1 over 10 min followed by 0.4 mug kg-1 h-1) was infused after the induction of general anaesthesia and continued until the end of surgery. The pain status of patients was assessed using the visual analogue scale at 2, 4, 6, 24 and 72 h postoperatively.
Intraoperative systemic dexmedetomidine alone did not reduce postoperative pain scores. However, co-administered neostigmine and dexmedetomidine significantly decreased scores at 24 and 72 h (Group C: 3.0 [1.0-5.8] and 2.0 [0.3-3.0]; Group N: 1.5 [0.3-3.4] and 0 [0-1.3]; Group D: 3.5 [0-5.0] and 0 [0-1.4]; and Group ND: 0 [0-1.0]* and 0 [0-0]; median [interquartile range] *P = 0.0031, P = 0.0045 compared with Group C).
The intraoperative systemic infusion of dexmedetomidine alone at doses causing sedation does not result in postoperative analgesic effects. However, the co-administration of systemic dexmedetomidine and epidural neostigmine at higher doses may be a useful method to improve postoperative pain although side-effects have to be evaluated.
确定术中静脉输注右美托咪定是否能改善术后疼痛，以及其与硬膜外新斯的明联合使用是否会产生镇痛效果。
60例行妇科手术的患者被随机分为四组，分别接受硬膜外新斯的明和/或静脉输注右美托咪定：对照组（C组）、硬膜外新斯的明组（N组）、静脉输注右美托咪定组（D组）以及新斯的明与右美托咪定联合使用组（ND组）。在全身麻醉诱导前，将硬膜外新斯的明（0.3mg）与10mL 0.75%罗哌卡因混合使用。全身麻醉诱导后开始静脉输注右美托咪定（负荷剂量为1μg·kg-1，持续10分钟，随后以0.4μg·kg-1·h-1的速度持续输注），直至手术结束。术后2、4、6、24和72小时使用视觉模拟评分法评估患者的疼痛状况。
术中单独静脉输注右美托咪定并不能降低术后疼痛评分。然而，新斯的明与右美托咪定联合使用组在术后24小时和72小时的疼痛评分显著降低（C组：3.0[1.0 - 5.8]和2.0[0.3 - 3.0]；N组：1.5[0.3 - 3.4]和0[0 - 1.3]；D组：3.5[0 - 5.0]和0[0 - 1.4]；ND组：0[0 - 1.0]*和0[0 - 0]；中位数[四分位数间距]*与C组相比，P = 0.0031，P = 0.0045）。
术中静脉输注引起镇静剂量的右美托咪定并不能产生术后镇痛效果。然而，较高剂量的静脉输注右美托咪定与硬膜外新斯的明联合使用可能是改善术后疼痛的有效方法，尽管其副作用仍需评估。
