Department of Anesthesia, Intensive Care, and Pain Management, South Egypt Cancer Institute, Assiut University, Assiut, Egypt; Department of Biostatistics and Cancer Epidemiology, National Cancer Institute, Cairo University, Egypt.
Pain Physician. 2014 Sep-Oct;17(5):E589-98.
There is little systematic research on the efficacy and tolerability of the addition of adjunctive analgesic agents in paravertebral analgesia. The addition of adjunctive analgesics, such as fentanyl and clonidine, to local anesthetics has been shown to enhance the quality and duration of sensory neural blockades, and decrease the dose of local anesthetic and supplemental analgesia.
Investigation of the safety and the analgesic efficacy of adding 1 μg/kg dexmedetomidine to bupivacaine 0.25% in thoracic paravertebral blocks (PVB) in patients undergoing modified radical mastectomy.
A randomized, double-blind trial.
Academic medical center.
Sixty American Society of Anesthesiologists physical status -I - III patients were randomly assigned to receive thoracicPVB with either 20 mL of bupivacaine 0.25% (Group B, n = 30), or 20 mL of bupivacaine 0.25% + 1 μg/kg dexmedetomidine (Group BD, n= 30). Assessment parameters included hemodynamics, sedation score, pain severity, time of first analgesics request, total analgesic consumption, and side effects in the first 48 hours.
There was a significant reduction in pulse rate and diastolic blood pressure starting at 30 minutes in both groups, but more evidenced in group BD (P < 0.001). Intraoperative Systolic blood pressure showed a significant reduction at 30 minutes in both groups (P < 0.001) then returned to baseline level at 120 minutes in both groups. There was a significant increase in pulse rate starting 2 hours postoperative until 48 hours postoperatively in group B but only after 12 hours until 48 hours in group BD (P < 0.001). The time of the first rescue analgesic requirement was significantly prolonged in the group BD (8.16 ± 42 hours) in comparison to group B (6.48 ± 5.24 hours) (P = 0.04). The mean total consumption of intravenous tramadol rescue analgesia in the postanesthesia care unit in the firtst 48 hours postoperatively was significantly decreased in group BD (150.19 ± 76.98 mg) compared to group B (194.44 ± 63.91 mg) (P = 0.03). No significant serious adverse effects were recorded during the study.
This study is limited by its sample size.
The addition of dexmedetomidine 1 μg/kg to bupivacaine 0.25% in thoracic PVB in patients undergoing modified radical mastectomy improves the quality and the duration of analgesia and also provides an analgesic sparing effect with no serious side effects.
在椎旁神经阻滞中添加辅助镇痛药物的疗效和耐受性方面，系统研究较少。在局部麻醉剂中添加辅助性镇痛药，如芬太尼和可乐定，已被证明可以提高感觉神经阻滞的质量和持续时间，并减少局部麻醉剂和补充镇痛药的剂量。
研究在接受改良根治性乳房切除术的患者中，在布比卡因 0.25%中添加 1μg/kg 右美托咪定对胸椎旁阻滞（PVB）的安全性和镇痛效果。
随机、双盲试验。
学术医疗中心。
60 名美国麻醉医师协会身体状况 I-III 级患者被随机分配接受胸椎 PVB，分别接受 20mL 布比卡因 0.25%（B 组，n=30）或 20mL 布比卡因 0.25%+1μg/kg 右美托咪定（BD 组，n=30）。评估参数包括血流动力学、镇静评分、疼痛严重程度、首次要求镇痛剂的时间、总镇痛剂消耗以及前 48 小时的副作用。
两组患者的心率和舒张压均在 30 分钟时开始显著下降，但 BD 组更明显（P<0.001）。两组患者的术中收缩压在 30 分钟时均显著下降（P<0.001），但 120 分钟时两组均恢复基线水平。B 组患者术后 2 小时至 48 小时的心率显著升高，但 BD 组仅在术后 12 小时至 48 小时升高（P<0.001）。BD 组首次需要抢救性镇痛的时间明显延长（8.16±42 小时），而 B 组（6.48±5.24 小时）（P=0.04）。BD 组患者在术后第 1 天至第 48 小时的静脉注射曲马多解救性镇痛的总消耗量明显低于 B 组（150.19±76.98mg）（P=0.03）。研究期间未记录到严重的不良反应。
本研究的样本量有限。
在接受改良根治性乳房切除术的患者中，在布比卡因 0.25%中添加 1μg/kg 右美托咪定可改善镇痛质量和持续时间，并具有镇痛节省作用，无严重副作用。
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