两种不同剂量右美托咪定作为布比卡因辅助用药用于择期腹部子宫切除术蛛网膜下腔阻滞的效果：一项前瞻性、双盲、随机对照研究

Effect of Two Different Doses of Dexmedetomidine as Adjuvant in Bupivacaine Induced Subarachnoid Block for Elective Abdominal Hysterectomy Operations: A Prospective, Double-blind, Randomized Controlled Study.

作者信息

Das Anjan, Halder Susanta, Chattopadhyay Surajit, Mandal Parthajit, Chhaule Subinay, Banu Rezina

机构信息

Department of Anesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, India.

Department. of Anesthesiology, Radha Gobinda Kar Medical College and Hospital, Kolkata, India.

出版信息

Oman Med J. 2015 Jul;30(4):257-63. doi: 10.5001/omj.2015.52.

DOI:10.5001/omj.2015.52

PMID:26366259

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4561636/

Abstract

OBJECTIVES

Improvements in perioperative pain management for lower abdominal operations has been shown to reduce morbidity, induce early ambulation, and improve patients' long-term outcomes. Dexmedetomidine, a selective alpha-2 agonist, has recently been used intrathecally as adjuvant to spinal anesthesia to prolong its efficacy. We compared two different doses of dexmedetomidine added to hyperbaric bupivacaine for spinal anesthesia. The primary endpoints were the onset and duration of sensory and motor block, and duration of analgesia. .

METHODS

A total of 100 patients, aged 35-60 years old, assigned to have elective abdominal hysterectomy under spinal anesthesia were divided into two equally sized groups (D5 and D10) in a randomized, double-blind fashion. The D5 group was intrathecally administered 3ml 0.5% hyperbaric bupivacaine with 5µg dexmedetomidine in 0.5ml of normal saline and the D10 group 3ml 0.5% bupivacaine with 10µg dexmedetomidine in 0.5ml of normal saline. For each patient, sensory and motor block onset times, block durations, time to first analgesic use, total analgesic need, postoperative visual analogue scale (VAS) scores, hemodynamics, and side effects were recorded. .

RESULTS

Although both groups had a similar demographic profile, sensory and motor block in the D10 group (p<0.050) was earlier than the D5 group. Sensory and motor block duration and time to first analgesic use were significantly longer and the need for rescue analgesics was lower in the D10 group than the D5 group. The 24-hour VAS score was significantly lower in the D10 group (p<0.050). Intergroup hemodynamics were comparable (p>0.050) without any appreciable side effects. .

CONCLUSION

Spinal dexmedetomidine increases the sensory and motor block duration and time to first analgesic use, and decreases analgesic consumption in a dose-dependent manner.

摘要

目的

已有研究表明，改善下腹部手术围手术期疼痛管理可降低发病率、促进早期活动并改善患者的长期预后。右美托咪定是一种选择性α-2激动剂，最近已被鞘内注射用作脊髓麻醉的辅助药物以延长其疗效。我们比较了添加到重比重布比卡因中用于脊髓麻醉的两种不同剂量的右美托咪定。主要终点是感觉和运动阻滞的起效时间及持续时间，以及镇痛持续时间。

方法

总共100例年龄在35至60岁之间、计划在脊髓麻醉下行择期腹部子宫切除术的患者，以随机、双盲方式分为两组，每组人数相等（D5组和D10组）。D5组鞘内注射3ml 0.5%重比重布比卡因与5μg右美托咪定溶于0.5ml生理盐水中，D10组鞘内注射3ml 0.5%布比卡因与10μg右美托咪定溶于0.5ml生理盐水中。记录每位患者的感觉和运动阻滞起效时间、阻滞持续时间、首次使用镇痛药的时间、总镇痛药需求量、术后视觉模拟评分（VAS）、血流动力学及副作用。

结果

尽管两组患者的人口统计学特征相似，但D10组的感觉和运动阻滞（p<0.050）比D5组更早。D10组的感觉和运动阻滞持续时间及首次使用镇痛药的时间显著更长，且抢救性镇痛药的需求量低于D5组。D10组的24小时VAS评分显著更低（p<0.050）。组间血流动力学具有可比性（p>0.050），且无任何明显副作用。