Kurhekar Pranjali, Kumar S Madan, Sampath D
Department of Anaesthesia, Madha Medical College and Research Institute, Kovur, Chennai, Tamil Nadu, India.
Indian J Anaesth. 2016 Jun;60(6):382-7. doi: 10.4103/0019-5049.183387.
Inrathecal opioids like morphine added to local anaesthetic agents have been found to be effective in achieving prolonged post-operative analgesia. Intrathecal dexmedetomidine may be devoid of undesirable side effects related to morphine and hence, this study was designed to evaluate analgesic efficacy, haemodynamic stability and adverse effects of both these adjuvants in patients undergoing gynaecological surgeries.
This was a prospective, randomised, double blind study involving 25 patients in each group. Group M received 15 mg of 0.5% hyperbaric bupivacaine with 250 μg of morphine while Group D received 15 mg of 0.5% hyperbaric bupivacaine with 2.5 μg of dexmedetomidine. Characteristics of spinal block, time for first rescue analgesic and total dose of rescue analgesics were noted. Vital parameters and adverse effects were noted perioperatively. Data analysis was done with independent two sample t-test and Mann-Whitney U test.
Time for first rescue analgesic (P = 0.056) and total analgesic demand were similar in both groups. Duration of sensory (P = 0.001) and motor (P = 000) block was significantly higher in dexmedetomidine group. Itching was noticed in 36% and nausea in 52% of patients in the morphine group, either of which was not seen in dexmedetomidine group.
Intrathecal dexmedetomidine produces prolonged motor and sensory blockade without undesirable side effects but intraoperative hypotension was more frequent in dexmedetomidine group.
已发现将鞘内阿片类药物如吗啡添加到局部麻醉剂中可有效实现延长的术后镇痛。鞘内右美托咪定可能没有与吗啡相关的不良副作用，因此，本研究旨在评估这两种佐剂在接受妇科手术患者中的镇痛效果、血流动力学稳定性及不良反应。
这是一项前瞻性、随机、双盲研究，每组纳入25例患者。M组接受15mg 0.5%的重比重布比卡因加250μg吗啡，而D组接受15mg 0.5%的重比重布比卡因加2.5μg右美托咪定。记录脊髓阻滞的特征、首次补救镇痛的时间及补救镇痛药的总剂量。围手术期记录生命体征参数及不良反应。采用独立两样本t检验和曼-惠特尼U检验进行数据分析。
两组首次补救镇痛的时间（P = 0.056）和总镇痛需求相似。右美托咪定组感觉阻滞（P = 0.001）和运动阻滞（P = 0.000）的持续时间明显更长。吗啡组36%的患者出现瘙痒，52%的患者出现恶心，右美托咪定组均未出现上述情况。
鞘内注射右美托咪定可产生延长的运动和感觉阻滞且无不良副作用，但右美托咪定组术中低血压更为常见。
