Department of Anaesthesiology, S.M.S. Medical College, Jaipur, Rajasthan, India.
J Neurosurg Anesthesiol. 2017 Oct;29(4):433-438. doi: 10.1097/ANA.0000000000000422.
Crippling postoperative pain linked with lumbar discectomies not only shackles patient's normal daily activities but also lengthens their hospital stay. So, allaying postoperative pain in these patients has become a substantive component in neuroanesthesia to expedite neurological recovery. Wound infiltration with local anesthetics is widely used to optimize postoperative pain. Different adjuvants like dexmedetomidine and tramadol when added to local anesthetics prolongs postoperative analgesia. The aim of this trial was to evaluate the analgesic efficacy of tramadol and dexmedetomidine when added to ropivacaine for wound infiltration in lumbar discectomies.
This study was prospective, randomized, double-blind, controlled in nature conducted among 45 adult patients belonging to American Society of Anesthesiologists' physical status 1 and 2, of either sex aged between 30 and 70 years undergoing elective lumbar discectomies. They were randomly allocated into 3 equal groups: group R received 100 mg of 0.5% ropivacaine (20 mL) and 2 mL normal saline, group RT received 100 mg of 0.5% ropivacaine (20 mL) and 2 mg/kg tramadol (2 mL), and group RD received 100 mg of 0.5% ropivacaine (20 mL) and 0.5 μg/kg dexmedetomidine (2 mL) (total volume, 22 mL). Visual analog scale at 0, 2, 4, 6, 12, 18, and 24 hours; time to first rescue analgesia, total supplemental analgesic consumption and side effects (if any) were assessed during first 24 hours postoperatively.
The median time to first rescue analgesia (median; 95% confidence interval [CI]) in group RD was 930 (854.3 to 1005.7) minutes. This was significantly longer (P=0.000) than group RT (420 [366.3 to 473.7] min) or group R (270 [243.2 to 296.8] min). Postoperative diclofenac consumed (median [interquartile range]) was 150 (150 to 200) mg in group R, 150 (75 to 150) mg in group RT and 75 (75 to 150) mg in group RD (P=0.008). Significant differences in mean visual analog scale scores were observed among the 3 groups at hours 0 (P=0.033), 2 (P=0.001), 4 (P=0.000), 6 (P=0.001), and 24 (P=0.013). No statistical significant side effects could be discerned among the groups.
We concluded that wound infiltration with combined ropivacaine and dexmedetomidine found to be significantly superior for postoperative analgesia compared with either combined ropivacaine and tramadol or ropivacaine alone for lumbar discectomies.
与腰椎间盘切除术相关的致残性术后疼痛不仅束缚了患者的正常日常活动，还延长了他们的住院时间。因此，缓解这些患者的术后疼痛已成为神经麻醉学中的一个重要组成部分，以加速神经恢复。局部麻醉剂的伤口浸润被广泛用于优化术后疼痛。不同的佐剂，如右美托咪定和曲马多，当添加到局部麻醉剂中时，可延长术后镇痛时间。本试验的目的是评估曲马多和右美托咪定在罗哌卡因伤口浸润中用于腰椎间盘切除术的镇痛效果。
这是一项前瞻性、随机、双盲、对照研究，在接受择期腰椎间盘切除术的美国麻醉医师协会身体状况 1 级和 2 级的 45 名成年患者中进行，性别为 30 至 70 岁。他们被随机分为 3 组：组 R 接受 100mg 0.5%罗哌卡因（20mL）和 2mL 生理盐水，组 RT 接受 100mg 0.5%罗哌卡因（20mL）和 2mg/kg 曲马多（2mL），组 RD 接受 100mg 0.5%罗哌卡因（20mL）和 0.5μg/kg 右美托咪定（2mL）（总容量 22mL）。在术后 24 小时内评估视觉模拟评分（VAS）在 0、2、4、6、12、18 和 24 小时时；首次补救性镇痛时间、总补充镇痛消耗和（如有）副作用。
RD 组首次补救性镇痛的中位数时间（中位数；95%置信区间[CI]）为 930（854.3 至 1005.7）分钟。这明显更长（P=0.000）比 RT 组（420 [366.3 至 473.7] 分钟）或 R 组（270 [243.2 至 296.8] 分钟）。R 组术后双氯芬酸消耗（中位数[四分位间距]）为 150（150 至 200）mg，RT 组为 150（75 至 150）mg，RD 组为 75（75 至 150）mg（P=0.008）。在 3 组中，在 0 小时（P=0.033）、2 小时（P=0.001）、4 小时（P=0.000）、6 小时（P=0.001）和 24 小时（P=0.013）观察到平均 VAS 评分有显著差异。各组之间未发现明显的副作用差异。
我们得出结论，与单独使用罗哌卡因或罗哌卡因联合曲马多相比，罗哌卡因联合右美托咪定的伤口浸润在腰椎间盘切除术后镇痛方面具有明显优势。
