Bi Yong-Hong, Cui Xiao-Guang, Zhang Rui-Qin, Song Chun-Yu, Zhang Yan-Zhuo
Department of Anesthesiology, China and Heilongjiang Key Laboratory for Anesthesia and Critical Care, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
Oncotarget. 2017 Jun 29;8(38):63587-63595. doi: 10.18632/oncotarget.18864. eCollection 2017 Sep 8.
In this study, we aimed to investigate the beneficial effects of dexmedetomidine on somato-visceral sensory block characteristcs, postoperative analgesia and stress response of intrathecal bupivacaine administration in women undergoing cesarean section, and to find out which dose is better.
Sixty parturients with the American Society of Anesthesiologists (ASA) physical status I or II were anesthetized with intrathecal bupivacaine(10mg) alone or in combination with dexmedetomidine (3 μg and 5 μg) to undergo cesarean section. The anesthetic parameters, postoperative analgesia and stress responses were monitored.
Co-administration of dexmedetomidine(3 μg and 5 μg) prolonged the duration of motor and sensory block compared with bupivacaine(10mg) alone. Less supplemental dose of lidocaine and fentanyl were required in dexmedetomidine(3 μg and 5 μg) co-administration groups. Visceral traction response and abdominal muscle relaxation in operation were better in dexmedetomidine(3 μg and 5 μg) co-administration groups. No difference in haemodynamics was detected among groups. There was no significant difference in Apgar scores, neonatal umbilical pH, oxygen pressure, carbon dioxide pressure and lactate level among groups. Postoperative plasma IL-6 and cortisol levels were lower in dexmedetomidine(3 μg and 5 μg) co-administration groups. At 6 hour after operation the visual analogue scale (VAS) was smaller in dexmedetomidine(3 μg and 5 μg) co-administration groups. The uterine contraction pain at 6 and 12 hour after operation and supplemental analgesics had no difference across three groups. No difference of side effects(shivering, nausea and vomiting, itching), the first anal aerofluxus time and intraoperation tramadol dose were detected among the three groups.
The use of dexmedetomidine especially at the dose of 3μg as an adjuvant to bupivacaine in cesarean surgery provides better intraoperative somato-visceral sensory block characteristcs and postoperative analgesia, which produced no influence on Apgar scores, side effects and stress response.
在本研究中，我们旨在探讨右美托咪定对剖宫产术中鞘内注射布比卡因的躯体-内脏感觉阻滞特征、术后镇痛及应激反应的有益影响，并找出哪种剂量效果更佳。
将60例美国麻醉医师协会（ASA）身体状况为Ⅰ或Ⅱ级的产妇，单独使用鞘内布比卡因（10mg）或联合右美托咪定（3μg和5μg）进行麻醉以行剖宫产术。监测麻醉参数、术后镇痛及应激反应。
与单独使用布比卡因（10mg）相比，联合使用右美托咪定（3μg和5μg）延长了运动和感觉阻滞的持续时间。右美托咪定（3μg和5μg）联合用药组所需的利多卡因和芬太尼补充剂量更少。右美托咪定（3μg和5μg）联合用药组术中的内脏牵拉反应和腹肌松弛情况更好。各组间血流动力学无差异。各组间阿氏评分、新生儿脐动脉血pH值、氧分压、二氧化碳分压及乳酸水平无显著差异。右美托咪定（3μg和5μg）联合用药组术后血浆白细胞介素-6和皮质醇水平较低。术后6小时，右美托咪定（3μg和5μg）联合用药组的视觉模拟评分（VAS）较小。术后6小时和12小时的子宫收缩痛及补充镇痛药在三组间无差异。三组间副作用（寒战、恶心呕吐、瘙痒）、首次肛门排气时间及术中曲马多剂量无差异。
在剖宫产手术中，右美托咪定尤其是3μg剂量作为布比卡因的辅助用药可提供更好的术中躯体-内脏感觉阻滞特征及术后镇痛效果，且对阿氏评分、副作用及应激反应无影响。
