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局部右美托咪定辅助用于阴囊手术患者精索阻滞麻醉的疗效:随机对照多中心临床试验

Efficacy of local dexmedetomidine add-on for spermatic cord block anesthesia in patients undergoing intrascrotal surgeries: randomized controlled multicenter clinical trial.

作者信息

Hetta Diab Fuad, Kamal Emad E, Mahran Ali M, Ahmed Doaa G, Elawamy Abdelraheem, Abdelraouf Abdelraouf Ms

机构信息

Department of Anesthesiology and Pain Management, South Egypt Cancer Institute.

Department of Dermatology and Andrology.

出版信息

J Pain Res. 2017 Nov 8;10:2621-2628. doi: 10.2147/JPR.S145305. eCollection 2017.

Abstract

STUDY OBJECTIVE

The objective of this study was to evaluate the effect of adding dexmedetomidine (DEX) to bupivacaine on the quality of spermatic cord block anesthesia and postoperative analgesia.

DESIGN

This is a randomized, double-blind study.

SETTING

This study was performed in an educational and research hospital.

PATIENTS

One hundred twenty adult males were scheduled for intrascrotal surgeries.

INTERVENTIONS

Patients were divided into two groups: group B received 10 mL of bupivacaine 0.25% for spermatic cord block and intravenous 50 µg of DEX and group BD received 10 mL of bupivacaine 0.25% added to 50 µg of DEX (9.5 mL bupivacaine 0. 25% + 0.5 mL [50 µg] DEX) for spermatic cord block, and for masking purposes, the patients received isotonic saline intravenously.

MEASUREMENTS

Time to first analgesic request, analgesic consumption, and visual analog scale (VAS) pain score in the first 24 hours postoperatively were assessed.

MAIN RESULTS

Time to first rescue analgesic was significantly delayed in group BD in comparison with group B, median (interquartile) range, 7 (6-12) hours versus 6 (5-7) hours, (=0.000), the mean cumulative morphine consumption (mg) in the first postoperative 24 hours was significantly lower in group BD compared with group B, 8.13±4.45 versus 12.7±3.79, with a mean difference (95% CI) of -4.57 (-6.06 to -3.07) (=0.000); also, there was a significant reduction of VAS pain score in group BD in comparison with group B at all measured time points, VAS 2 hours (1.28±0.9 vs 1.92±0.8), VAS 6 hours (2.62±1.5 vs 3.93±1.2), VAS 12 hours (2.40±1.1 vs 3.57±0.65), VAS 24 hours (1.90±0.68 vs 2.53±0.62) (=0.000).

CONCLUSION

The addition of 50 µg of DEX to bupivacaine 0.25% in spermatic cord block for intrascrotal surgeries resulted in delay of first analgesic supplementation, reduction of postoperative analgesic consumption as well as improvement of the success rate of the block.

摘要

研究目的

本研究的目的是评估在布比卡因中添加右美托咪定(DEX)对精索阻滞麻醉质量和术后镇痛的影响。

设计

这是一项随机双盲研究。

地点

本研究在一家教学和研究医院进行。

患者

120名成年男性计划进行阴囊内手术。

干预措施

患者分为两组:B组接受10 mL 0.25%布比卡因用于精索阻滞,并静脉注射50 μg DEX;BD组接受10 mL添加了50 μg DEX的0.25%布比卡因(9.5 mL 0.25%布比卡因 + 0.5 mL [50 μg] DEX)用于精索阻滞,为了进行盲法,患者静脉注射等渗盐水。

测量指标

评估术后24小时内首次镇痛需求时间、镇痛药物消耗量和视觉模拟评分(VAS)疼痛评分。

主要结果

与B组相比,BD组首次补救镇痛时间显著延迟,中位数(四分位间距)为7(6 - 12)小时对6(5 - 7)小时,P = 0.000;术后24小时内BD组平均累积吗啡消耗量(mg)显著低于B组,分别为8.13±4.45对12.7±3.79,平均差值(95%CI)为 - 4.57(- 6.06至 - 3.07),P = 0.000;此外,在所有测量时间点,BD组的VAS疼痛评分与B组相比均显著降低,VAS 2小时(1.28±0.9对1.92±0.8),VAS 6小时(2.62±1.5对3.93±1.2),VAS 12小时(2.40±1.1对3.57±0.65),VAS 24小时(1.90±0.68对2.53±0.62),P = 0.000。

结论

在阴囊内手术的精索阻滞中,在0.25%布比卡因中添加50 μg DEX可导致首次镇痛补充延迟、术后镇痛药物消耗量减少以及阻滞成功率提高。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8fbf/5687449/f080abf32e57/jpr-10-2621Fig1.jpg

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