静脉注射右美托咪定延长肌间沟臂丛神经阻滞镇痛时间的有效剂量：一项单中心、前瞻性、双盲、随机对照试验。
Effective Dose of Intravenous Dexmedetomidine to Prolong the Analgesic Duration of Interscalene Brachial Plexus Block: A Single-Center, Prospective, Double-Blind, Randomized Controlled Trial.
机构信息
Department of Orthopedics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
出版信息
Reg Anesth Pain Med. 2018 Jul;43(5):488-495. doi: 10.1097/AAP.0000000000000773.
BACKGROUND AND OBJECTIVES
Intravenous (IV) dexmedetomidine (DEX) is reported to prolong the analgesic duration after single-shot interscalene brachial plexus block (ISBPB). However, the effective analgesic dose of IV DEX remains undetermined. Therefore, we aimed to elucidate the clinically relevant dose of IV DEX to prolong the analgesic duration of ISBPB.
METHODS
Seventy-two patients scheduled for arthroscopic shoulder surgery received ISBPB with 15 mL of 0.5% ropivacaine with 1:200,000 epinephrine and were randomly assigned to 1 of 4 groups (n = 18, each): (1) IV normal saline (control), (2) IV DEX 0.5 μg/kg (DEX 0.5), (3) IV DEX 1.0 μg/kg (DEX 1.0), and (4) IV DEX 2.0 μg/kg (DEX 2.0). The primary outcome was time to the first pain at surgical site.
RESULTS
The median (interquartile range) duration of analgesia was significantly prolonged for the DEX 2.0 (874 minutes [727-1153 minutes]) compared with 656 minutes (590-751 minutes), 703 minutes (644-761 minutes), and 696 minutes (615-814 minutes) for the control, DEX 0.5 and DEX 1.0 groups, respectively (P = 0.001, P = 0.008, and P = 0.003, respectively). Postoperative cumulative IV morphine equivalent consumption at 24 hours was significantly lower in the DEX 2.0 compared with the control, DEX 0.5 and DEX 1.0 groups (P < 0.001, P < 0.001, and P = 0.007, respectively). There were no significant differences in the incidence of intraoperative hypotension and the number of patients who required ephedrine after the pairwise group analysis. Also, there were no significant differences on the durations of motor blockade and sedation and the incidence of bradycardia.
CONCLUSIONS
Intravenous DEX at a dose of 2.0 μg/kg significantly increased the duration of ISBPB analgesia without prolonging motor blockade and reduced the cumulative opioid consumption at the first 24 hours in patients undergoing arthroscopic shoulder surgery.
CLINICAL TRIAL REGISTRATION
This study was registered at the Clinical Trial Registry of Korea, identifier KCT0002119.
背景与目的
静脉内（IV）右美托咪定（DEX）据报道可延长单次肌间沟臂丛阻滞（ISBPB）后的镇痛持续时间。然而，IV DEX 的有效镇痛剂量仍未确定。因此，我们旨在阐明 IV DEX 的临床相关剂量，以延长 ISBPB 的镇痛持续时间。
方法
72 例行关节镜肩关节手术的患者接受了 15 mL 0.5%罗哌卡因加 1：200,000 肾上腺素的 ISBPB，并随机分为 4 组（每组 18 例）：（1）IV 生理盐水（对照），（2）IV DEX 0.5 μg/kg（DEX 0.5），（3）IV DEX 1.0 μg/kg（DEX 1.0）和（4）IV DEX 2.0 μg/kg（DEX 2.0）。主要结局是手术部位首次疼痛的时间。
结果
与对照组 656 分钟（590-751 分钟）、DEX 0.5 组 703 分钟（644-761 分钟）和 DEX 1.0 组 696 分钟（615-814 分钟）相比，DEX 2.0 组（874 分钟[727-1153 分钟]）的镇痛持续时间明显延长（P = 0.001，P = 0.008，P = 0.003）。与对照组、DEX 0.5 组和 DEX 1.0 组相比，24 小时时的术后累积 IV 吗啡等效消耗量在 DEX 2.0 组明显较低（P < 0.001，P < 0.001，P = 0.003）。在两两组分析后，术中低血压的发生率和需要麻黄碱的患者数量无显著差异。此外，运动阻滞和镇静的持续时间以及心动过缓的发生率也无显著差异。
结论
在接受关节镜肩关节手术的患者中，静脉内给予 2.0 μg/kg DEX 可显著延长 ISBPB 的镇痛持续时间，而不会延长运动阻滞，并减少前 24 小时的阿片类药物累积消耗量。
临床实验注册号
本研究在韩国临床试验注册中心注册，注册号为 KCT0002119。
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