Soni Sumit, Parmar Kalpesh, Charan Shyam Meena, Sethi Sameer, Naik Naveen B
Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India.
Department of Urology, PGIMER, Chandigarh, India.
Anesth Essays Res. 2019 Jan-Mar;13(1):1-6. doi: 10.4103/aer.AER_1_19.
Dexmedetomidine has been found as an effective adjuvant in various nerve blocks. Despite several studies on dexmedetomidine with ropivacaine, there is no study on comparing with fentanyl in peritubal infiltration in percutaneous nephrolithotomy (PCNL).
The aim of this study was to compare the effect of the addition of dexmedetomidine or fentanyl in peritubal local anesthetic infiltration on pain scores and analgesic consumption in patients who underwent PCNL.
This was a prospective, randomized, double-blind, tertiary care center-based study.
A total of 60 American Society of Anesthesiologists Class I, II, and III patients were selected and randomly divided into two groups: Group RF ropivacaine and fentanyl ( = 30) and Group RD ropivacaine and dexmedetomidine ( = 30). Balanced general anesthesia was given. After completion of the surgery, peritubal infiltration was given at 6 and 12 O'clock positions under fluoroscopic guidance. Postoperative pain was assessed using the visual analog scale and dynamic visual analog scale rating 0-10 for initial 48 h. Postoperative sedation was assessed using five-point sedation score. Time to first rescue analgesic, number of doses of tramadol, and total consumption of tramadol required in 48 h were noted.
Descriptive data were expressed in mean and standard deviation for between-group comparisons; the Chi-square and Fisher's exact tests were used for categorical variables, whereas -test and Mann-Whitney U-test were used to compare continuous variables between two groups.
Duration of analgesia in group RD (12.87 ± 3.85) is more prolonged than group RF (8.13 ± 3.28) h. Total dose of rescue analgesia required in 48 h in group RF was higher as compared to group RD.
Addition of dexmedetomidine to ropivacaine is more effective than fentanyl in terms of prolongation of analgesic efficacy of local anesthetic in peritubal block along with short-lived mild sedation.
右美托咪定已被发现是各种神经阻滞中一种有效的辅助药物。尽管有几项关于右美托咪定与罗哌卡因的研究，但尚无关于经皮肾镜取石术（PCNL）中输卵管周围浸润时与芬太尼比较的研究。
本研究的目的是比较在接受PCNL的患者中，在输卵管周围局部麻醉浸润中添加右美托咪定或芬太尼对疼痛评分和镇痛药物消耗量的影响。
这是一项基于三级护理中心的前瞻性、随机、双盲研究。
总共选择60例美国麻醉医师协会I、II和III级患者，并随机分为两组：RF组（罗哌卡因和芬太尼，n = 30）和RD组（罗哌卡因和右美托咪定，n = 30）。给予平衡全身麻醉。手术完成后，在荧光透视引导下于6点和12点位置进行输卵管周围浸润。术后48小时内使用视觉模拟量表和动态视觉模拟量表（评分0 - 10）评估术后疼痛。使用五点镇静评分评估术后镇静情况。记录首次使用补救镇痛药的时间、曲马多的剂量数以及48小时内所需曲马多的总消耗量。
描述性数据以均值和标准差表示用于组间比较；卡方检验和Fisher精确检验用于分类变量，而t检验和Mann-Whitney U检验用于比较两组之间的连续变量。
RD组的镇痛持续时间（12.87 ± 3.85）小时比RF组（8.13 ± 3.28）小时更长。RF组48小时内所需的补救镇痛药总剂量高于RD组。
在输卵管周围阻滞中，在罗哌卡因中添加右美托咪定在延长局部麻醉药的镇痛效果以及短暂轻度镇静方面比芬太尼更有效。
