Taher-Baneh Naseh, Ghadamie Negin, Sarshivi Farzad, Sahraie Reza, Nasseri Karim
Kurdistan University of Medical Sciences, School of Medicine, Department of Anesthesiology, Sanandaj, Irã.
Kurdistan University of Medical Sciences, Faculty of Medicine, Department of Anesthesiology, Sanandaj, Irã.
Braz J Anesthesiol. 2019 Jul-Aug;69(4):369-376. doi: 10.1016/j.bjan.2019.03.005. Epub 2019 Jul 27.
One of the disadvantages of unilateral spinal anesthesia is the short duration of post-operative analgesia, which can be addressed by adding adjuvants to local anesthetics. The aim of current study was to compare the effects of adding dexmedetomidine, fentanyl, or saline to bupivacaine on the properties of unilateral spinal anesthesia in patients undergoing calf surgery.
In this double-blind clinical trial, 90 patients who underwent elective calf surgery were randomly divided into three groups. The spinal anesthetic rate in each of the three groups was 1 mL bupivacaine 0.5% (5 mg). In groups BD, BF and BS, 5 μg of dexmedetomidine, 25 μg of fentanyl and 0.5 mL saline were added, respectively. The duration of the motor and sensory blocks in both limbs and the rate of pain during 24 h after surgery were calculated. Hemodynamic changes were also measured during anesthesia for up to 90 min.
The duration of both of motor and sensory block was significantly longer in dependent limb in the BF (96 and 169 min) and BD (92 and 166 min) groups than the BS (84 and 157 min) group. Visual Analog Scale was significantly lower in the two groups of BF (1.4) and BD (1.3), within 24 h after surgery, than the BS (1.6) group.
The addition of fentanyl and dexmedetomidine to bupivacaine in unilateral spinal anesthesia can increase the duration of the motor and sensory block in dependent limb and prolong the duration of postoperative pain. However, fentanyl is more effective than dexmedetomidine.
单侧脊髓麻醉的缺点之一是术后镇痛时间短，可通过在局部麻醉药中添加佐剂来解决。本研究的目的是比较在布比卡因中添加右美托咪定、芬太尼或生理盐水对接受小腿手术患者单侧脊髓麻醉特性的影响。
在这项双盲临床试验中，90例接受择期小腿手术的患者被随机分为三组。三组的脊髓麻醉剂量均为1 mL 0.5%布比卡因（5 mg）。在BD组、BF组和BS组中，分别添加5 μg右美托咪定、25 μg芬太尼和0.5 mL生理盐水。计算双下肢运动和感觉阻滞的持续时间以及术后24小时内的疼痛发生率。在麻醉期间长达90分钟内还测量了血流动力学变化。
BF组（96和169分钟）和BD组（92和166分钟）患侧肢体运动和感觉阻滞的持续时间均明显长于BS组（84和157分钟）。术后24小时内，BF组（1.4）和BD组（1.3）的视觉模拟评分明显低于BS组（1.6）。
在单侧脊髓麻醉中，布比卡因添加芬太尼和右美托咪定可增加患侧肢体运动和感觉阻滞的持续时间，并延长术后疼痛持续时间。然而，芬太尼比右美托咪定更有效。
