Zhang Panpan, Liu Shijiang, Zhu Jingming, Rao Zhuqing, Liu Cunming
Department of Anesthesiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China.
Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University(Jiangsu Province Hospital), Nanjing, China.
Reg Anesth Pain Med. 2019 Aug 8. doi: 10.1136/rapm-2018-100221.
Perineural dexamethasone or dexmedetomidine prolongs the duration of single-injection peripheral nerve block when added to the local anesthetic solution. In a randomized, controlled, double-blinded study in patients undergoing thoracoscopic pneumonectomy, we tested the hypothesis that combined perineural dexamethasone and dexmedetomidine prolonged the duration of analgesia as compared with either perineural dexamethasone or perineural dexmedetomidine after intercostal nerve block (INB).
Eighty patients were randomized to receive INB using 28 mL 0.5% ropivacaine, with 2 mL normal saline (R group), with 10 mg dexamethasone in 2 mL (RS group) or 1 µg/kg dexmedetomidine in 2 mL (RM group), or with 1 µg/kg dexmedetomidine and 10 mg dexamethasone in 2 mL (RSM group) administrated perineurally. The INB was performed by the surgeon under thoracoscopic direct vision; a total of six intercostal spaces were involved, each with an injection of 5 mL. The primary outcome was the duration of analgesia. Secondary outcomes included total postoperative fentanyl consumption, visual analog scale pain score and safety assessment (adverse effects).
The duration of analgesia in RSM (824.2±105.1 min) was longer than that in RS (611.5±133.0 min), RM (602.5±108.5 min) and R (440.0±109.6 min) (p<0.001). Total postoperative fentanyl consumption was lower in RSM (106.0±84.0 µg) compared with RS (243.0±175.2 µg), RM (237.0±98.7 µg) and R (369.0±134.2 µg) (p<0.001). No significant difference was observed in the incidences of adverse effects between the four groups.
The addition of combined perineural dexmedetomidine and dexamethasone to ropivacaine for INB seemed to be an attractive method for prolonged analgesia with almost no adverse effects.
ChiCTR-IOR-17012183.
将神经周围地塞米松或右美托咪定添加至局部麻醉溶液中，可延长单次注射外周神经阻滞的持续时间。在一项针对接受电视胸腔镜肺叶切除术患者的随机、对照、双盲研究中，我们检验了以下假设：与肋间神经阻滞（INB）后单独使用神经周围地塞米松或神经周围右美托咪定相比，联合使用神经周围地塞米松和右美托咪定可延长镇痛持续时间。
80例患者被随机分为四组，分别接受以下处理：使用28 mL 0.5%罗哌卡因加2 mL生理盐水进行INB（R组）；使用28 mL 0.5%罗哌卡因加2 mL含10 mg地塞米松的溶液进行INB（RS组）；使用28 mL 0.5%罗哌卡因加2 mL含1 μg/kg右美托咪定的溶液进行INB（RM组）；使用28 mL 0.5%罗哌卡因加2 mL含1 μg/kg右美托咪定和10 mg地塞米松的溶液进行INB（RSM组）。INB由外科医生在电视胸腔镜直视下进行；总共涉及六个肋间间隙，每个间隙注射5 mL。主要观察指标为镇痛持续时间。次要观察指标包括术后芬太尼总用量、视觉模拟评分法疼痛评分及安全性评估（不良反应）。
RSM组的镇痛持续时间（824.2±105.1分钟）长于RS组（611.5±133.0分钟）、RM组（602.5±108.5分钟）和R组（440.0±109.6分钟）（p<0.001）。RSM组术后芬太尼总用量（106.0±84.0 μg）低于RS组（243.0±175.2 μg）、RM组（237.0±98.7 μg）和R组（369.0±134.2 μg）（p<0.001）。四组间不良反应发生率无显著差异。
在罗哌卡因中联合使用神经周围右美托咪定和地塞米松用于INB似乎是一种延长镇痛时间且几乎无不良反应的有效方法。
ChiCTR-IOR-17012183。
