Yang Yichen, Song Chengjun, Song Chengwei, Li Chengwen
Department of Anesthesiology, Zoucheng People's Hospital, Zoucheng, Shandong 273500, P.R. China.
Department of Anesthesiology, Jining No. 1 People's Hospital, Jining Medical University, Jining, Shandong 272011, P.R. China.
Exp Ther Med. 2020 Mar;19(3):1747-1754. doi: 10.3892/etm.2020.8429. Epub 2020 Jan 7.
The aim of the present study was to evaluate the effectiveness and safety of the combination of epidural dexmedetomidine and morphine in providing anesthesia during cesarean surgery and analgesia for post-cesarean pain relief when added to epidural ropivacaine. A total of 80 females at term scheduled for elective cesarean delivery were randomly assigned to two groups (n=40/group): In the morphine group (group M), patients received an epidural injection of 0.75% ropivacaine (12 ml) and morphine (2 mg) for surgical anesthesia, and epidural infusion of morphine (2 mg) in 100 ml 0.2% ropivacaine at 2 ml/h for 48-h post-operative analgesia; and in the morphine combined with dexmedetomidine group (group DM), patients received an epidural injection of 0.75% ropivacaine (12 ml) and morphine (2 mg) combined with dexmedetomidine (0.5 µg/kg) for surgical anesthesia, and epidural infusion of morphine (2 mg) and dexmedetomidine (200 µg) in 100 ml 0.2% ropivacaine at 2 ml/h for 48-h post-operative analgesia. The primary outcomes included blockade and analgesic effects, sedation and adverse reactions associated with the drugs. Neonatal outcome was also assessed by determining the Apgar score and umbilical cord blood analysis. There was no significant difference between the groups in the cephalad levels of sensory blockade at 20 min post-injection, or in muscle relaxation scores or pain intensity scores at rest or upon movement at 4, 12, 24 or 48 h post-injection (P>0.05). The maternal patients in the DM group experienced more complete motor blockade at 20 min post-injection, better sedation during surgery and following delivery, and less visceral pain caused by peritoneal traction during surgery and by uterine contraction after delivery, compared with those in group M (P<0.05). The patients in group M had a lower incidence and severity score of post-operative nausea than those in the DM group (P<0.05). There was no significant difference between the groups in terms of Apgar score or umbilical cord blood gas values (P>0.05). In conclusion, epidural dexmedetomidine reduces intra-operative and post-operative visceral pain and produces better sedation during surgery and following delivery, without any significant influence on morphine-associated side effects and post-operative analgesia, in females undergoing elective cesarean section under epidural anesthesia with morphine and ropivacaine (registration number ChiCTR1900027942; retrospectively registered with the Chinese Clinical Registry Center on December 6, 2019).
本研究的目的是评估硬膜外给予右美托咪定与吗啡联合用药，在剖宫产手术中提供麻醉以及在硬膜外罗哌卡因基础上用于剖宫产术后镇痛的有效性和安全性。总共80名足月择期剖宫产的女性被随机分为两组（每组n = 40）：吗啡组（M组），患者接受硬膜外注射0.75%罗哌卡因（12 ml）和吗啡（2 mg）用于手术麻醉，并在术后48小时以2 ml/h的速度硬膜外输注含吗啡（2 mg）的100 ml 0.2%罗哌卡因用于镇痛；吗啡联合右美托咪定组（DM组），患者接受硬膜外注射0.75%罗哌卡因（12 ml）、吗啡（2 mg）联合右美托咪定（0.5 µg/kg）用于手术麻醉，并在术后48小时以2 ml/h的速度硬膜外输注含吗啡（2 mg）和右美托咪定（200 µg）的100 ml 0.2%罗哌卡因用于镇痛。主要观察指标包括阻滞和镇痛效果、镇静情况以及与药物相关的不良反应。还通过测定阿氏评分和脐血分析来评估新生儿结局。两组在注射后20分钟时感觉阻滞的头侧水平、注射后4、12、24或48小时时静息或运动时的肌肉松弛评分或疼痛强度评分方面均无显著差异（P>0.05）。与M组相比，DM组的产妇在注射后20分钟时运动阻滞更完全，手术期间及分娩后镇静效果更好，手术期间腹膜牵拉及分娩后子宫收缩引起的内脏疼痛更少（P<0.05）。M组患者术后恶心的发生率和严重程度评分低于DM组（P<0.05）。两组在阿氏评分或脐血气值方面无显著差异（P>0.05）。总之，在硬膜外使用吗啡和罗哌卡因进行麻醉的择期剖宫产女性中，硬膜外给予右美托咪定可减轻术中及术后内脏疼痛，并在手术期间及分娩后产生更好的镇静效果，对吗啡相关的副作用及术后镇痛无显著影响（注册号ChiCTR1900027942；于2019年12月6日在中国临床注册中心进行回顾性注册）。
