Yao Fei, Xu Shaojun, Zhang Wenjing, Xiong Huaping, Han Jinfeng, Zhu Aibing
Department of Anesthesiology, Wuxi Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Wuxi 214002, China.
Ann Palliat Med. 2020 Mar;9(2):447-450. doi: 10.21037/apm.2020.03.25.
To investigate the effectiveness and rationality of different administration modes of dexmedetomidine with 0.5% ropivacaine on intercostal nerve block.
In total, 150 patients aged from 20-45 years with a body mass index (BMI): 18.5-23.9 kg/m2, met the criteria from the American Society of Anesthesiologists (ASA) class: I-II, and underwent lumpectomy in our center were equally randomized into three groups using a table of random numbers. Group D1: perineural administration of dexmedetomidine 0.5 µg/kg + intercostal nerve block with 0.5% ropivacaine; group D2: intravenous infusion of dexmedetomidine0.5 µg/kg + intercostal nerve block with 0.5% ropivacaine; and group R: intercostal nerve block with 0.5% ropivacaine. The Numerical Rating Scale (NRS) of pain and the Ramsay Sedation Scale were used for assessing pain and sedation levels 4, 8, 12, and 24 hours after the operation. The total duration of analgesia, total requirement of rescue analgesia, and adverse reactions were recorded.
The NRS scores in groups D1 and D2 were significantly lower than that in group R, 8 hours after the operation (both P<0.05), and the NRS score in group D1 was significantly lower than in group D2 12 hours after the operation (P<0.05). The Ramsay scores showed no significant differences among all three groups at all time points after surgery. The duration of analgesia in group D1 was significantly longer than in group D2 (P<0.05). No rescue analgesia was needed in all three groups, and no adverse reactions such as dizziness, dry mouth, nausea, vomiting, and respiratory depression were reported.
The combinations of dexmedetomidine with ropivacaine for intercostal nerve blocking can prolong the duration of analgesia after lumpectomy; however, the duration of analgesia is longer via the perineural route than via the intravenous route.
探讨右美托咪定与0.5%罗哌卡因不同给药方式用于肋间神经阻滞的有效性及合理性。
选取150例年龄20 - 45岁、体重指数（BMI）为18.5 - 23.9 kg/m²、符合美国麻醉医师协会（ASA）分级标准Ⅰ - Ⅱ级且在本中心行肿块切除术的患者，采用随机数字表法将其均分为三组。D1组：神经周围注射右美托咪定0.5 μg/kg + 0.5%罗哌卡因肋间神经阻滞；D2组：静脉输注右美托咪定0.5 μg/kg + 0.5%罗哌卡因肋间神经阻滞；R组：0.5%罗哌卡因肋间神经阻滞。采用数字疼痛评分法（NRS）和Ramsay镇静评分法评估术后4、8、12及24小时的疼痛及镇静程度。记录镇痛总时长、补救性镇痛总需求量及不良反应。
术后8小时，D1组和D2组的NRS评分均显著低于R组（均P < 0.05）；术后12小时，D1组的NRS评分显著低于D2组（P < 0.05）。术后各时间点，三组的Ramsay评分均无显著差异。D1组的镇痛时长显著长于D2组（P < 0.05）。三组均无需补救性镇痛，且未报告头晕、口干、恶心、呕吐及呼吸抑制等不良反应。
右美托咪定与罗哌卡因联合用于肋间神经阻滞可延长肿块切除术后的镇痛时长；然而，神经周围给药途径的镇痛时长较静脉给药途径更长。
