Post Graduate Institute of Medical Education and Research (PGIMER), Department of Anaesthesia, Chandigarh, India.
Post Graduate Institute of Medical Education and Research (PGIMER), Department of Anaesthesia, Chandigarh, India.
Braz J Anesthesiol. 2021 Jul-Aug;71(4):358-366. doi: 10.1016/j.bjane.2021.02.018. Epub 2021 Feb 10.
Thoracic paravertebral block (TPVB) has emerged as an effective and feasible mode of providing analgesia in laparoscopic cholecystectomy. Though a variety of local anaesthetic combinations are used for providing TPVB, literature is sparse on use of dexmedetomidine in TPVB. We aimed to compare levobupivacaine and levobupivacaine-dexmedetomidine combination in ultrasound guided TPVB in patients undergoing laparoscopic cholecystectomy.
70 ASA I/II patients, aged 18-60 years, scheduled to undergo laparoscopic cholecystectomy under general anaesthesia were enrolled and divided into two groups. Before anaesthesia induction, group A patients received unilateral right sided ultrasound guided TPVB with 15 ml 0.25% levobupivacaine plus 2 ml normal saline while group B patients received unilateral right sided ultrasound guided TPVB with 15 ml 0.25% levobupivacaine plus 2 ml solution containing dexmedetomidine 1 μg.kg. Patients were monitored for pain using Numeric Rating Scale (NRS) at rest, on movement, coughing and comfort scores post surgery. Total analgesic consumption in first 48 hour postoperative period, time to first request analgesic and pain scores were recorded.
Total amount of rescue analgesia (injection tramadol plus injection tramadol intravenous equivalent dose) consumed during 48 hours postoperatively in group A was 146.55 mg while in group B was 111.30 mg (p = 0.026). Mean time for demanding rescue analgesia was 273 minutes in group A while in group B was 340 minutes (p = 0.00).
TPVB using dexmedetomidine 1 μg.kg added to levobupivacaine 0.25% in patients undergoing laparoscopic cholecystectomy significantly reduced total analgesic consumption in first 48 hours and provided longer duration of analgesia postoperatively compared to levobupivacaine 0.25% alone.
胸椎旁神经阻滞（TPVB）已成为腹腔镜胆囊切除术提供镇痛的一种有效且可行的方式。尽管有多种局部麻醉剂组合用于提供 TPVB，但关于 TPVB 中使用右美托咪定的文献很少。我们旨在比较超声引导下 TPVB 中使用左旋布比卡因与左旋布比卡因-右美托咪定组合在接受腹腔镜胆囊切除术的患者中的效果。
纳入 70 例 ASA I/II 级、年龄 18-60 岁的患者，计划在全身麻醉下接受腹腔镜胆囊切除术，将其分为两组。在麻醉诱导前，A 组患者接受单侧右侧超声引导下 TPVB，注入 15ml0.25%左旋布比卡因加 2ml 生理盐水；B 组患者接受单侧右侧超声引导下 TPVB，注入 15ml0.25%左旋布比卡因加 2ml 含有右美托咪定 1μg/kg 的溶液。患者在休息、运动、咳嗽和手术后舒适度方面使用数字评分量表（NRS）进行疼痛监测。记录术后 48 小时内的总镇痛药物消耗、首次要求镇痛的时间和疼痛评分。
A 组患者在术后 48 小时内消耗的总解救镇痛药物（注射曲马多加注射曲马多静脉等效剂量）量为 146.55mg，而 B 组为 111.30mg（p=0.026）。A 组要求解救镇痛的平均时间为 273 分钟，而 B 组为 340 分钟（p=0.00）。
与单独使用 0.25%左旋布比卡因相比，在接受腹腔镜胆囊切除术的患者中，将右美托咪定 1μg/kg 加入 0.25%左旋布比卡因中用于 TPVB 可显著减少术后 48 小时内的总镇痛药物消耗，并提供更长时间的术后镇痛。
