Alimian Mahzad, Imani Farnad, Rahimzadeh Poupak, Faiz Seyed Hamid Reza, Bahari-Sejahrood Leila, C Hertling Arthur
Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran.
Department of Anesthesiology, Perioperative Care, and Pain Medicine, New York University School of Medicine, NY, USA.
Anesth Pain Med. 2021 Dec 8;11(6):e120787. doi: 10.5812/aapm.120787. eCollection 2021 Dec.
Paravertebral blocks are one of the possible postoperative pain management modalities after laparotomy. Adjuvants to local anesthetics, including alpha agonists, have been shown to lead to better pain relief and increased duration of analgesia.
The aim of this study is to examine the effect of adding dexmedetomidine to bupivacaine for ultrasound-guided paravertebral blocks in laparotomy.
In this double-blind, randomized controlled trial (RCT), we enrolled 42 patients scheduled for T6 to T8 thoracic paravertebral block (TPVB) for analgesia after laparotomy. The patients were randomly assigned into two groups of BD (bupivacaine 2.5 mg/mL 20 mL plus dexmedetomidine 100 µg) and B (bupivacaine 20 mL alone). Following surgery, intravenous fentanyl patient-controlled analgesia was initiated. The numerical rating scale (NRS) for pain, sedation score, total analgesic consumption, time to first analgesic requirement, side effects (such as nausea and vomiting), respiratory depression, and patients' satisfaction during the first 48 hours of evaluation were compared in the two groups.
Pain scores and mean total analgesic consumption at the first 48 hours in the BD group were significantly lower than Group B (P = 0.03 and P < 0.001, respectively). The time of first analgesic request was significantly longer in BD group (P < 0.001). Sedation scores and side effects did not differ significantly between the two groups.
Adding dexmedetomidine to bupivacaine for TPVB after laparotomy yielded better postoperative pain management without significant complications.
椎旁阻滞是剖腹手术后可能的术后疼痛管理方式之一。已证实，包括α激动剂在内的局部麻醉辅助剂可带来更好的疼痛缓解效果，并延长镇痛时间。
本研究旨在探讨在布比卡因中添加右美托咪定用于剖腹手术超声引导下椎旁阻滞的效果。
在这项双盲、随机对照试验（RCT）中，我们纳入了42例计划接受T6至T8胸椎椎旁阻滞（TPVB）以进行剖腹手术后镇痛的患者。患者被随机分为两组，即BD组（2.5 mg/mL布比卡因20 mL加右美托咪定100 μg）和B组（仅20 mL布比卡因）。手术后，开始静脉注射芬太尼患者自控镇痛。比较两组在评估的前48小时内的疼痛数字评分量表（NRS）、镇静评分、总镇痛药物消耗量、首次需要镇痛的时间、副作用（如恶心和呕吐）、呼吸抑制以及患者满意度。
BD组在最初48小时的疼痛评分和平均总镇痛药物消耗量显著低于B组（分别为P = 0.03和P < 0.001）。BD组首次需要镇痛的时间显著更长（P < 0.001）。两组之间的镇静评分和副作用没有显著差异。
剖腹手术后在布比卡因中添加右美托咪定用于TPVB可实现更好的术后疼痛管理，且无明显并发症。
