Mahmoudi Kamran, Rashidi Mahboobeh, Soltani Farhad, Savaie Mohsen, Hedayati Ehsan, Rashidi Parisa
Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Anesth Pain Med. 2021 Nov 24;11(6):e118667. doi: 10.5812/aapm.118667. eCollection 2021 Dec.
Thoracotomy is one of the most painful surgeries, and failure to alleviate patients' pain can have dangerous consequences.
This study aimed to evaluate the addition of dexmedetomidine to ropivacaine in the intercostal block for postoperative pain control in patients undergoing thoracotomy.
In this randomized clinical trial, 74 patients aged 18 to 60 years with ASA class I or II, BMI less than 40, and no severe systemic problems referred to a teaching hospital in Ahvaz to undergo thoracotomy were included in the study and randomly divided into two groups. After surgery, an ultrasound-guided intercostal block was done with ropivacaine (5 cc of 0.25% solution; group R) or ropivacaine (5 cc of 0.25% solution) plus dexmedetomidine (0.5 µg/kg; group RD) per dermatome. Two dermatomes above and two dermatomes below the level of surgical incision were used. Pain, total opioid consumption, length of ICU stays, time to first rescue analgesic, and time to get out of bed were compared between the two groups.
The intercostal block significantly reduced pain in both groups (P < 0.0001). The pain was lower in the RD group than in the R group from six hours after the intervention up to 24 hours after (P < 0.001). The number of patients who needed rescue analgesia at 12 hours was significantly lower in the RD group (P < 0.05). The RD group also had lower total opioid consumption and a longer time to receive the first rescue analgesia (P < 0.01). There was no significant difference between the two groups in the length of hospitalization and the time to get out of bed.
Dexmedetomidine is an effective and safe choice to be used as an adjunct to ropivacaine in ICB, and it extends the duration of analgesia in combination with ropivacaine after thoracotomy.
开胸手术是最疼痛的手术之一，未能减轻患者疼痛可能会产生危险后果。
本研究旨在评估在开胸手术患者的肋间神经阻滞中，右美托咪定添加到罗哌卡因中对术后疼痛控制的效果。
在这项随机临床试验中，74例年龄在18至60岁、ASA分级为I或II级、BMI小于40且无严重全身问题的患者被转诊至阿瓦士的一家教学医院接受开胸手术，并随机分为两组。术后，在每个皮节用罗哌卡因（5毫升0.25%溶液；R组）或罗哌卡因（5毫升0.25%溶液）加右美托咪定（0.5微克/千克；RD组）进行超声引导下的肋间神经阻滞。使用手术切口水平上方两个皮节和下方两个皮节。比较两组之间的疼痛、总阿片类药物消耗量、ICU住院时间、首次使用解救镇痛药的时间和下床时间。
肋间神经阻滞在两组中均显著减轻了疼痛（P < 0.0001）。从干预后6小时至24小时，RD组的疼痛低于R组（P < 0.001）。RD组在12小时时需要解救镇痛药的患者数量显著低于R组（P < 0.05）。RD组的总阿片类药物消耗量也较低，且首次接受解救镇痛药的时间较长（P < 0.01）。两组在住院时间和下床时间方面无显著差异。
右美托咪定作为罗哌卡因在肋间神经阻滞中的辅助用药是一种有效且安全的选择，它与罗哌卡因联合使用可延长开胸手术后的镇痛时间。
