右美托咪定辅助竖脊肌平面阻滞在剖宫产术中的效果：一项随机对照研究。

Effect of Dexmedetomidine as an adjuvant in quadratus lumborum block in patient undergoing caesarean section - A randomised controlled study.

机构信息

Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Bhubaneswar 751019, Odisha, India.

出版信息

J Clin Anesth. 2022 Oct;81:110892. doi: 10.1016/j.jclinane.2022.110892. Epub 2022 Jun 4.

DOI:10.1016/j.jclinane.2022.110892

PMID:35671598

Abstract

STUDY OBJECTIVE

This study was conducted to evaluate the effect of Dexmedetomidine as an adjuvant in quadratus lumborum block (QLB) for postoperative pain relief at rest in patients undergoing caesarean section (CS). The primary objective was to compare the time to the first request of rescue analgesia. Secondary objectives were to compare the amount of rescue analgesia, patient satisfaction, Numeric rating scale (NRS), and Ramsay sedation score (RSS) during the first 24 h.

DESIGN

A randomised, double-blinded study.

SETTING

The study was conducted at AIIMS Bhubaneswar from December 2019 to February 2021in the Operating Theatre complex (for the immediate postoperative follow-up) and in the Obstetric Ward (for follow-up at the later time points).

PATIENTS

A total of 70 patients were enrolled with singleton term pregnancies scheduled for CS under spinal anaesthesia after written informed consent.

INTERVENTION

Bilateral QLB was given in the recovery area. Group A received 30 ml of 0.25% Bupivacaine and group B received 30 ml 0.25% bupivacaine with Dexmedetomidine 1 μg/kg. They received inj. Paracetamol 15 mg/kg intravenously TDS and Inj. Tramadol 1 mg/kg as rescue analgesia (if Numeric rating scale (NRS) Score ≥ 4). We also compared the rescue analgesia in the first 24 h, patient satisfaction scores, Ramsay sedation score (RSS), and NRS scores at 2, 4, 6, 8, 12, 18, and 24 h.

MAIN RESULTS

The time to request the first rescue analgesia was significantly prolonged in group B [Mean ± SD (95% CI)] 880 ± 351 (720-1040) min. vs group A 439 ± 208 (368-510) min., p < 0.001). There was a significant decrease in the amount of rescue analgesia [(Inj. Tramadol (1 mg/ kg)] used in the group with dexmedetomidine [group B Mean ± SD (95% CI) (57 ± 18 (49-65) mg. vs group A - 81 ± 25 (73-90)] mg., p < 0.001]. A significant difference was seen in patient satisfaction scores and pain scores between the groups up to 18 h. (p < 0.05) but not in RSS.

CONCLUSION

Dexmedetomidine can be considered an effective adjuvant for QLB in CS in the absence of intrathecal morphine.

摘要

研究目的

本研究旨在评估右美托咪定作为辅助药物在接受剖宫产术（CS）患者的竖脊肌阻滞（QLB）中对术后休息时缓解疼痛的效果。主要目的是比较首次需要抢救性镇痛的时间。次要目的是比较在 24 小时内需要抢救性镇痛的次数、患者满意度、数字评分量表（NRS）和 Ramsay 镇静评分（RSS）。

设计

随机、双盲研究。

地点

该研究于 2019 年 12 月至 2021 年 2 月在 AIIMS Bhubaneswar 的手术室（用于术后即刻随访）和产科病房（用于后续时间点的随访）进行。

患者

共纳入 70 名单胎足月妊娠患者，在脊髓麻醉下接受 CS，在知情同意后纳入研究。

干预措施

在恢复区进行双侧 QLB。A 组接受 30ml0.25%布比卡因，B 组接受 30ml0.25%布比卡因加右美托咪定 1μg/kg。他们接受静脉注射扑热息痛 15mg/kg，每日 3 次，曲马多 1mg/kg 作为抢救性镇痛（如果数字评分量表（NRS）评分≥4）。我们还比较了在 24 小时内需要抢救性镇痛的次数、患者满意度评分、Ramsay 镇静评分（RSS）和 NRS 评分在 2、4、6、8、12、18 和 24 小时的变化。

主要结果

B 组首次要求抢救性镇痛的时间明显延长[均数±标准差（95%CI）]880±351（720-1040）min. vs A 组 439±208（368-510）min，p<0.001）。使用右美托咪定的组中抢救性镇痛药物的用量[曲马多（1mg/kg）]显著减少[B 组均数±标准差（95%CI）（57±18（49-65）mg。vs A 组-81±25（73-90）mg]，p<0.001）。两组患者在 18 小时内的满意度评分和疼痛评分均有显著差异（p<0.05），但 RSS 无显著差异。