Department of Anesthesiology, Jiaozuo People's Hospital.
J Nippon Med Sch. 2022;89(4):399-404. doi: 10.1272/jnms.JNMS.2022_89-406.
Pain after colon cancer surgery can be effectively relieved by transversus abdominis plane (TAP) block. We aimed to determine the optimal dose of dexmedetomidine for preemptive analgesia when combined with TAP block after colon cancer surgery.
A total of 120 patients undergoing laparoscopic resection for colon cancer from March 2018 to October 2019 were randomly assigned to control (group C), low-dose (group L, 0.5 μg/kg), moderate-dose (group M, 1 μg/kg), and high-dose groups (group H, 1.5 μg/kg) (n=30 each). After puncture under ultrasound guidance, the designated dexmedetomidine dose and 0.25% ropivacaine were injected on both sides (20 mL each side). Mean arterial pressure (MAP), heart rate (HR), numeric rating scale (NRS) score, and Ramsay score were compared at 2 h (T0), 4 h (T1), 8 h (T2), 12 h (T3), 24 h (T4), and 48 h (T5) after surgery. The area sensitive to mechanical stimulation-induced pain at the incision was measured at T4, T5, and 72 h after surgery (T6). Adverse reactions were compared.
MAP and HR were lower in the dexmedetomidine groups, especially groups M and H, than in group C (P<0.05). NRS scores at T0-T5 and pain-sensitive areas at T4-T6 were lower in the dexmedetomidine groups than in group C (P<0.05), but Ramsay scores were similar (P>0.05). Compared with group L, groups M and H had lower NRS scores and pain-sensitive areas (P<0.05). The incidence rates of adverse reactions were lower in the dexmedetomidine groups than in group C (P<0.05).
Dexmedetomidine 1 or 1.5 μg/kg is effective and did not increase adverse reactions. A dose of 1 μg/kg is recommended as an adjuvant to ropivacaine for TAP block.
腹横肌平面（TAP）阻滞可有效缓解结肠癌手术后的疼痛。我们旨在确定结肠癌手术后 TAP 阻滞时与右美托咪定联合使用的最佳预激剂量。
2018 年 3 月至 2019 年 10 月，120 例行腹腔镜结直肠癌切除术的患者被随机分为对照组（C 组）、低剂量组（L 组，0.5μg/kg）、中剂量组（M 组，1μg/kg）和高剂量组（H 组，1.5μg/kg）（每组 30 例）。在超声引导下穿刺后，在两侧（每侧 20ml）注射指定剂量的右美托咪定和 0.25%罗哌卡因。比较术后 2 小时（T0）、4 小时（T1）、8 小时（T2）、12 小时（T3）、24 小时（T4）和 48 小时（T5）的平均动脉压（MAP）、心率（HR）、数字评分量表（NRS）评分和 Ramsay 评分。术后 4 小时（T4）、5 小时（T5）和 72 小时（T6）测量切口机械刺激诱导疼痛的敏感区域。比较不良反应。
与 C 组相比，右美托咪定组，尤其是 M 组和 H 组的 MAP 和 HR 较低（P<0.05）。与 C 组相比，右美托咪定组 T0-T5 的 NRS 评分和 T4-T6 的疼痛敏感区域较低（P<0.05），但 Ramsay 评分相似（P>0.05）。与 L 组相比，M 组和 H 组的 NRS 评分和疼痛敏感区域较低（P<0.05）。与 C 组相比，右美托咪定组不良反应发生率较低（P<0.05）。
右美托咪定 1 或 1.5μg/kg 有效，且不增加不良反应。推荐 1μg/kg 剂量作为罗哌卡因 TAP 阻滞的辅助用药。
