Abdallah Maha Younis Youssef, Abdallah Mohamed Younes Yousef
Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Anesth Essays Res. 2022 Jan-Mar;16(1):154-159. doi: 10.4103/aer.aer_89_22. Epub 2022 Aug 9.
Severe postoperative pain is a major dilemma for patients undergoing abdominal aortic surgery. Transversus abdominis plane (TAP) block has been described a successful pain management technique after major abdominal surgery. Dexmedetomidine was proved to enhance the analgesic action of local anesthetics.
This study was aimed to assess the impact of adding dexmedetomidine to levobupivacaine during TAP block in patients undergoing abdominal aortic operations.
We included 114 patients in this prospective trial, and they were enrolled into two groups; the L group received levobupivacaine only, and the LD group received levobupivacaine plus dexmedetomidine. The block was performed before anesthetic induction. Postoperative pain score was our main outcome.
The collected data were tabulated and analyzed through the SPSS software program IBM's Statistical Package for the Social Sciences (SPSS) statistics for Windows (version 25, 2017) (IBM Corporation, Armonk, NY, USA). The categorical data were expressed as numbers and percentages and then compared using the Chi-square test. The continuous data were expressed as mean and standard deviation if normally distributed, or median and range if abnormally distributed. The former data were compared through the one-way ANOVA, while the latter were compared through the Kruskal-Wallis test. Any < 0.05 was considered statistically significant.
Group LD showed significantly earlier sensory blocks compared to the other group. Postoperative pain scores were comparable between the two groups for the initial 4 h following the surgery. Adjuvant dexmedetomidine was associated with better pain scores for the subsequent 12 h compared to Group L. The duration till the first analgesic request showed a significant increase in the LD group (13.3 vs. 11.09 h in Group L). In addition, the same group showed a significant decline in their opioid consumption after the operation (48.95 μg vs. 72.63 μg in the other group). Postoperative nausea and vomiting were significantly increased in Group L.
Adjuvant dexmedetomidine has a significant beneficial impact on postoperative analgesic profile. Its use as an adjuvant to peripheral and neuraxial nerve blocks should be recommended in pain management practice.
严重的术后疼痛是接受腹主动脉手术患者面临的主要难题。腹横肌平面（TAP）阻滞已被描述为腹部大手术后一种成功的疼痛管理技术。右美托咪定被证明可增强局部麻醉药的镇痛作用。
本研究旨在评估在接受腹主动脉手术的患者TAP阻滞期间，将右美托咪定添加到左旋布比卡因中的影响。
我们将114例患者纳入这项前瞻性试验，并将他们分为两组；L组仅接受左旋布比卡因，LD组接受左旋布比卡因加右美托咪定。阻滞在麻醉诱导前进行。术后疼痛评分是我们的主要观察指标。
收集的数据通过IBM社会科学统计软件包（SPSS）统计软件程序（适用于Windows的SPSS，版本25，2017）（美国纽约州阿蒙克市IBM公司）制成表格并进行分析。分类数据以数字和百分比表示，然后使用卡方检验进行比较。连续数据如果呈正态分布，则以均值和标准差表示，如果呈非正态分布，则以中位数和范围表示。前者的数据通过单因素方差分析进行比较，而后者通过Kruskal-Wallis检验进行比较。任何P<0.05被认为具有统计学意义。
与另一组相比，LD组的感觉阻滞明显更早出现。术后最初4小时内，两组的疼痛评分相当。与L组相比，辅助使用右美托咪定在随后12小时内的疼痛评分更好。直到首次要求使用镇痛药的时间在LD组显著延长（LD组为13.3小时，L组为11.09小时）。此外，同一组术后阿片类药物的消耗量显著下降（另一组为72.63μg，该组为48.95μg）。L组术后恶心和呕吐明显增加。
辅助使用右美托咪定对术后镇痛效果有显著的有益影响。在疼痛管理实践中，应推荐将其用作外周和神经轴索阻滞的辅助药物。
