超声引导下腹横肌平面阻滞中右美托咪定与芬太尼作为布比卡因佐剂的比较研究：一项前瞻性随机研究。
Comparative study of dexmedetomidine versus fentanyl as adjuvants to bupivacaine in ultrasound-guided transversus abdominis plane block in patients undergoing radical cystectomy: a prospective randomised study.
机构信息
Department of Anesthesiology, Surgical Intensive Care and Pain Management, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt.
出版信息
BMC Anesthesiol. 2022 Nov 7;22(1):340. doi: 10.1186/s12871-022-01877-1.
BACKGROUND
Transversus abdominis plane (TAP) block is beneficial for pain management after conducting abdominal surgery.
OBJECTIVE
To compare the outcomes of dexmedetomidine and fentanyl, as adjuvants to bupivacaine, for ultrasound-guided TAP block analgesia among patients undergoing radical cystectomy for postoperative pain management.
METHODS
This prospective, randomised, comparative study included a total of 60 patients, who underwent radical cystectomy. Participants were randomly divided into three categories with 20 subjects each; group B had patients who received a single shot US-guided TAP block on each side with 20 ml of 0.25% bupivacaine + 2 ml normal saline; group BF had patients who received a single shot US-guided TAP block on each side with 20 ml of 0.25% bupivacaine + 1 µg/kg fentanyl dissolved in 2 ml normal saline and group BD had patients who received a single shot US-guided TAP block on each side with 20 ml of 0.25% bupivacaine + 1 µg/kg dexmedetomidine dissolved in 2 ml normal saline.The researchers recorded the time taken for first rescue analgesia, total analgesic dose in the first 24 h after surgery, patient satisfaction, sedation score, and postoperative complications.
RESULTS
The time taken for first rescue analgesia was significantly lengthier in group (BD) (8.90 ± 2.47) than (BF) (6.50 ± 1.43) and (B) (4.40 ± 1.05) groups. The total nalbuphine consumption, during the first 24 h, was significantly lower in (BD) (0.15 ± 0.00) group compared to (BF) (0.20 ± 0.07) and (B) (0.24 ± 0.08) groups.
CONCLUSION
In comparison with fentanyl, as an adjuvant to bupivacaine, dexmedetomidine was found to be associated with prolonged postoperative analgesia, less postoperative pain scores and low opioid consumption.
TRIAL REGISTRATION
This study was registered at Clinical Trials.gov on 23 March 2020 (registration number: NCT04318158).
背景
腹横肌平面（TAP）阻滞有利于腹部手术后的疼痛管理。
目的
比较右美托咪定和芬太尼作为布比卡因佐剂用于超声引导 TAP 阻滞镇痛在根治性膀胱切除术患者中的效果，以用于术后疼痛管理。
方法
本前瞻性、随机对照研究纳入了 60 例接受根治性膀胱切除术的患者。参与者被随机分为三组，每组 20 例；B 组患者在每侧接受单次超声引导 TAP 阻滞，注射 20ml 0.25%布比卡因+2ml 生理盐水；BF 组患者在每侧接受单次超声引导 TAP 阻滞，注射 20ml 0.25%布比卡因+1µg/kg 芬太尼溶解于 2ml 生理盐水；BD 组患者在每侧接受单次超声引导 TAP 阻滞，注射 20ml 0.25%布比卡因+1µg/kg 右美托咪定溶解于 2ml 生理盐水。研究者记录首次解救镇痛的时间、术后 24 小时内的总镇痛剂量、患者满意度、镇静评分和术后并发症。
结果
BD 组（8.90±2.47）首次解救镇痛的时间明显长于 BF 组（6.50±1.43）和 B 组（4.40±1.05）。BD 组（0.15±0.00）在术后 24 小时内纳布啡的总消耗量明显低于 BF 组（0.20±0.07）和 B 组（0.24±0.08）。
结论
与布比卡因佐剂芬太尼相比，布比卡因佐剂右美托咪定与延长术后镇痛时间、降低术后疼痛评分和减少阿片类药物消耗相关。
试验注册
本研究于 2020 年 3 月 23 日在 ClinicalTrials.gov 注册（注册号：NCT04318158）。
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