Li Yue, Zhang Le, Jiao Jing, Yu Xinhua, Huang Shaoqiang
Department of Anesthesiology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN.
Clin J Pain. 2023 Feb 1;39(2):85-90. doi: 10.1097/AJP.0000000000001087.
The optimal dosage of dexmedetomidine (DEX) for postoperative analgesia of quadratus lumborum block (QLB) after laparoscopic myomectomy is not clear. Our study evaluated the analgesic and adverse effects of different doses of locally administered DEX.
Patients underwent laparoscopic myomectomy were enrolled in this randomized controlled trial. Transmuscular bilateral QLB was conducted postoperatively using local anesthetic plus different doses of DEX, as an adjuvant, per side. Numeric rating scales (NRS) of pain score and heart rate (HR) were assessed after performing QLB. Additional analgesics through patient-controlled analgesia pump, recovery time to first flatus, hospital stay, and other outcomes were also compared.
A total of 150 participants were randomly divided into 3 groups (DEX1 group: 0.1 μg/kg; DEX2 group: 0.3 μg/kg; DEX3 group: 0.5 μg/kg), 50 for each group. Compared with the DEX1 group, NRS pain scores were lower in groups DEX2 and DEX3 ( P <0.017) 20 minutes after QLB and the significance lasted for 24 hours. Patients in groups DEX2 and DEX3 needed fewer additional analgesics than the group DEX1 ( P <0.017). HR in groups DEX2 and DEX3 was lower than the group DEX1 10 minutes and 20 minutes after QLB, respectively ( P <0.017). Sixty minutes after QLB, HR in the DEX3 group was still lower than the other groups. More patients in the DEX3 group were found bradycardia. Satisfaction score of postoperative analgesia was higher in groups DEX2 and DEX3 than the DEX1 group ( P <0.017).
The results suggest that solution of DEX 0.3 μg/kg in ropivacaine 0.25% for QLB is recommended to relieve postoperative pain after laparoscopic myomectomy effectively and safely.
腹腔镜子宫肌瘤切除术后腰方肌阻滞（QLB）用于术后镇痛的右美托咪定（DEX）最佳剂量尚不清楚。本研究评估了不同剂量局部应用DEX的镇痛效果及不良反应。
本随机对照试验纳入接受腹腔镜子宫肌瘤切除术的患者。术后采用局部麻醉药加不同剂量DEX进行双侧经肌QLB，每侧作为辅助用药。进行QLB后评估疼痛评分和心率（HR）的数字评分量表（NRS）。还比较了通过患者自控镇痛泵追加的镇痛药、首次排气恢复时间、住院时间及其他结局。
共150名参与者被随机分为3组（DEX1组：0.1μg/kg；DEX2组：0.3μg/kg；DEX3组：0.5μg/kg），每组50人。与DEX1组相比，QLB后20分钟DEX2组和DEX3组的NRS疼痛评分更低（P<0.017），且这种差异持续24小时。DEX2组和DEX3组患者需要的追加镇痛药比DEX1组更少（P<0.017）。DEX2组和DEX3组的HR分别在QLB后10分钟和20分钟低于DEX1组（P<0.017）。QLB后60分钟，DEX3组的HR仍低于其他组。DEX3组发现更多患者出现心动过缓。DEX2组和DEX3组术后镇痛满意度评分高于DEX1组（P<0.017）。
结果表明，推荐在0.25%罗哌卡因中加入0.3μg/kg DEX用于QLB，以有效、安全地缓解腹腔镜子宫肌瘤切除术后的疼痛。
