右美托咪定作为高位胸椎竖脊肌平面阻滞辅助镇痛在肩关节镜手术中的作用：一项随机对照研究。

The role of dexmedetomidine as an adjuvant for high-thoracic erector spinae plane block for analgesia in shoulder arthroscopy; a randomized controlled study.

机构信息

Department of Anesthesiology, Faculty of Medicine, Fayoum University, Fayoum, 63511, Egypt.

Department of Orthopedics, Faculty of Medicine, Fayoum University, Faiyum, Egypt.

出版信息

BMC Anesthesiol. 2023 Feb 15;23(1):53. doi: 10.1186/s12871-023-02014-2.

DOI:10.1186/s12871-023-02014-2

PMID:36793000

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9930274/

Abstract

BACKGROUND

Management of postoperative pain after shoulder arthroscopy is an important issue. Dexmedetomidine, as an adjuvant, improves nerve block efficacy and decreases postoperative consumption of opioids. As a result, we designed this study to determine if adding dexmedetomidine to an erector spinae plane block (ESPB) that is guided by ultrasound (US) is beneficial for treating immediate postoperative pain following shoulder arthroscopy.

METHODS

This randomized controlled double-blind trial recruited 60 cases 18-65 years old of both sexes, American Society of Anesthesiologists (ASA) physical status I-II, scheduled for elective shoulder arthroscopy. Random allocation of 60 cases was done equally into two groups according to the solution injected in US-guided ESPB at T2 before general anesthetic induction. Group (ESPB): 20 ml 0.25% bupivacaine. Group (ESPB + DEX): 19 ml bupivacaine 0.25% + 1 mL dexmedetomidine 0.5 µg/kg. The primary outcome was The total rescue morphine consumption in the first 24 postoperative hours.

RESULTS

The mean intraoperative fentanyl consumption was significantly lower in the group (ESPB + DEX) compared to the group (ESPB) (82.86 ± 13.57 versus 100.74 ± 35.07, respectively, P = 0.015). The median (IQR) time of the 1 rescue analgesic request was significantly delayed in the group (ESPB + DEX) compared to group (ESPB) [18.5 (18.25-18.75) versus 12 (12-15.75), P = 0.044]. The number of cases that required morphine was significantly lower in the group (ESPB + DEX) than in the group (ESPB) (P = 0.012). The median (IQR) of total postoperative morphine consumption in 1 24 h was significantly lower in the group (ESPB + DEX) compared to the group (ESPB) [0 (0-0) versus 0 (0-3), P = 0.021].

CONCLUSION

The dexmedetomidine as an adjuvant to bupivacaine in ESPB produced adequate analgesia by reducing the intraoperative and postoperative opioid requirements in shoulder arthroscopy.

TRIAL REGISTRATION

This study is registered on ClinicalTrials.gov (NCT05165836; principal investigator: Mohammad Fouad Algyar; registration date: 21/12/ 2021).

摘要

背景

肩关节镜术后疼痛的管理是一个重要问题。右美托咪定作为一种辅助药物，可以提高神经阻滞效果，减少术后阿片类药物的消耗。因此，我们设计了这项研究，以确定在超声引导的竖脊肌平面阻滞（ESPB）中加入右美托咪定是否有助于治疗肩关节镜术后即刻疼痛。

方法

这是一项随机对照双盲试验，纳入了 60 例年龄在 18-65 岁之间、ASA 身体状况 I-II 级、择期行肩关节镜手术的患者。根据全身麻醉诱导前 T2 处超声引导的 ESPB 中注射的溶液，将 60 例患者随机分为两组。ESPB 组：20ml0.25%布比卡因；ESPB+DEX 组：19ml0.25%布比卡因+1ml 0.5μg/kg 右美托咪定。主要结局为术后 24 小时内总解救吗啡消耗量。

结果

与 ESPB 组相比，ESPB+DEX 组术中芬太尼用量显著降低（分别为 82.86±13.57 与 100.74±35.07，P=0.015）。ESPB+DEX 组需要 1 次解救镇痛的中位数（IQR）时间明显延迟（18.5（18.25-18.75）与 12（12-15.75），P=0.044）。需要吗啡的病例数在 ESPB+DEX 组明显低于 ESPB 组（P=0.012）。术后 24 小时内总吗啡消耗量的中位数（IQR）在 ESPB+DEX 组明显低于 ESPB 组（0（0-0）与 0（0-3），P=0.021）。