罗哌卡因联合右美托咪定用于超声引导下小儿腋路臂丛神经阻滞的随机对照研究。
Ropivacaine combined with dexmedetomidine in ultrasound-guided axillary brachial plexus block in children, a randomized controlled trial.
机构信息
Department of Anesthesiology, The Second Affiliated Hospital of Fujian Medical University, No.950 of Donghai Street, Fengze District, Quanzhou, 362000, China.
Department of Anesthesiology, Children's Hospital of Fudan University (Xiamen Branch), Xiamen Children's Hospital, No.92-98 of Yibin Road, Huli District, Xiamen, 361000, China.
出版信息
Eur J Med Res. 2024 Aug 13;29(1):416. doi: 10.1186/s40001-024-01997-z.
OBJECTIVE
In this study, we evaluated the efficacy and safety of 1 μg/kg dexmedetomidine as an adjuvant treatment to ropivacaine in children undergoing upper limb surgeries under ultrasound-guided axillary brachial plexus blocks and general anesthesia.
METHODS
We enrolled 90 children (aged 1-8 years; ASA I-II) undergoing closed reduction and internal fixation for upper extremity fractures at the Xiamen Children's Hospital and randomly assigned them to one of two groups: L (injection with 0.25% ropivacaine) or D (injection with 0.25% ropivacaine containing 1 μg/kg dexmedetomidine) using the random number table method. The main outcome indicators recorded were the facial expression, leg activity, position, crying, and Face, Legs, Activity, Cry, and Consolability (FLACC) scale scores of children after surgery and the duration of block and analgesia maintenance. The secondary outcome indicators were vital sign data at the time of ultrasound probe placement (T1), at the time of block completion (T2), prior to the beginning of surgery (T3), 5 min after the beginning of surgery (T4), and at the end of surgery (T5), as well as the time of postoperative recovery, the number of cases of remedial analgesia, and complications.
RESULTS
There was no statistical difference between the two groups in terms of general data, block completion time, postoperative recovery time, and complications (P > 0.05). Compared to the L group, the D group had significantly lower FLACC scores at 6 h after surgery, as well as significantly lower systolic blood pressure, diastolic blood pressure, and heart rate values at T4 and T5, and significantly longer duration of postoperative analgesia maintenance (all P < 0.05).
CONCLUSION
Dexmedetomidine (1 μg/kg) as a local anesthetic adjuvant to ropivacaine can alleviate pain at 6 h postoperatively, prolong analgesia maintenance, and reduce intraoperative blood pressure and heart rate in pediatric patients undergoing closed reduction and internal fixation for upper extremity fractures, with no obvious complications or delayed recovery.
CLINICAL REGISTRY NUMBER
Registration website: www.chictr.org.cn, Registration number: ChiCTR2200065163, Registration date: October, 30, 2022.
目的
本研究旨在评估 1μg/kg 右美托咪定作为辅助药物用于超声引导下腋路臂丛神经阻滞和全身麻醉下小儿上肢手术中罗哌卡因的有效性和安全性。
方法
本研究纳入了在厦门市儿童医院接受上肢骨折闭合复位内固定术的 90 例（年龄 1-8 岁；ASA I-II 级）患儿，采用随机数字表法将其分为 L 组（注射 0.25%罗哌卡因）或 D 组（注射 0.25%罗哌卡因+1μg/kg 右美托咪定）。主要观察指标为术后患儿的面部表情、腿部活动、体位、哭闹及面部、腿部、活动、哭泣、安慰（FLACC）评分，以及阻滞和镇痛维持时间。次要观察指标为超声探头放置时（T1）、阻滞完成时（T2）、手术开始前（T3）、手术开始后 5min（T4）、手术结束时（T5）的生命体征数据，以及术后恢复时间、补救性镇痛例数和并发症情况。
结果
两组患儿一般资料、阻滞完成时间、术后恢复时间及并发症比较，差异无统计学意义（P＞0.05）。与 L 组比较，D 组术后 6h 的 FLACC 评分更低，T4、T5 时的收缩压、舒张压和心率更低，术后镇痛维持时间更长（均 P＜0.05）。
结论
右美托咪定（1μg/kg）作为罗哌卡因的局部麻醉辅助药物，可减轻小儿上肢骨折闭合复位内固定术后 6h 的疼痛，延长镇痛维持时间，降低术中血压和心率，且无明显并发症或恢复延迟。
临床注册号
登记网站：www.chictr.org.cn，注册号：ChiCTR2200065163，登记日期：2022 年 10 月 30 日。
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