Dhanya A, Yadav Shilpi, Thomas Charls, Vardhan Vikram, Kabi Ankita, Sharma Ravi Shankar, Pipal Vibha Rani, Yadav Seema, Pipal Dharmendra K, Mohanty Aroop, Rath Rama Shankar, Bhalla Hira Lal, Vasudeva Abhimanyu
Fellow, Paediatric Anaesthesia, Wadia Hospital, Mumbai 400 012, India.
Associate Professor, MGM Institute of Medical Sciences, Kamothe 410209, Navi Mumbai, India.
Maedica (Bucur). 2024 Jun;19(2):283-291. doi: 10.26574/maedica.2024.19.2.283.
PECs blocks are usually combined for breast surgery under general anesthesia (GA) to provide postoperative analgesia rather than primary anesthesia technique.
A prospective, interventional, single-center, double-blind, randomized, parallel-group, active-controlled, Helsinki protocol-compliant clinical study was conducted in a tertiary care teaching center after obtaining the Ethics Committee's approval and patients' written informed consent. Forty-eight American Society of Anesthesiologists physical status I/II patients aged 18-60 years, undergoing elective unilateral breast surgery were enrolled. Patients were block-randomized (computer-generated) to two equal groups (24 patients each), with one of them receiving Dexmedetomidine and the other one Ketamine. For concealment, sequentially numbered, sealed, opaque envelopes were used. The study was double-blinded for both the anesthesiologist and outcome assessor anesthesiologist. Obese patients (body mass index > 30), those with infection at block site, coagulopathy and known hypersensitivity to local anesthetics or study medications as well as individuals who refused participation in research were all excluded. The Dexmedetomidine group received a bolus of 0.5 mcg/kg over ten minutes, followed by an infusion of 0.3 mcg/kg/hour, while the Ketamine group received a bolus of 0.5 mg/kg over ten minutes, followed by an infusion of 0.3 mg/kg/hour. Postoperative analgesia was compared using a visual analogue scale (VAS) at regular intervals. When VAS exceeded four, 1 mg/kg intravenous Pethidine was administered as a rescue analgesic.
Sub-anesthetic low-dose Ketamine was more effective than low-dose Dexmedetomidine in prolonging PECs block analgesia, which was statistically significant (p value < 0.001). The Ketamine group had lower rescue analgesic Pethidine consumption and longer first-rescue analgesia demand time. There was no significant hemodynamic difference between the study groups.
Ketamine was more efficient than Dexmedetomidine for postoperative analgesia.
胸肌间沟阻滞（PECs 阻滞）通常在全身麻醉（GA）下用于乳腺手术以提供术后镇痛，而非作为主要麻醉技术。
在一家三级护理教学中心进行了一项前瞻性、干预性、单中心、双盲、随机、平行组、活性对照、符合赫尔辛基协议的临床研究，研究获得了伦理委员会的批准以及患者的书面知情同意。纳入了 48 例年龄在 18 - 60 岁、美国麻醉医师协会身体状况分级为 I/II 级、接受择期单侧乳腺手术的患者。患者被区组随机（计算机生成）分为两组（每组 24 例），其中一组接受右美托咪定，另一组接受氯胺酮。为了隐藏分组信息，使用了按顺序编号、密封、不透明的信封。该研究对麻醉医生和结局评估麻醉医生均为双盲。肥胖患者（体重指数>30）、阻滞部位有感染的患者、凝血功能障碍患者、已知对局部麻醉药或研究药物过敏的患者以及拒绝参与研究的个体均被排除。右美托咪定组在 10 分钟内静脉注射负荷剂量 0.5 mcg/kg，随后以 0.3 mcg/kg/小时的速度输注，而氯胺酮组在 10 分钟内静脉注射负荷剂量 0.5 mg/kg，随后以 0.3 mg/kg/小时的速度输注。定期使用视觉模拟评分法（VAS）比较术后镇痛效果。当 VAS 超过 4 时，静脉注射 1 mg/kg 哌替啶作为补救镇痛药。
亚麻醉剂量的低剂量氯胺酮在延长 PECs 阻滞镇痛方面比低剂量右美托咪定更有效，差异具有统计学意义（p 值<0.001）。氯胺酮组的补救镇痛药哌替啶消耗量更低，首次补救镇痛需求时间更长。研究组之间的血流动力学无显著差异。
氯胺酮在术后镇痛方面比右美托咪定更有效。
