右美托咪定作为术前超声引导下喉上神经内支阻滞辅助用药对双腔气管插管患者术后咽痛及血流动力学的影响：一项随机对照试验
Effects of Dexmedetomidine as an Adjuvant in Preoperative Ultrasound-Guided Internal Branch of Superior Laryngeal Nerve Block on Postoperative Sore Throat and Hemodynamics in Patients With Double-Lumen Endotracheal Intubation: A Randomized Controlled Trial.
作者信息
Chen Zheping, Zhang Le, Lu Guodong, Zhang Yizheng, Zhao Dexu, Zhao Shanshan, Zhang He, Jin Yuelong, Zhao Xin, Jin Yanwu
机构信息
Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Translational Research Institute of Brain and Brain-Like Intelligence, Clinical Research Center for Anesthesiology and Perioperative Medicine, Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, 200434, People's Republic of China.
Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People's Republic of China.
出版信息
J Pain Res. 2025 Jan 17;18:229-241. doi: 10.2147/JPR.S498538. eCollection 2025.
BACKGROUND
Postoperative sore throat (POST) is a significant adverse effect after endotracheal intubation, especially with double-lumen endotracheal tubes (DLTs). Ultrasound-guided internal branch of the superior laryngeal nerve block (US-guided iSLNB) presents a potential intervention for POST. In this first randomized controlled trial to date, we aimed to investigate the effects of US-guided iSLNB, with or without perineural dexmedetomidine, on the incidence and severity of POST following DLTs.
METHODS
A total of 159 patients were randomly assigned to three groups: control, bilateral US-guided iSLNB (2 mL 0.20% ropivacaine + 1 mL saline on each side), and bilateral US-guided iSLNB combined with perineural dexmedetomidine group (2 mL 0.20% ropivacaine + 1 mL 0.5 μg·kg dexmedetomidine on each side). The incidence and severity of POST, hemodynamic fluctuations during intubation and extubation, the incidence and severity of cough and agitation during extubation, and perioperative complications were assessed. The primary outcome was the incidence of POST at 6 h after surgery.
RESULTS
Compared with the control group, preoperative US-guided iSLNB significantly reduced the incidence and severity of POST at 1 and 6 h after surgery, mitigated the incidence and severity of cough during extubation, and attenuated hemodynamic responses, including heart rate, mean arterial pressure, and rate-pressure product during intubation, 1 min after intubation, and 1 min after extubation (all < 0.01). Compared with US-guided iSLNB alone, the combination of US-guided iSLNB with perineural dexmedetomidine reduced the incidence and severity of POST at 1, 6, and 12 h, as well as coughing during extubation (all < 0.01). However, it demonstrated little effect on hemodynamics (all > 0.05). No significant perioperative complications were observed in the three groups (all > 0.05).
CONCLUSION
Preoperative US-guided iSLNB combined with perineural dexmedetomidine effectively reduced the incidence, severity, and duration of POST and cough during extubation. No additional hemodynamic benefits were observed.
CLINICAL TRIAL REGISTRATION
Chinese Clinical Trial Registry (ChiCTR2200061001).
背景
术后咽痛（POST）是气管插管后的一种重要不良反应，尤其是使用双腔气管导管（DLT）时。超声引导下喉上神经内支阻滞（US-guided iSLNB）是一种针对POST的潜在干预措施。在这项迄今为止的首个随机对照试验中，我们旨在研究US-guided iSLNB联合或不联合神经周围右美托咪定对DLT术后POST的发生率和严重程度的影响。
方法
总共159例患者被随机分为三组：对照组、双侧US-guided iSLNB组（每侧2 mL 0.20%罗哌卡因+1 mL生理盐水）和双侧US-guided iSLNB联合神经周围右美托咪定组（每侧2 mL 0.20%罗哌卡因+1 mL 0.5 μg·kg右美托咪定）。评估POST的发生率和严重程度、插管和拔管期间的血流动力学波动、拔管期间咳嗽和躁动的发生率和严重程度以及围手术期并发症。主要结局是术后6小时POST的发生率。
结果
与对照组相比，术前US-guided iSLNB显著降低了术后1小时和6小时POST的发生率和严重程度，减轻了拔管期间咳嗽的发生率和严重程度，并减弱了血流动力学反应，包括插管期间、插管后1分钟和拔管后1分钟的心率、平均动脉压和率压乘积（均P<0.01）。与单独的US-guided iSLNB相比，US-guided iSLNB联合神经周围右美托咪定降低了术后1小时、6小时和12小时POST的发生率和严重程度以及拔管期间的咳嗽（均P<0.01）。然而，其对血流动力学影响不大（均P>0.05）。三组均未观察到明显的围手术期并发症（均P>0.05）。
结论
术前US-guided iSLNB联合神经周围右美托咪定可有效降低POST的发生率、严重程度和持续时间以及拔管期间的咳嗽。未观察到额外的血流动力学益处。
临床试验注册
中国临床试验注册中心（ChiCTR2200061001）
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