地塞米松和右美托咪定作为局部麻醉混合剂的佐剂用于竖脊肌平面阻滞联合前锯肌平面阻滞的胸腔镜手术：一项前瞻性随机对照试验。

Dexamethasone and dexmedetomidine as adjuvants to local anesthetic mixture in erector spinae plane block combined with serratus anterior plane block for thoracoscopic surgery: a prospective, randomized controlled trial.

作者信息

Zhang Li, Xu Zhibiao, Liu Yuyun, Meng Yuxiang, Yuan Sumin, Ling Zijie, Li Ziwei, Liu Su, Zhang Hao, Zhao Linlin

机构信息

Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China.

Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.

出版信息

Minerva Anestesiol. 2025 Jun 23. doi: 10.23736/S0375-9393.25.18895-0.

DOI:10.23736/S0375-9393.25.18895-0

PMID:40548617

Abstract

BACKGROUND

We aimed to investigate the effect of dexamethasone and dexmedetomidine in erector spinae plane block combined with serratus anterior plane block for thoracoscopic postoperative analgesia.

METHODS

Ninety-six patients undergoing thoracoscopic surgery were randomly divided into group R (0.375% ropivacaine + saline diluted to 40 mL), group RS (0.375% ropivacaine + 10 mg dexamethasone + normal saline diluted to 40 mL), group RM (0.375% ropivacaine + 1 μg/kg dexmedetomidine + normal saline diluted to 40 mL), and group RSM (0.375% ropivacaine + 10 mg dexamethasone + 1 μg/kg dexmedetomidine + normal saline diluted to 40 mL). All four groups underwent ultrasound-guided erector spinae plane block combined with serratus anterior plane block within 30 minutes before anesthesia induction. The primary outcome was duration of effective analgesia, defined as the time from the onset of block to the first use of PCIA. Secondary outcomes included postoperative NRS scores, opioid consumption, rescue analgesia, quality of recovery, and adverse effects.

RESULTS

The duration of effective analgesia for group RSM (1770.0 [858.0] min) was significantly longer than group R (975.0 [471.5] min, P<0.001), group RS (1072.0 [695.0] min, P<0.05) and group RM (1340.0 [630.0] min, P<0.05). Group RSM also lowered postoperative pain scores, reduced opioid consumption and rescue analgesia, and improved quality of recovery compared with group R, group RS and group RM (all P<0.05). There was no significant difference in adverse effects, except that less nausea and vomiting were observed in group RSM (P<0.05).

CONCLUSIONS

Dexamethasone and dexmedetomidine as adjuvants to local anesthetic mixture in erector spinae plane block combined with serratus anterior plane block could prolong the duration of effective analgesia after thoracoscopic surgery.

摘要

背景

我们旨在研究地塞米松和右美托咪定在竖脊肌平面阻滞联合前锯肌平面阻滞用于胸腔镜术后镇痛中的效果。

方法

96例行胸腔镜手术的患者被随机分为R组（0.375%罗哌卡因+生理盐水稀释至40 mL）、RS组（0.375%罗哌卡因+10 mg地塞米松+生理盐水稀释至40 mL）、RM组（0.375%罗哌卡因+1 μg/kg右美托咪定+生理盐水稀释至40 mL）和RSM组（0.375%罗哌卡因+10 mg地塞米松+1 μg/kg右美托咪定+生理盐水稀释至40 mL）。所有四组在麻醉诱导前30分钟内均接受超声引导下竖脊肌平面阻滞联合前锯肌平面阻滞。主要结局为有效镇痛时间，定义为从阻滞开始至首次使用患者自控静脉镇痛（PCIA）的时间。次要结局包括术后数字评分法（NRS）评分、阿片类药物消耗量、补救性镇痛、恢复质量及不良反应。

结果

RSM组的有效镇痛时间（1770.0 [858.0]分钟）显著长于R组（975.0 [471.5]分钟，P<0.001）、RS组（1072.0 [695.0]分钟，P<0.05）和RM组（1340.0 [630.0]分钟，P<0.05）。与R组、RS组和RM组相比，RSM组还降低了术后疼痛评分，减少了阿片类药物消耗量和补救性镇痛，并改善了恢复质量（均P<0.05）。不良反应方面无显著差异，只是RSM组恶心和呕吐较少（P<0.05）。