比较在腹腔镜胆囊切除术中，在腹横肌平面阻滞中布比卡因添加右美托咪定与地塞米松对术后疼痛强度的影响。
Comparison of the Effect of Adding Dexmedetomidine Versus Dexamethasone to Bupivacaine in Transverse Abdominis Plane Block on Postoperative Pain Intensity in Patients Undergoing Laparoscopic Cholecystectomy.
作者信息
Zamani Kiasari Alieh, Razavi Ramin, Sobhani Samira, Shirvani Ghadikolaee Negar, Mousavi Khorshidi Nasimalsadat, Shabankhani Keihan, Faghani-Makrani Nafiseh
机构信息
Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
Department of Anesthesiology, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran.
出版信息
Anesth Pain Med. 2025 Jul 15;15(4):e162462. doi: 10.5812/aapm-162462. eCollection 2025 Aug 31.
BACKGROUND
Laparoscopic cholecystectomy, compared to open surgery, offers advantages such as lower pain levels and shorter hospitalization. However, postoperative pain remains a common challenge. Inadequate pain control may lead to discomfort, reduced mobility, and prolonged hospitalization. This study aimed to compare the effect of adding dexmedetomidine versus dexamethasone to bupivacaine in transverse abdominis plane (TAP) block on postoperative pain intensity in patients undergoing laparoscopic cholecystectomy.
OBJECTIVES
The present study aimed to compare the efficacy of dexmedetomidine and dexamethasone as adjuvants to bupivacaine in ultrasound-guided TAP blocks for laparoscopic cholecystectomy. Primary outcomes included sensory block duration, postoperative pain scores, 24-hour morphine consumption, and time to rescue analgesia. Secondary outcomes included sedation levels, hemodynamic stability, and incidence of adverse events.
METHODS
This randomized, double-blind, controlled clinical trial included 120 ASA I-II patients aged 18 - 65 years, allocated into three groups: Bupivacaine alone, dexamethasone + bupivacaine, and dexmedetomidine + bupivacaine. Pain intensity, morphine consumption, time to first analgesia, block characteristics, hospital stay, and complications were evaluated.
RESULTS
The addition of dexmedetomidine or dexamethasone to bupivacaine in ultrasound-guided TAP blocks significantly improved postoperative outcomes. Compared to the control group (bupivacaine alone), both adjuvants reduced pain intensity (VAS scores, P < 0.001) and 24-hour morphine consumption (P < 0.001), with dexmedetomidine demonstrating superior efficacy. Sensory block duration was prolonged in the dexmedetomidine (330 minutes) and dexamethasone (180 minutes) groups versus control (155 minutes; P < 0.001). Hospital stays were shortest in the dexmedetomidine group (1 day vs. 2.5 days control; P < 0.001).
CONCLUSIONS
Adding dexmedetomidine or dexamethasone to bupivacaine in TAP block enhances analgesia and shortens hospital stay following laparoscopic cholecystectomy.
背景
与开放手术相比，腹腔镜胆囊切除术具有疼痛程度较低和住院时间较短等优势。然而，术后疼痛仍然是一个常见的挑战。疼痛控制不佳可能导致不适、活动减少和住院时间延长。本研究旨在比较在腹腔镜胆囊切除术患者的腹横肌平面（TAP）阻滞中，在布比卡因中添加右美托咪定与地塞米松对术后疼痛强度的影响。
目的
本研究旨在比较右美托咪定和地塞米松作为布比卡因辅助剂在超声引导下TAP阻滞用于腹腔镜胆囊切除术的疗效。主要结局包括感觉阻滞持续时间、术后疼痛评分、24小时吗啡消耗量和补救镇痛时间。次要结局包括镇静水平、血流动力学稳定性和不良事件发生率。
方法
这项随机、双盲、对照临床试验纳入了120例年龄在18至65岁的ASA I-II级患者，分为三组：单纯布比卡因组、地塞米松+布比卡因组和右美托咪定+布比卡因组。评估疼痛强度、吗啡消耗量、首次镇痛时间、阻滞特征、住院时间和并发症。
结果
在超声引导下的TAP阻滞中，在布比卡因中添加右美托咪定或地塞米松可显著改善术后结局。与对照组（单纯布比卡因）相比，两种辅助剂均降低了疼痛强度（视觉模拟评分，P<0.001）和24小时吗啡消耗量（P<0.001），右美托咪定显示出更好的疗效。右美托咪定组（330分钟）和地塞米松组（180分钟）的感觉阻滞持续时间比对照组（155分钟）延长（P<0.001）。右美托咪定组的住院时间最短（1天 vs. 对照组2.5天；P<0.001）。
结论
在TAP阻滞中，在布比卡因中添加右美托咪定或地塞米松可增强镇痛效果并缩短腹腔镜胆囊切除术后的住院时间。
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