罗哌卡因复合地塞米松或右美托咪定对肋锁间隙臂丛神经阻滞患者反弹性疼痛的影响

Effect of ropivcaine combined with dexamethasone or dexmedetomidine on rebound pain in patients undergoing costoclavicular brachial plexus block

中文关键词: 反弹性疼痛  肋锁间隙臂丛神经阻滞  上肢手术  右美托咪定  地塞米松

英文关键词: Rebound pain  Costoclavicular brachial plexus block  Upper extremity surgery  Dexmedetomidine  Dexamethasone

中文摘要:

      
目的：比较单次注射0.5%罗哌卡因复合地塞米松或右美托咪定对肋锁间隙臂丛神经阻滞（CCB）患者反弹性疼痛（RP）的影响。
方法：选择行上肢骨折切开复位内固定术的患者223例，男103例，女120例，年龄18～64岁，BMI 18.5～30.0 kg/m²，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为两组：0.5%罗哌卡因复合地塞米松8 mg组（D1组，n=113）和0.5%罗哌卡因复合右美托咪定1 μg/kg组（D2组，n=110）。记录术后48 h内RP发生情况，两组RP发生率等效界值设为15%。记录感觉和运动阻滞起效和持续时间、镇痛持续时间以及不良反应发生情况。记录术后24 h 15项恢复质量（QoR-15）评分。
结果：术后48 h内两组RP发生率差异无统计学意义。D2组与D1组术后48 h内RP发生率差值为4.1%,95%可信区间（CI）为-6.2%～14.4%，在等效区间内。两组RP发生时间差异无统计学意义。与D1组比较，D2组感觉和运动阻滞起效时间、镇痛持续时间明显缩短（P<0.05），心动过缓发生率明显升高（P<0.05）。两组QoR-15评分差异无统计学意义。
结论：单次注射0.5%罗哌卡因复合地塞米松8 mg或右美托咪定1 μg/kg在降低CCB患者的RP发生方面效果相似，而复合右美托咪定可以明显缩短神经阻滞起效时间。

英文摘要:

      
Objective: To compare the effect of a single injection of 0.5% ropivacaine combined with dexamethasone or dexmedetomidine on rebound pain (RP) in patients undergoing costoclavicular brachial plexus block (CCB).
Methods: A total of 223 patients, 103 males and 120 females, aged 18-64 years, BMI 18.5-30.0 kg/m², ASA physical status Ⅰ or Ⅱ, undergoing open reduction and internal fixation of upper limb fractures, were randomly divided into two groups: 0.5% ropivacaine combined with dexamethasone 8 mg (group D1, n = 113), and 0.5% ropivacaine combined with dexmedetomidine 1 μg/kg (group D2, n = 110). The occurrence of RP within 48 hours after surgery was recorded, and the equivalence margin for the incidence of RP in the two groups was set at 15%. The onset and duration of sensory and motor block, the duration of analgesia, and the occurrence of adverse reactions were recorded. The 15-item quality of recovery (QoR-15) scores was recorded 24 hours after surgery.
Results: There was no significant difference in the incidence of RP between the two groups 48 hours after surgery. The difference in the incidence rate of RP between group D2 and group D1 within 48 hours after surgery was 4.1%, with a 95% confidence interval (CI) of -6.2% to 14.4%, within the equivalence interval. There was no significant difference in the occurrence time of RP between the two groups. Compared with group D1, the onset of sensory and motor block, the duration of analgesia was significantly shorter in group D2 (P < 0.05), and the incidence of bradycardia was significantly increased in group D2 (P < 0.05). There was no significant difference in QoR-15 score between the two groups.
Conclusion: Single injection of ropivacaine combined with dexamethasone 8 mg or dexmedetomidine 1 μg/kg are similar to reduce the incidence of RP in patients undergoing CCB, but dexmedetomidine can significantly shorten the onset time of nerve block.