Analgesia of Ultrasound-guided Single-dose Adductor Canal Block with Dexmedetomidine Combined with Ropivacaine after Patella Fracture Surgery in Adults
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摘要:
目的 对比超声引导下右美托咪定复合罗哌卡因的单次收肌管阻滞与单纯罗哌卡因的连续股神经阻滞在髌骨骨折手术术后镇痛的效果。 方法 择期全麻下髌骨骨折患者31例，年龄21～69岁，BMI≤35 kg/m2，ASA 分级Ⅰ级～Ⅲ级，随机分为2组， 100 μg右美复合0.25%罗哌卡因50 mg的单次收肌管组（A组，n = 21），单纯0.25%罗哌卡因250 mg的连续股神经阻滞组（F组，n = 10）。观察比较2组患者术后6、8、12、24、36、48 h的镇痛、镇静、肌力评分，记录术后追加镇痛和不良反应的发生情况。 结果 2组患者术后各个时间点的VAS、Raymay和Lovett评分比较无统计学差异（P > 0.05）。 结论 右美托咪定作为佐剂的罗哌卡因的单次收肌管阻滞可以为髌骨骨折提供良好的术后镇痛。 Abstract:Objective To compare the analgesic effect between ultrasound-guided single-dose adductor canal block with dexmedetomidine combined with ropivacaine and continuous femoral nerve block with ropivacaine after patella fracture surgery. Methods 31 patients with patella fractures who underwent elective general anesthesia, with age ranging from 21 to 69, BMI ≤ 35 kg/m2, ASA grading Ⅰ～Ⅲ, were randomly divided into two groups. Single-dose adductor canal block group who received 100 μg dexmedetomidine combined with 0.25% ropivacaine 50 mg （A group, n = 21）, and continuous femoral nerve block group who received 0.25% ropivacaine 250 mg （F group, n = 10）. The scores regarding analgesia, sedation, and muscle strength at 6, 8, 12, 24, 36 and 48 h after surgery were observed and compared between the two groups and the additional postoperative analgesia and adverse reactions were recorded. Results The analgesic effect, postoperative scores based on sedation and muscle strength were not statistically different between the two groups at various points during the observation period （P > 0.05）. Conclusion Single-dose adductor canal block with dexmedetomidine combined with ropivacaine can provide good analgesia after patella fracture surgery. -
Key words:
- Adductor canal nerve block /
- Dexmedetomidine /
- Ropivacaine /
- Patellar fracture /
- Analgesia /
- Ultralsound guidance
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表 1 2 组患者一般情况的比较（
$\bar x \pm s $ ）Table 1. Comparison of general conditions between two groups of patients （
$\bar x \pm s $ ）组别 n 男/女（n） 年龄（岁） ASAⅠ/Ⅱ/Ⅲ（n） BMI（kg/m2） A 21 10/11 41.9 ± 18.75 8/10/3 37.38 ± 5.54 F 10 5/5 46.6 ± 19.68 3/5/2 40.7 ± 4.52 t/卡方值 −0.64 0.47 −1.63 P 1.000 0.53 1.00 0.11 
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表 2 2组患者不同时间点VAS评分的比较 [ （
$ \bar x \pm s $ ），分]Table 2. Comparison of VAS scores between two groups at different time points [（
$ \bar x \pm s $ ），分]指标 组别 T1 T2 T3 VAS A 1.57 ± 2.27 1.38 ± 1.88 1.86 ± 2.31 F 0.7 ± 1.55 0.7 ± 1.55 1.00 ± 2.10 T4 T5 T6 A 2.24 ± 2.49 2.00 ± 1.95 2.00 ± 2.14 F 2.80 ± 2.89 2.20 ± 1.72 1.80 ± 1.08
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表 3 2组患者不同时间点镇静、肌力评分的比较[（
$ \bar x \pm s $ ），分]Table 3. Comparison of sedation, muscle strength scores between two groups at different time points [（
$ \bar x \pm s $ ），分]指标 组别 T1 T2 T3 Ramsay A 1.81 ± 0.40 1.90 ± 0.30 1.90 ± 0.30 F 1.90 ± 0.30 1.90 ± 0.30 1.80 ± 0.40 T4 T5 T6 A 1.95 ± 0.38 1.95 ± 0.22 2.00 ± 0.00 F 1.70 ± 0.46 2.00 ± 0.00 1.90 ± 0.30 T1 T2 T3 lovett A 1.81 ± 1.21 1.95 ± 1.20 2.00 ± 1.14 F 2.00 ± 0.63 2.10 ± 0.54 2.10 ± 0.54 T4 T5 T6 A 2.33 ± 1.02 2.24 ± 1.04 2.33 ± 1.11 F 2.20 ± 0.75 2.40 ± 0.66 2.40 ± 0.66
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表 4 2组患者术后各时间点的其他情况[n（%）]
Table 4. Other conditions of the two groups at each postoperative time points [n（%）]
事件 组别 n T1 T2 T3 T4 T5 T6 追加镇痛药 A 21 2（9.52） 0 2（9.52） 3（14.28） 0 0 F 10 2（20.00） 1（10.00） 2（20.00） 3（30.00） 2（20.00） 1（10.00） 恶心、呕吐 A 21 0 1（4.76） 1（4.76） 1（4.76） 2（9.52） 0 F 10 1（10.0） 1（10.00） 0 0 0 0 肢体异感 A 21 3（14.29） 3（14.29） 3（14.29） 4（19.05） 4（19.05） 4（19.05） F 10 0 0 0 0 0 0 头痛 A 21 1（4.76） 1（4.76） 1（4.76） 0 0 0 F 10 0 0 0 0 0 0 其他 A 21 无 无 无 无 无 无 F 10 无 无 无 脱管2例 无 无
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