超声引导下右美托咪定作为佐剂的罗哌卡因单次收肌管阻滞用于成人髌骨骨折术后镇痛的效果

鲁月; 邱昌明; 杨云丽; 黄治国; 李治贵; 麻伟青; 李娜

doi:10.12259/j.issn.2095-610X.S20220613

超声引导下右美托咪定作为佐剂的罗哌卡因单次收肌管阻滞用于成人髌骨骨折术后镇痛的效果

doi: 10.12259/j.issn.2095-610X.S20220613

鲁月^{1, 2},
邱昌明²,
杨云丽²,
黄治国²,
李治贵²,
麻伟青²,
李娜^2, ,

1.
昆明医科大学，云南昆明　650500
2.
联勤保障部队第九二○医院麻醉科，云南昆明　650100

基金项目: 云南省应用基础研究计划面上项目（2017FB112）；全军医学科技青年培育项目（13QNP064）

详细信息

作者简介:
鲁月（1997～），女，云南，在读硕士研究生，主要研究方向：围手术期急慢性疼痛的管理；邱昌明与鲁月对本文有同等贡献

通讯作者:
李娜，E-mail：lina_anesth@163.com

中图分类号: R614.3
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- 文章访问数: 4182
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- 被引次数: 19
出版历程
- 收稿日期: 2022-02-26
- 网络出版日期: 2022-06-07
- 刊出日期: 2022-06-30

Analgesia of Ultrasound-guided Single-dose Adductor Canal Block with Dexmedetomidine Combined with Ropivacaine after Patella Fracture Surgery in Adults

1.
Kunming Medical University，Kunming，Yunnan 650500
2.
Dept. of Anesthesiology，920th Hospital of Joint Logistics Support Force，Kunming Yunnan 650100，China

摘要

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。
- 收肌管阻滞 /
- 右美托咪定 /
- 罗哌卡因 /
- 髌骨骨折 /
- 镇痛 /
- 超声引导
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.
- 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
追加镇痛药	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
恶心、呕吐	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）
肢体异感	F	10	0	0	0	0	0	0
头痛	A	21	1（4.76）	1（4.76）	1（4.76）	0	0	0
头痛	F	10	0	0	0	0	0	0
其他	A	21	无	无	无	无	无	无
其他	F	10	无	无	无	脱管2例	无	无

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超声引导下右美托咪定作为佐剂的罗哌卡因单次收肌管阻滞用于成人髌骨骨折术后镇痛的效果

doi: 10.12259/j.issn.2095-610X.S20220613

作者简介:
鲁月（1997～），女，云南，在读硕士研究生，主要研究方向：围手术期急慢性疼痛的管理；邱昌明与鲁月对本文有同等贡献

通讯作者:
李娜，E-mail：lina_anesth@163.com

计量

Analgesia of Ultrasound-guided Single-dose Adductor Canal Block with Dexmedetomidine Combined with Ropivacaine after Patella Fracture Surgery in Adults

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[12]	刘旺生, 王金鸿, 黄欢. PCEA联合规律间断注入联合不同剂量罗哌卡因对产妇分娩镇痛效果及母婴结局的影响, 昆明医科大学学报.
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[14]	宋仕钦. 右美托咪定对老年手术患者氧合功能及心肺功能的影响, 昆明医科大学学报.
[15]	乔飞, 汪珺, 展希, 杨文燕. 超声引导下椎旁阻滞在开胸手术后镇痛的临床应用, 昆明医科大学学报.
[16]	张灿华, 钱金桥. 超声引导下外周神经阻滞麻醉对老年人下肢骨科术后功能恢复的影响, 昆明医科大学学报.
[17]	陈永伦. 椎旁神经阻滞复合全麻在胸科手术中的应用, 昆明医科大学学报.
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[19]	温开兰. 股神经阻滞自控镇痛在全膝关节置换术后镇痛中的应用, 昆明医科大学学报.
[20]	李翠林. 罗哌卡因或左布比卡因复合舒芬太尼用于分娩镇痛的临床比较, 昆明医科大学学报.

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超声引导下右美托咪定作为佐剂的罗哌卡因单次收肌管阻滞用于成人髌骨骨折术后镇痛的效果

doi: 10.12259/j.issn.2095-610X.S20220613

作者简介: 鲁月（1997～），女，云南，在读硕士研究生，主要研究方向：围手术期急慢性疼痛的管理；邱昌明与鲁月对本文有同等贡献

通讯作者: 李娜，E-mail：lina_anesth@163.com

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Analgesia of Ultrasound-guided Single-dose Adductor Canal Block with Dexmedetomidine Combined with Ropivacaine after Patella Fracture Surgery in Adults

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作者简介:
鲁月（1997～），女，云南，在读硕士研究生，主要研究方向：围手术期急慢性疼痛的管理；邱昌明与鲁月对本文有同等贡献

通讯作者:
李娜，E-mail：lina_anesth@163.com