右美托咪定复合罗哌卡因后路腰方肌阻滞在剖宫产术后多模式镇痛中的应用

Application of dexmedetomidine combined with ropivacaine for posterior quadratus lumborum block in multimodal analgesia of cesarean section

关键词:  腰方肌阻滞  右美托咪定  剖宫产  术后镇痛

Key words:  quadratus lumborum block  dexmedetomidine  caesarean section  postoperative analgesia

摘要:

目的　探讨右美托咪定复合罗哌卡因后路腰方肌阻滞在剖宫产术后多模式镇痛中的作用。方法　选取2020年11月至2021年6月择期行剖宫产手术的患者120例随机分为三组，R组为0.25%罗哌卡因30 mL腰方肌阻滞组；D组为0.2 μg/kg右美托咪定+0.25%罗哌卡因30 mL腰方肌阻滞组；C组作为空白对照组。腰方肌阻滞于术后进行，所有患者接受统一多模式镇痛方案（PCIA+对乙酰氨基酚1 g Q6 h口服，布洛芬400 mg Q6 h口服，爆发性疼痛予肌注哌替啶补救）。记录三组术后2、4、6、8、12、24、48小时患者静息和运动疼痛数字评分(numeric rating scales，NRS)，布托啡诺总用量，哌替啶用量；恶心、呕吐，首次排气、哺乳、下床时间，患者镇痛满意度。结果　术后2、4、6、8、12小时静息及运动NRS评分C组显著高于R组和D组，差异有统计学意义(P＜0.05）。术后24、48小时静息及运动NRS评分C组和R组均显著高于D组，差异有统计学意义（P＜0.05）。术后PCIA按压次数和布托啡诺总用量C组显著高于R组和D组，差异有统计学意义(P＜0.05），R组显著高于D组，差异有统计学意义(P＜0.05）。首次下床时间和住院时间C组显著高于R组和D组，差异有统计学意义(P＜0.05）；满意度评分R组和D组均显著高于C组，差异有统计学意义(P＜0.05）。结论　后路腰方肌阻滞能明显改善剖宫产术后疼痛，右美托咪定复合罗哌卡因腰方肌阻滞，可以延长阻滞时间，在剖宫产术后多模式镇痛中发挥重要作用。

Abstract:

Objective　To study the effect of dexmedetomidine combined with ropivacaine for posterior quadratus lumborum block (QLB) in multimodal analgesia of cesarean section. 　Methods　A total of 120 patients with elective cesarean section in our hospital from November 2020 to June 2021 were selected and randomly divided into three groups: group R, 0.25% ropivacaine 30 mL, quadratus lumborum block; group D, 0.2 μg/kg dexmedetomidine+0.25% ropivacaine 30 mL quadratus lumborum block; group C, no block. The quadratus lumborum block was performed after surgery, and all patients received a unified multimodal analgesia regimen (PCIA+acetaminophen 1 g Q6 h orally, ibuprofen 400 mg Q6 h orally, and intramuscular pethidine was used to rescue the breakthrough pain). The numeric rating scales （NRS）pain score (resting and exercise), total dosage of butorphanol, pethidine dosage, nausea, vomiting, first gassing, breastfeeding, the time of getting out of bed and thes patient's satisfaction scores were recorded at 2,4,6,8,12,24, and 48 hours after operation. 　Results　The resting and exercise NRS scores of group C at 2,4,6,8,12 h after operation were significantly higher than those of group R and group D (P＜0.05), and the resting and exercise NRS scores of group C and group R at 24 h and 48 h after operation were significantly higher than those of group D(P＜0.05). Postoperative PCIA press times and total dosage of butorphanol in group C were significantly higher than those in group R and D (P＜0.05), and they were significantly higher in group R when compared to group D(P＜0.05). The time of first getting out of bed and hospital stay in group C were significantly higher than those in groups R and D (P＜0.05); the satisfaction scores in groups R and D were significantly higher than those in group C(P＜0.05). 　Conclusion　dexmedetomidine combined with ropivacaine posterior quadratus lumborum block can significantly improve analgesic effect after cesarean section, and plays an important role in multimodal analgesia after cesarean section.