硫酸镁或右美托咪定复合罗哌卡因颈浅丛阻滞对人工耳蜗植入术后镇痛效果的比较

    Comparison of the analgesia effects between magnesium sulfate or dexmedetomidine combined with ropivacaine in superficial cervical plexus block after cochlear implantation

    • 摘要:
      目的评价硫酸镁或右美托咪定复合罗哌卡因颈浅丛神经阻滞对人工耳蜗植入术术后镇痛效果。
      方法择期行人工耳蜗植入术病人88例,根据数字表法随机分为3组,R组(29例):0.25%罗哌卡因13 mL+2 mL 0.9%氯化钠溶液行颈浅丛阻滞;RD组(29例):0.25%罗哌卡因13 mL+0.75 μg/kg右美托咪定稀释至2 mL颈浅丛阻滞;RM组(30例):0.25%罗哌卡因13 mL+4 mg/kg硫酸镁稀释至2 mL颈浅丛阻滞。3组均采用静吸复合全麻。记录3组病人术后1、6、12、18及24 h病人疼痛评分(VAS评分);拔管时苏醒期Ricker镇静-躁动评分;首次补救镇痛时间和补救镇痛药物用量;围术期相关不良反应发生情况及病人满意度评价。
      结果VAS评分方面,3组病人术后1 h、6 h和24 h各组间无差异;术后12 h RM组和RD组较R组低,术后18 h RD组较RM组和R组低,差异均有统计学意义(P < 0.05)。拔管时Ricker躁动评分,R组>RD组>RM组;首次镇痛所需时间,RD组和RM组均较R组延长;补充镇痛药量,R组>RD组>RM组;病人满意度评分,R组低于RD组和RM组,差异均有统计学意义(P < 0.05~P < 0.01)。术后3组呕吐率差异无统计学意义(P>0.05);心动过缓率RD组发生率高于R组和RM组,差异有统计学意义(P < 0.05)。
      结论硫酸镁和右美托咪定作为辅剂复合罗哌卡因超声引导下颈浅丛阻滞用于人工耳蜗手术病人都可延长术后镇痛时间,减少静脉镇痛药物使用,降低麻醉苏醒期躁动发生率,提高病人满意度,右美托咪定可能作用时间更久,但麻醉苏醒期躁动和术后心动过缓发生率较硫酸镁高。

       

      Abstract:
      ObjectiveTo evaluate the analgesia effects between magnesium sulfate or dexmedetomidine combined with ropivacaine in superficial cervical plexus block after cochlear implantation.
      MethodsEighty-eight patients scheduled by cochlear implantation were randomly divided into the group R(29 cases), group RD(29 cases) and group RM(30 cases) according to digital table
      method.The superficial cervical plexus block in group R was implemented using 13 mL of 0.25% ropivacaine combined with 2 mL of 0.9% sodium chloride solution, the superficial cervical plexus block in group RD was implemented using 13 mL of 0.25% ropivacaine combined with 0.75 mg/kg dexmedetomidine diluted to 2 mL, and the superficial cervical plexus block in group RM was implemented using 13 mL of 0.25% ropivacaine combined with 4 mg/kg magnesium sulfate diluted to 2 mL.Three groups were treated with static aspiration combined general anesthesia.The VAS scores in three groups after 1, 6, 12, 18 and 24 h of operation were recorded.The Ricker sedation-agitation score in the wake period during extubation, time of the first remedial analgesia, dosage of the remedial analgesia drugs, incidence rate of perioperative adverse reactions and satisfaction scores of patients among three groups were compared.
      ResultsThe differences of the VAS scores among three groups after 1, 6 and 24 h of operation were not statistically significant(P>0.05), the VAS scores in group RM and group RD after 12 h of operation were lower than those in group R, and the VAS score in group RD after 12 h of operation was lower than that in group RM and group R(P < 0.05).The Ricker sedation-agitation scores in group R, group RD and group RM during extubation gradually decreased, the time of the first remedial analgesia in group RD and group RM prolonged compared with group R, the dosage of the remedial analgesia drugs in group R, group RD and group RM gradually decreased, and the satisfaction score in group R was lower than that in group RD and group RM(P < 0.05 to P < 0.01).There was no statistical significance in the vomiting rate among three groups(P>0.05).The incidence rate of bradycardia in group RD was higher than that in group R and group RM(P < 0.05).
      ConclusionsBoth magnesium sulfate and dexmedetomidine combined with ropivacaine ultrasonic-guided superficial cervical plexus block can prolong the duration of postoperative analgesia, reduce the use of intravenous analgesia drugs and incidence rate of agitation during anaesthesia recovery, and improve satisfaction in patients treated with cochlear implantion.Compared with magnesium sulfate, the duration of postoperative analgesia is relatively long, and the agitationnd postoperative bradycardia rate are high in patients treated with dexmedetomidine.

       

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