Zhang Xuerong,Pairuhe·Paierhati,Xu Chenxie,et al.Effect of ropivacaine plus dexmedetomidine on thoracic paravertebral nerve block during postoperative analgesia and rehabilitation in children with pectus excavatum after Nuss surgery[J].Journal of Clinical Pediatric Surgery,,():1175-1179.[doi:10.3760/cma.j.cn101785-202502016-015]
Effect of ropivacaine plus dexmedetomidine on thoracic paravertebral nerve block during postoperative analgesia and rehabilitation in children with pectus excavatum after Nuss surgery
- Keywords:
- Funnel Chest; Thoracic Surgical Procedures; Ropivacaine; Dexmedetomidine; Anesthesia and Analgesia; Thoracic Paravertebral Nerve Block; Treatment Outcome; Rehabilitation
- Abstract:
- Objective To explore the analgesic effect of ropivacaine plus dexmedetomidine thoracic paravertebral nerve block (TPVB) during postoperative rehabilitation effect after Nuss surgery in children with pectus excavatum (PE). Methods From July 2020 to October 2024,84 children with congenital PE undergoing Nuss surgery were selected and randomized into two groups of observation (D,n=42) and control (R,n=42).Ultrasound-guided TPVB was performed after general anesthesia intubation in both groups.Group D was injected with 20 mL 0.3% ropivacaine+3 mL diluent containing 0.5 μg/kg adjuvant dexmedetomidine; group R was injected with 20 mL 0.3% ropivacaine+3 mL saline.A postoperative patient-controlled intravenous analgesia pump (patient-controlled intravenous analgesia,PCIA) was provided.Observation parameters included:a) heart rate (HR) and mean arterial pressure (MAP) during surgical plate placement; b) numerical Rating Scale (NRS) pain scores at 6/12/24h postoperatively; c) number of effective presses of patient-controlled intravenous analgesia (PCIA) pump and other rescue analgesic measures within 48h postoperatively; d) time to initial ambulation; e) length of hospital stay and adverse reactions. Results There was no statistically significant difference in HR ［89(81.00，99.25)/min vs.92(86.75，104.25)/min］ and MAP［ (63.69±5.00) mmHg vs.(65.40±5.20) mmHg］ between the two groups during surgical plate placement (P>0.05); Group D exhibited significantly lower NRS pain scores than Group R at 6 and 12 hours postoperatively during rest ［6 hours: 0(0，1) point vs.1(0，1) point; 12 hours: 1(1，2) point vs.2(2，3) points］ and during movement ［6 hours: 2(1，2) points vs.2(2，3) points; 12 hours: 2(2，3) points vs.3(2，4) points］ (P<0.05); There was no statistically significant difference in NRS pain scores between the two groups at 24 hours postoperatively during rest ［ 3(3，4) points vs.3(3，4) points］ and during activity ［4(3，4) points vs.4(3，4) points］ (P>0.05); Group D had fewer effective PCIA button presses ［5(4，6)times vs.6(5，8)times］ and lower demand for supplemental analgesia (19.0% vs.40.5%) within 48 hours postoperatively compared to Group R,with statistically significant differences (P<0.05); Group D achieved earlier first ambulation than Group R ［(24.17±2.90) h vs.(27.33±3.70) h］,with statistically significant differences (P<0.05); There were no statistically significant differences between the two groups in postoperative hospital stay ［5(4，5) days vs.5(4，5) days］ or incidence of adverse reactions ［nausea and vomiting (16.7% vs.19.0%),drowsiness (11.9% vs.4.8%),bradycardia (14.3% vs.2.4%)］ (P>0.05). Conclusions For PE children,combining ropivacaine and dexmedetomidine thoracic paravertebral nerve block during Nuss procedure may more effectively alleviate postoperative pain,lower the use of analgesic medications and demonstrate excellent safety.
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收稿日期:2025-2-9。
通讯作者:朱钧,Email:paruh17@163.com