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,2025,(12):1175-1179.[doi:10.3760/cma.j.cn101785-202502016-015]
罗哌卡因联合右美托咪定胸椎旁神经阻滞对儿童漏斗胸Nuss手术后镇痛效果及康复的影响
- Title:
- 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
- 摘要:
- 目的 探讨罗哌卡因联合右美托咪定胸椎旁神经阻滞(thoracic paravertebral nerve block,TPVB)对儿童漏斗胸Nuss手术后镇痛效果及康复的影响。方法 本研究为前瞻性随机对照研究。以2020年7月至2024年10月于新疆维吾尔自治区儿童医院手术麻醉科接受Nuss手术的84例先天性漏斗胸患儿为研究对象,采用随机数字表法分为观察组(D组,n=42)和对照组(R组,n=42)。两组均行全身麻醉气管插管+超声引导下TPVB。D组注入0.3%罗哌卡因注射液20 mL+0.5 μg/kg右美托咪定溶液3 mL;R组注入0.3%罗哌卡因注射液20 mL+生理盐水3 mL。两组术后均使用自控静脉镇痛泵(patient-controlled intravenous analgesia,PCIA)镇痛。观察指标: ①手术置入钢板时心率(heart rate,HR)及平均动脉压(mean arterial pressure,MAP); ②术后6 h、12 h、24 h的数字评定量表(numerical rating scale,NRS)疼痛评分; ③术后48 h内PCIA有效按压次数及其他补救性镇痛措施; ④首次下床活动时间; ⑤住院天数及不良反应情况。结果 两组手术置入钢板时HR［89(81.00，99.25)次/分比92(86.75，104.25)次/分］及MAP比较［(63.69±5.00)mmHg比(65.40±5.20)mmHg］差异无统计学意义（P>0.05）；D组术后6 h、12 h静息［术后6 h：0(0，1)分比1(0，1)分；术后12 h：1(1，2)分比2(2，3)分］及运动时［术后6 h：2(1，2)分比2(2，3)分；术后12 h：2(2，3)分比3(2，4)分］NRS疼痛评分均低于R组，差异具有统计学意义（P<0.05）；两组术后24 h静息［3(3，4)分比3(3，4)分］和运动时［4(3，4)分比4(3，4)分］NRS疼痛评分差异无统计学意义（P>0.05）；D组术后48 h内PCIA有效按压次数［5(4，6)次比6(5，8)次］及补救性镇痛需求(19.0%比40.5%)少于R组，差异具有统计学意义（P<0.05）；D组首次下床活动时间早于R组［(24.17±2.90)h比(27.33±3.70)h］，差异具有统计学意义（P<0.05）；两组术后住院天数［5(4，5)d比5(4，5)d］、不良反应发生率［恶心、呕吐(16.7%比19.0%)、嗜睡(11.9%比4.8%)、心动过缓(14.3%比2.4%)］比较，差异均无统计学意义（P>0.05）。结论 罗哌卡因联合右美托咪定胸椎旁神经阻滞用于儿童漏斗胸Nuss手术可以更加有效地缓解漏斗胸手术后疼痛,减少术后镇痛药物的使用,且具有良好的安全性。
- 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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备注/Memo
收稿日期:2025-2-9。
通讯作者:朱钧,Email:paruh17@163.com