Krishna Boliwal, I. Kumari, Sandeep Savitaprakash Sharma, S. Ola, S. Choudhary, Vidhu Yadav
{"title":"右美托咪定辅助罗哌卡因在USG引导下竖脊肌平面阻滞改良乳房切除术中的疗效——前瞻性随机双盲对照研究","authors":"Krishna Boliwal, I. Kumari, Sandeep Savitaprakash Sharma, S. Ola, S. Choudhary, Vidhu Yadav","doi":"10.4103/theiaforum.theiaforum_2_23","DOIUrl":null,"url":null,"abstract":"Background and Aims: Modified radical mastectomy (MRM) is associated with considerable acute postoperative pain and even chronic persistent pain. Erector spinae plane block (ESPB) is interfascial block for thoracic analgesia. This study was planned to evaluate efficacy of dexmedetomidine as adjuvant with ropivacaine in ESPB for postoperative analgesia in MRM surgery. Materials and Methods: In this prospective randomized double-blind controlled study, 60 American Society of Anesthesiologists Grade I and II female patients, aged 18–60 years scheduled for MRM surgery under general anesthesia were randomly allocated into Group R and RD to receive ultrasound (USG)-guided ESPB with 20 ml 0.375% ropivacaine and 1 μg/kg dexmedetomidine added to 20 ml 0.375% ropivacaine, respectively. Visual Analog Score (VAS) was recorded at 0, 2, 4, 6, 8, 10, 12, and 24 h postoperatively. Duration of analgesia together with total number and amount of analgesic drug required was recorded in first 24 h postoperatively. Patient's satisfaction score was recorded on 10-point scale. Chi-square test, t-test, and Wilcoxon signed-rank test were applied where deemed appropriate. P <0.05 was considered statistically significant. Results: VAS score was less in Group RD at all measured time points postoperatively. Duration of analgesia was prolonged in Group RD (683.00 ± 83.99 min vs. 620.63 ± 70.42 min). Total number and amount of intravenous diclofenac (rescue analgesic) was lower in Group RD (1.13 ± 0.57 vs. 1.46 ± 0.57, 85.00 ± 42.85 vs. 110.00 ± 42.85). Patients in group RD were better satisfied with their anesthesia experience (8 [8–9] vs. 8 [7–8], P = 0.00194). Group RD demonstrated a lower heart rate, systolic blood pressure, diastolic blood pressure, and mean blood pressure intraoperatively. Conclusion: Dexmedetomidine as an adjuvant to ropivacaine in USG-guided ESPB for MRM surgery leads to lower postoperative pain scores, prolongs postoperative analgesia, reduces postoperative rescue analgesics requirements, and provides better hemodynamic stability and good patient satisfaction.","PeriodicalId":42359,"journal":{"name":"Indian Anaesthetists Forum","volume":"24 1","pages":"65 - 71"},"PeriodicalIF":0.2000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Efficacy of dexmedetomidine as an adjuvant with ropivacaine in USG guided erector spinae plane block for modified radical mastectomy surgery- prospective randomized double blind controlled study\",\"authors\":\"Krishna Boliwal, I. Kumari, Sandeep Savitaprakash Sharma, S. Ola, S. Choudhary, Vidhu Yadav\",\"doi\":\"10.4103/theiaforum.theiaforum_2_23\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background and Aims: Modified radical mastectomy (MRM) is associated with considerable acute postoperative pain and even chronic persistent pain. Erector spinae plane block (ESPB) is interfascial block for thoracic analgesia. This study was planned to evaluate efficacy of dexmedetomidine as adjuvant with ropivacaine in ESPB for postoperative analgesia in MRM surgery. Materials and Methods: In this prospective randomized double-blind controlled study, 60 American Society of Anesthesiologists Grade I and II female patients, aged 18–60 years scheduled for MRM surgery under general anesthesia were randomly allocated into Group R and RD to receive ultrasound (USG)-guided ESPB with 20 ml 0.375% ropivacaine and 1 μg/kg dexmedetomidine added to 20 ml 0.375% ropivacaine, respectively. Visual Analog Score (VAS) was recorded at 0, 2, 4, 6, 8, 10, 12, and 24 h postoperatively. Duration of analgesia together with total number and amount of analgesic drug required was recorded in first 24 h postoperatively. Patient's satisfaction score was recorded on 10-point scale. Chi-square test, t-test, and Wilcoxon signed-rank test were applied where deemed appropriate. P <0.05 was considered statistically significant. Results: VAS score was less in Group RD at all measured time points postoperatively. Duration of analgesia was prolonged in Group RD (683.00 ± 83.99 min vs. 620.63 ± 70.42 min). Total number and amount of intravenous diclofenac (rescue analgesic) was lower in Group RD (1.13 ± 0.57 vs. 1.46 ± 0.57, 85.00 ± 42.85 vs. 110.00 ± 42.85). Patients in group RD were better satisfied with their anesthesia experience (8 [8–9] vs. 8 [7–8], P = 0.00194). Group RD demonstrated a lower heart rate, systolic blood pressure, diastolic blood pressure, and mean blood pressure intraoperatively. Conclusion: Dexmedetomidine as an adjuvant to ropivacaine in USG-guided ESPB for MRM surgery leads to lower postoperative pain scores, prolongs postoperative analgesia, reduces postoperative rescue analgesics requirements, and provides better hemodynamic stability and good patient satisfaction.\",\"PeriodicalId\":42359,\"journal\":{\"name\":\"Indian Anaesthetists Forum\",\"volume\":\"24 1\",\"pages\":\"65 - 71\"},\"PeriodicalIF\":0.2000,\"publicationDate\":\"2023-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Indian Anaesthetists Forum\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.4103/theiaforum.theiaforum_2_23\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Indian Anaesthetists Forum","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4103/theiaforum.theiaforum_2_23","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景和目的:改良根治性乳房切除术(MRM)与相当大的术后急性疼痛甚至慢性持续疼痛有关。勃起棘平面阻滞(ESPB)是一种用于胸部镇痛的筋膜间阻滞。本研究旨在评估右美托咪定作为罗哌卡因辅助的ESPB在MRM手术术后镇痛中的疗效。材料和方法:在本前瞻性随机双盲对照研究中,将计划在全麻下进行MRM手术的18-60岁年龄组随机分为R组和RD组,分别接受超声(USG)引导的ESPB,其中20 ml 0.375%罗哌卡因和1μg/kg右美托咪定添加到20 ml 0.375%罗哌卡因中。术后0、2、4、6、8、10、12和24小时记录视觉模拟评分(VAS)。术后24小时记录镇痛持续时间以及所需镇痛药物的总数和用量。患者的满意度评分采用10分制进行记录。在适当的情况下采用卡方检验、t检验和Wilcoxon符号秩检验。P<0.05被认为具有统计学意义。结果:RD组术后各时间点VAS评分均较低。RD组镇痛时间延长(683.00±83.99分钟vs.620.63±70.42分钟)。RD组静脉注射双氯芬酸(抢救性镇痛药)的总数和量较低(1.13±0.57 vs.1.46±0.57,85.00±42.85 vs.110.00±42.85%)。RD组患者对自己的麻醉体验更满意(8[8-9]vs.8[7-8],P=0.00194),以及术中平均血压。结论:右美托咪定作为罗哌卡因的辅助药物,在USG引导下的ESPB用于MRM手术,可降低术后疼痛评分,延长术后镇痛时间,减少术后抢救性镇痛药的需求,并提供更好的血液动力学稳定性和良好的患者满意度。
Efficacy of dexmedetomidine as an adjuvant with ropivacaine in USG guided erector spinae plane block for modified radical mastectomy surgery- prospective randomized double blind controlled study
Background and Aims: Modified radical mastectomy (MRM) is associated with considerable acute postoperative pain and even chronic persistent pain. Erector spinae plane block (ESPB) is interfascial block for thoracic analgesia. This study was planned to evaluate efficacy of dexmedetomidine as adjuvant with ropivacaine in ESPB for postoperative analgesia in MRM surgery. Materials and Methods: In this prospective randomized double-blind controlled study, 60 American Society of Anesthesiologists Grade I and II female patients, aged 18–60 years scheduled for MRM surgery under general anesthesia were randomly allocated into Group R and RD to receive ultrasound (USG)-guided ESPB with 20 ml 0.375% ropivacaine and 1 μg/kg dexmedetomidine added to 20 ml 0.375% ropivacaine, respectively. Visual Analog Score (VAS) was recorded at 0, 2, 4, 6, 8, 10, 12, and 24 h postoperatively. Duration of analgesia together with total number and amount of analgesic drug required was recorded in first 24 h postoperatively. Patient's satisfaction score was recorded on 10-point scale. Chi-square test, t-test, and Wilcoxon signed-rank test were applied where deemed appropriate. P <0.05 was considered statistically significant. Results: VAS score was less in Group RD at all measured time points postoperatively. Duration of analgesia was prolonged in Group RD (683.00 ± 83.99 min vs. 620.63 ± 70.42 min). Total number and amount of intravenous diclofenac (rescue analgesic) was lower in Group RD (1.13 ± 0.57 vs. 1.46 ± 0.57, 85.00 ± 42.85 vs. 110.00 ± 42.85). Patients in group RD were better satisfied with their anesthesia experience (8 [8–9] vs. 8 [7–8], P = 0.00194). Group RD demonstrated a lower heart rate, systolic blood pressure, diastolic blood pressure, and mean blood pressure intraoperatively. Conclusion: Dexmedetomidine as an adjuvant to ropivacaine in USG-guided ESPB for MRM surgery leads to lower postoperative pain scores, prolongs postoperative analgesia, reduces postoperative rescue analgesics requirements, and provides better hemodynamic stability and good patient satisfaction.