不同剂量地塞米松用于超声引导下罗哌卡因髂筋膜阻滞的效果观察

doi:10.11958/20212860

天津医药 ›› 2022, Vol. 50 ›› Issue (8): 878-882.doi: 10.11958/20212860

不同剂量地塞米松用于超声引导下罗哌卡因髂筋膜阻滞的效果观察

王丹¹(), 赵丽霞¹, 彭雅琪¹, 原大江¹^,²^,^Δ()

1山西医科大学麻醉学院（邮编030012）
2山西医科大学第二医院重症医学科

收稿日期:2021-12-31 修回日期:2022-02-21 出版日期:2022-08-15 发布日期:2022-08-12
通讯作者: 原大江 E-mail:1019784728@qq.com;yuandajiang@sina.com
作者简介:王丹（1995）,女,硕士在读,主要从事麻醉与器官功能保护方面研究。E-mail： 1019784728@qq.com

Effects of different doses of dexamethasone on iliac fascia block of ropivacaine under ultrasound guidance

WANG Dan¹(), ZHAO Lixia¹, PENG Yaqi¹, YUAN Dajiang¹^,²^,^Δ()

1 School of Anesthesia, Shanxi Medical University, Taiyuan 030012, China
2 Department of Intensive Care Unit, the Second Hospital of Shanxi Medical University

Received:2021-12-31 Revised:2022-02-21 Published:2022-08-15 Online:2022-08-12
Contact: YUAN Dajiang E-mail:1019784728@qq.com;yuandajiang@sina.com

王丹, 赵丽霞, 彭雅琪, 原大江. 不同剂量地塞米松用于超声引导下罗哌卡因髂筋膜阻滞的效果观察[J]. 天津医药, 2022, 50(8): 878-882.

WANG Dan, ZHAO Lixia, PENG Yaqi, YUAN Dajiang. Effects of different doses of dexamethasone on iliac fascia block of ropivacaine under ultrasound guidance[J]. Tianjin Medical Journal, 2022, 50(8): 878-882.

摘要/Abstract

摘要：

目的探讨不同剂量地塞米松复合罗哌卡因髂筋膜间隙阻滞（FICB）对全髋关节置换术（THA）后的阻滞效果。方法根据随机数字表法将83例接受THA的患者分为观察组1（27例）、观察组2（28例）和对照组（28例）。所有患者均在超声引导下行FICB,观察组1、观察组2、对照组分别给予0.25%罗哌卡因100 mg复合地塞米松5 mg、10 mg、0 mg。记录手术持续时间及患者注入局麻药后（注药后）4、8、12、24、36、48 h静息和运动时视觉模拟评分（VAS）,注药后8、12、24、36、48 h股四头肌肌力评分,以及术后48 h内镇痛泵按压次数及补救镇痛次数。结果 3组患者手术持续时间及注药后4、8、48 h时静息与运动时VAS差异无统计学意义;注药后12、24、36 h时观察组1、观察组2静息与运动时VAS均低于对照组（P<0.05）,观察组1与观察组2静息与运动时VAS差异无统计学意义。3组患者注药后8、12、24、36、48 h时肌力1~5级评分构成差异无统计学意义。观察组1与观察组2术后48 h内镇痛泵按压2次及以上次数、补救镇痛1次及以上次数比例均低于对照组（P<0.05）,而观察组1与观察组2间差异无统计学意义。结论地塞米松5 mg与10 mg等效能地加强罗哌卡因FICB镇痛效果,并且不会增加股四头肌肌力抑制效应。

关键词: 地塞米松, 神经传导阻滞, 关节成形术,置换,髋, 罗哌卡因

Abstract:

Objective To investigate the blocking effects of different doses of dexamethasone combined with ropivacaine in iliac fascia space block (FICB) after total hip replacement (THA). Methods A total of 83 patients with THA were divided into the observation group 1 (n=27), the observation group 2 (n=28) and the control group (n=28) according to the random number table. All patients were performed FICB guided by ultrasound. The observation group 1, the observation group 2 and the control group were given 0.25% ropivacaine 100 mg combined with dexamethasone 5 mg, 10 mg and 0 mg, respectively. The duration of surgery and visual analog scale (VAS) scores at rest and exercise at 4, 8, 12, 24, 36 and 48 hours after local anesthetic injection were recorded. Quadriceps muscle strength scores at 8, 12, 24, 36, 48 hours after injection, analgesic pump pressing times and remedial analgesia times within 48 hours after injection were recorded. Results There were no significant differences in operation duration, VAS scores at 4, 8 and 48 hours between the three groups. At 12, 24 and 36 hours, the VAS scores during rest and exercise were significantly lower in the observation group 1 and the observation group 2 than those of the control group (P<0.05), and there were no significant differences in VAS scores during rest and exercise between the observation group 1 and the observation group 2. There were no significant differences in muscle strength grade 1-5 score composition at 8, 12, 24, 36 and 48 hours between the three groups. The ratio of 2 or more times of analgesic pump pressing and 1 or more times of remedial analgesia within 48 hours after operation were significantly lower in the observation group 1 and the observation group 2 compared with those of the control group (P<0.05), but there were no significant differences between the observation group 1 and the observation group 2. Conclusion The FICB analgesic effect of ropivacaine can be enhanced by dexamethasone 5 mg and 10 mg, but the inhibitory effect of quadriceps muscle strength is not increased.

Key words: Dexamethasone, nerve block, arthroplasty, replacement, hip, Ropivacaine

中图分类号:

R614.4

图/表 4

表1 3组患者的一般情况比较

Tab.1 Comparison of general conditions between the three groups

表2 3组患者VAS比较 ($\bar{x}±s$)

Tab.2 Comparison of VAS between the three groups of patients

表3 3组患者术后48 h内肌力1~5级评分构成差异比较 (例)

Tab.3 Comparison of muscle strength score 1-5 within 48 h after operation between the three groups of patients

表4 3组间镇痛泵按压及补救镇痛0~3次构成差异比较

Tab.4 Comparison the difference of analgesic pump pressing 0-3 times and remedial analgesia 0-3 times between the three groups of patients

参考文献 16

[1]	NEUPREZ A, NEUPREZ A H, KAUX J F, et al. Total joint replacement improves pain,functional quality of life,and health utilities in patients with late-stage knee and hip osteoarthritis for up to 5 years[J]. Clin Rheumatol, 2020, 39(3):861-871. doi: 10.1007/s10067-019-04811-y.
[2]	ZHAO J, DAVIS S P. An integrative review of multimodal pain management on patient recovery after total hip and knee arthroplasty[J]. Int J Nurs Stud, 2019, 98:94-106. doi: 10.1016/j.ijnurstu.2019.06.010.
[3]	BANG S, CHUNG J, JEONG J, et al. Efficacy of ultrasound-guided fascia iliaca compartment block after hip hemiarthroplasty:A prospective,randomized trial[J]. Medicine (Baltimore), 2016, 95(39):e5018. doi: 10.1097/MD.0000000000005018.
[4]	SONG Z G, PANG S Y, WANG G Y, et al. Comparison of postoperative analgesic effects in response to either dexamethasone or dexmedetomidine as local anesthetic adjuvants:A systematic review and meta-analysis of randomized controlled trials[J]. J Anesth, 2021, 35(2):270-287. doi: 10.1007/s00540-021-02895-y.
[5]	夏俊伟, 吴茜, 张霜, 等. 全髋关节置换术患者延迟出院的危险因素分析[J]. 临床麻醉学杂志, 2020, 36(4):354-358.
	XIA J W, WU Q, ZHANG S, et al. Risk factors for delayed hospital discharge in patients undergoing total hip joint replacement surgery[J]. J Clin Anesthesiol, 2020, 36(4):354-358. doi: 10.12089/jca.2020.04.010.
[6]	MEMTSOUDIS S G, COZOWICZ C, BEKERIS J, et al. Peripheral nerve block anesthesia/analgesia for patients undergoing primary hip and knee arthroplasty:recommendations from the International Consensus on Anesthesia-Related Outcomes after Surgery (ICAROS) group based on a systematic review and Meta-analysis of current literature[J]. Reg Anesth Pain Med, 2021, 46(11):971-985. doi: 10.1136/rapm-2021-102750.
[7]	VERMEYLEN K, DESMET M, LEYUNEN I, et al. Supra-inguinal injection for fascia iliaca compartment block results in more consistent spread towards the lumbar plexus than an infra-inguinal injection:A volunteer study[J]. Reg Anesth Pain Med, 2019, 44(4):483-491. doi: 10.1136/rapm-2018-100092.
[8]	BRAVO D, ALISTE J, LAYERA S, et al. A multicenter,randomized comparison between 2,5,and 8 mg of perineural dexamethasone for ultrasound-guided infraclavicular block[J]. Reg Anesth Pain Med, 2019, 44(1):46-51. doi: 10.1136/rapm-2018-000032.
[9]	MARTY P, BENNIS M, LEGAILLARD B, et al. A new step toward evidence of in vivo perineural dexamethasone safety:An animal study[J]. Reg Anesth Pain Med, 2018, 43(2):180-185. doi: 10.1097/AAP.0000000000000392.
[10]	PEHORA C, PEARSON A M, KAUSHAL A, et al. Dexamethasone as an adjuvant to peripheral nerve block[J]. Cochrane Database Syst Rev, 2017, 11(11):CD011770. doi: 10.1002/14651858.CD011770.
[11]	戴鹏, 王汉兵, 刘洪珍, 等. 超声引导下罗哌卡因复合地塞米松腰方肌阻滞对全髋关节置换术患者术后镇痛的影响[J]. 临床麻醉学杂志, 2021, 37(11):1134-1138.
	DAI P, WANG H B, LIU H Z, et al. Effect of ropivacaine combined with dexamethasone in ultrasound-guided quadratus lumborum block on postoperative analgesia in patients with total hip arthroplasty[J]. J Clin Anesthesiol, 2021, 37(11):1134-1138. doi: 10.12089/jca.2021.11.003.
[12]	MARHOFER P, COLUMB M, HOPKINS P M, et al. Dexamethasone as an adjuvant for peripheral nerve blockade:a randomised,triple-blinded crossover study in volunteers[J]. Br J Anaesth, 2019, 122(4):525-531. doi: 10.1016/j.bja.2019.01.004.
[13]	ALBRECHT E, REYNVOET M, FOURNIER N, et al. Dose-response relationship of perineural dexamethasone for interscalene brachial plexus block:a randomised,controlled,triple-blind trial[J]. Anaesthesia, 2019, 74(8):1001-1008. doi: 10.1111/anae.14650.
[14]	WOO J H, KIM Y J, KIM D Y, et al. Dose-dependency of dexamethasone on the analgesic effect of interscalene block for arthroscopic shoulder surgery using ropivacaine 0.5%:A randomised controlled trial[J]. Eur J Anaesthesiol, 2015, 32(9):650-655. doi: 10.1097/EJA.0000000000000213.
[15]	张大志, 王怀江, 刘永盛, 等. 不同剂量地塞米松对罗哌卡因神经阻滞作用的影响[J]. 临床麻醉学杂志, 2013, 29(3):213-215.
	ZHANG D Z, WANG H J, LIU Y S, et al. Effect of different doses of dexamethasone on action of ropivacaine[J]. J Clin Anesthesiol, 2013, 29(3):213-215.
[16]	LIU J, RICHMAN K A, GRODOFSKY S R, et al. Is there a dose response of dexamethasone as adjuvant for supraclavicular brachial plexus nerve block? A prospective randomized double-blinded clinical study[J]. J Clin Anesth, 2015, 27(3):237-242. doi: 10.1016/j.jclinane.2014.12.004.

不同剂量地塞米松用于超声引导下罗哌卡因髂筋膜阻滞的效果观察

Effects of different doses of dexamethasone on iliac fascia block of ropivacaine under ultrasound guidance

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