METHODS: Randomized controlled trial.
METHODS: The preoperative area, operating room, postanesthesia recovery room and bed ward.
METHODS: A total of 312 adult patients (104 per group) with gastric cancer were included.
METHODS: Patients received bilateral subcostal TAP block with three different anesthetics (60 ml 0.25% ropivacaine added with 10 mg dexamethasone and 1 μg·kg-1 dexmedetomidine [A] or 10 mg dexamethasone [B] or 1 μg·kg-1 dexmedetomidine [C]).
METHODS: The primary outcome was the incidence of moderate-to-severe pain 24 h on movement. Secondary outcomes included incidence of moderate-to-severe pain, pain score, opioids use, recovery quality and adverse events.
RESULTS: The incidence of moderate-to-severe pain on movement 24 h postoperatively of group A was significantly lower than group B (45.19% vs 63.46%; RR 0.71; 95% CI, 0.55 to 0.92) and group C (45.19% vs 73.08%, RR 0.62; 95% CI, 0.49 to 0.79). The median moving pain scores decreased significantly at 24 h (3.00 [3.00,5.00] vs 4.00 [3.00,6.00] vs 4.00 [3.00,5.00]; P < 0.001). There were significant differences in the opioids consumption within the first 24 h (27.5 [17.0,37.2] vs 30.0 [20.0,42.0] vs 32.0 [25.0,44.0] mg; P = 0.01) and the duration to first rescue analgesia (65.5 ± 26.7 vs 45.9 ± 34.5 vs 49.2 ± 27.2 h; P = 0.04).
CONCLUSIONS: The combination with dexamethasone and dexmedetomidine as adjuvants for TAP block reduced the incidence of moderate-to-severe pain and pain score both on movement and at rest at 24 h with prolonged duration to first rescue analgesia after gastric cancer surgery.
BACKGROUND: ChiCTR2000037981.
方法:随机对照试验。
方法:术前区域,手术室,麻醉后恢复室和病床病房。
方法:共纳入312例成人胃癌患者(每组104例)。
方法:患者接受三种不同麻醉药的双侧肋下TAP阻滞(60ml0.25%罗哌卡因加10mg地塞米松和1μg·kg-1右美托咪定[A]或10mg地塞米松[B]或1μg·kg-1右美托咪定[C])。
方法:主要结果是24h运动时中度至重度疼痛的发生率。次要结果包括中度至重度疼痛的发生率,疼痛评分,阿片类药物的使用,恢复质量和不良事件。
结果:A组术后24h运动时中重度疼痛的发生率明显低于B组(45.19%vs63.46%;RR0.71;95%CI,0.55至0.92)和C组(45.19%vs73.08%,RR0.62;95%CI,0.49至0.79)。中位运动疼痛评分在24h时显著降低(3.00[3.00,5.00]vs4.00[3.00,6.00]vs4.00[3.00,5.00];P<0.001)。前24小时内阿片类药物的消耗量存在显着差异(27.5[17.0,37.2]vs30.0[20.0,42.0]vs32.0[25.0,44.0]mg;P=0.01),首次抢救镇痛的持续时间(65.5±26.7vs45.9±34.5vs49.2±27.2h;P=0.04)。
结论:联合地塞米松和右美托咪定作为TAP阻滞佐剂可降低胃癌术后24h运动和静息时的中重度疼痛发生率和疼痛评分,延长首次抢救镇痛时间。
背景:ChiCTR2000037981。