目的:在本研究中,我们评估了1μg/kg右美托咪定辅助治疗罗哌卡因在超声引导下腋路臂丛神经阻滞和全身麻醉下上肢手术患儿的疗效和安全性.
方法:我们在厦门儿童医院招募了90例(年龄1-8岁;ASAI-II)上肢骨折闭合复位内固定的儿童,并随机分为两组:L(注射0.25%罗哌卡因)或D(注射0.25%罗哌卡因,含1μg/kg右美托咪定)。主要结果指标为面部表情,腿部活动,position,哭泣,脸,腿,活动,哭吧,术后患儿的可协和性量表(FLACC)评分及阻滞和镇痛维持时间。次要结果指标是超声探头放置时(T1)的生命体征数据,在块完成时(T2),在手术开始之前(T3),手术开始后5分钟(T4),在手术结束时(T5),以及术后恢复的时间,补救镇痛的病例数,和并发症。
结果:两组在一般资料方面无统计学差异,块完成时间,术后恢复时间,和并发症(P>0.05)。与L组相比,D组术后6小时FLACC评分明显降低,以及显著降低收缩压,舒张压,T4和T5时的心率值,术后镇痛维持时间明显延长(均P<0.05)。
结论:右美托咪定(1μg/kg)作为罗哌卡因的局部麻醉辅助药可以减轻术后6h的疼痛。延长镇痛维持,并降低上肢骨折闭合复位内固定术患儿的术中血压和心率,无明显并发症或恢复延迟。
■注册网站:www.chictr.org.cn,注册号:ChiCTR2200065163,注册日期:十月,30,2022年。
OBJECTIVE: In this
study, we evaluated the efficacy and safety of 1 μg/kg dexmedetomidine as an adjuvant treatment to ropivacaine in children undergoing upper limb surgeries under ultrasound-guided axillary brachial plexus blocks and general anesthesia.
METHODS: We enrolled 90 children (aged 1-8 years; ASA I-II) undergoing closed reduction and internal fixation for upper extremity fractures at the Xiamen Children\'s Hospital and randomly assigned them to one of two groups: L (injection with 0.25% ropivacaine) or D (injection with 0.25% ropivacaine containing 1 μg/kg dexmedetomidine) using the random number table method. The main outcome indicators recorded were the facial expression, leg activity, position, crying, and Face, Legs, Activity, Cry, and Consolability (FLACC) scale scores of children after surgery and the duration of block and analgesia maintenance. The secondary outcome indicators were vital sign data at the time of ultrasound probe placement (T1), at the time of block completion (T2), prior to the beginning of surgery (T3), 5 min after the beginning of surgery (T4), and at the end of surgery (T5), as well as the time of postoperative recovery, the number of cases of remedial analgesia, and complications.
RESULTS: There was no statistical difference between the two groups in terms of general data, block completion time, postoperative recovery time, and complications (P > 0.05). Compared to the L group, the D group had significantly lower FLACC scores at 6 h after surgery, as well as significantly lower systolic blood pressure, diastolic blood pressure, and heart rate values at T4 and T5, and significantly longer duration of postoperative analgesia maintenance (all P < 0.05).
CONCLUSIONS: Dexmedetomidine (1 μg/kg) as a local anesthetic adjuvant to ropivacaine can alleviate pain at 6 h postoperatively, prolong analgesia maintenance, and reduce intraoperative blood pressure and heart rate in pediatric patients undergoing closed reduction and internal fixation for upper extremity fractures, with no obvious complications or delayed recovery.
UNASSIGNED: Registration website: www.chictr.org.cn, Registration number: ChiCTR2200065163, Registration date: October, 30, 2022.