右美托咪定可延长区域阻滞的持续时间,而其全身镇静作用在神经腔内给药时是未知的。我们旨在评估右美托咪定在腋路臂丛神经阻滞(ABPB)后患者的全身镇静效果。这项单盲前瞻性随机对照试验包括80例接受ABPB腕部手术的患者。患者被随机分为两组-对照组(CG,N=40)和右美托咪定组(DG,N=40)。两组均接受含20ml0.5%布比卡因和10ml2%利多卡因的ABPB。此外,DG患者在神经腔内接受100mcg右美托咪定.在ABPB之后立即使用Narcontrend指数(NI)和Ramsay镇静量表(RSS)评估镇静深度,直到120分钟。使用术后调查评估阻滞持续时间以及患者对镇静的满意度。我们的结果表明,NI和RSS在组间有统计学差异,与对照组相比,在DG的前90分钟表现出更深的镇静水平,P<0.001。在ABPB后的前10至60分钟内,DG组的RSS中位数为4(中位数内的IQR),NI中位数为60(IQR44-80),与CG患者相比,在整个手术过程中,RSS中位数为2(IQR在中位数内),NI中位数为97(IQR96-98).在ABPB后90分钟和120分钟,当DG的中位NI值为98(97-99)和CG的97.5(97-98)时,两组的镇静水平变得相等。P=0.276,两组的RSS中位数为2(中位数内的IQR),P=0.128。在血液动力学或呼吸参数方面没有发现明显的组间差异。DG患者对镇静表示满意,86.5%的患者注意到感觉与普通睡眠相似。在DG中,运动阻滞的平均持续时间为13.5±2.1h,感觉阻滞为12.7±2.8h,与CG6.3±1.5h相比明显更长,P<0.001和6.4±1.8h,P<0.001。我们发现除了延长镇痛时间,右美托咪定经神经途径给药可提供相当安全舒适的镇静作用,对血流动力学或呼吸稳定性无显著影响,患者满意度较高.
Dexmedetomidine prolongs the duration of regional block while its systemic sedative effect when administered perineurally is unknown. We aimed to evaluate the systemic sedative effect of perineural dexmedetomidine in patients after axillary brachial plexus block (ABPB). This single-blinded prospective randomized control
trial included 80 patients undergoing wrist surgery receiving ABPB. Patients were randomized into two groups - Control group (CG, N = 40) and dexmedetomidine group (DG, N = 40). Both groups received ABPB with 20 ml of 0.5% Bupivacaine and 10 ml of 2% Lidocaine. Additionally, patients in DG received 100 mcg of dexmedetomidine perineurally. Depth of sedation was evaluated using Narcontrend Index (NI) and Ramsay Sedation Scale (RSS) immediately after ABPB and in several time points up to 120 min. Duration of block as well as patient satisfaction with sedation was evaluated using a postoperative survey. Our results showed that NI and RSS statistically differed between groups, presenting a deeper level of sedation during the first 90 min in DG compared to controls, P < 0.001. In the first 10 to 60 min after ABPB the median RSS was 4 (IQR within median) and median NI was 60 (IQR 44-80) in DG group, in contrast to CG patients where median RSS was 2 (IQR within median) and median NI was 97 (IQR 96-98) throughout surgery. The level of sedation became equal in both groups 90 and 120 min after ABPB when the median NI value was 98 (97-99) in DG and 97.5 (97-98) in CG, P = 0.276, and the median RSS was 2 (IQR within median) in both groups, P = 0.128. No significant intergroup differences in hemodynamic or respiratory parameters were found. Patients in DG expressed satisfaction with sedation and 86.5% noted that the sensation was similar to ordinary sleep. In DG mean duration of motor block was 13.5 ± 2.1 h and sensory block was 12.7 ± 2.8 h which was significantly longer compared to CG 6.3 ± 1.5 h, P < 0.001 and 6.4 ± 1.8 h, P < 0.001. We found that beside prolongation of analgesia, perineural administration of dexmedetomidine might provide rather safe and comfortable sedation with no significant effect on hemodynamic or respiratory stability and yields a high level of patient satisfaction.