目的:探讨罗哌卡因复合右美托咪定与罗哌卡因单独腹腔灌注对腹腔镜全子宫切除术(TLH)患者术后恢复质量的影响。
方法:在福建省妇幼保健院进行全麻下行TLH的女性患者。在气腹结束之前,患者在腹腔镜下腹腔输注0.25%罗哌卡因40ml(R组)或0.25%罗哌卡因联合1µg/kg右美托咪定40ml(RD组).主要结果是QoR-40,在手术前和手术后24小时进行评估。次要结果包括术后NRS评分,术后麻醉剂量,步行的时间,拔除导尿管,和肛门排气。头晕的发生率,恶心,并对呕吐进行了分析。
结果:共招募了109名女性。术后24h,RD组QoR评分高于R组(p<0.05)。与R组相比,RD组NRS评分在术后2、6、12和24h均下降(均p<0.05)。在RD组中,术后第一剂量阿片类药物的时间更长,PCA压缩的累积和有效时间少于R组(均p<0.05)。同时,步行时间(p=0.033),肛门排气(p=0.002),RD组的导尿管拔除时间缩短(p=0.018)。RD组头晕发生率较低,恶心,呕吐(p<0.05)。
结论:腹腔输注罗哌卡因复合右美托咪定可提高TLH患者的恢复质量。
背景:ChiCTR2000033209,注册日期:2020年5月24日。
OBJECTIVE: To investigate the effect of intraperitoneal infusion of ropivacaine combined with dexmedetomidine and ropivacaine alone on the quality of postoperative recovery of patients undergoing total laparoscopic hysterectomy (TLH).
METHODS: Female patients scheduled to undergo a TLH under general anesthesia at Fujian Maternity and Child Health Hospital were included. Before the end of pneumoperitoneum, patients were laparoscopically administered an intraperitoneal infusion of 0.25% ropivacaine 40 ml (R group) or 0.25% ropivacaine combined with 1 µg/kg dexmedetomidine 40 ml (RD group). The primary outcome was QoR-40, which was assessed before surgery and 24 h after surgery. Secondary outcomes included postoperative NRS scores, postoperative anesthetic dosage, the time to ambulation, urinary catheter removal, and anal exhaust. The incidence of dizziness, nausea, and vomiting was also analyzed.
RESULTS: A total of 109 women were recruited. The RD group had higher QoR scores than the R group at 24 h after surgery (p < 0.05). Compared with the R group, NRS scores in the RD group decreased at 2, 6, 12, and 24 h after surgery (all p < 0.05). In the RD group, the time to the first dosage of postoperative opioid was longer and the cumulative and effective times of PCA compression were less than those in the R group (all p < 0.05). Simultaneously, the time to ambulation (p = 0.033), anal exhaust (p = 0.002), and urethral catheter removal (p = 0.018) was shortened in the RD group. The RD group had a lower incidence of dizziness, nausea, and vomiting (p < 0.05).
CONCLUSIONS: Intraperitoneal infusion of ropivacaine combined with dexmedetomidine improved the quality of recovery in patients undergoing TLH.
BACKGROUND: ChiCTR2000033209, Registration Date: May 24, 2020.