进行阴囊内外科手术的患者精索阻滞时加入右美托咪定的效果：随机对照的多中心临床试验
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Efficacy of local dexmedetomidine add-on for spermatic cord block anesthesia in patients undergoing intrascrotal surgeries: randomized controlled multicenter clinical trial
背景与目的：本研究的目的是探讨追加右美托咪定 (DEX)于使用布比卡因的精索阻滞和术后镇痛的效果。
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方法：120名计划择期进行阴囊内外科手术的成年男性，患者被分为两组:B组使用10ml 0.25%布比卡因做精索阻滞，静脉注射50μg右美托咪定，BD组10ml 0.25%布比卡因加入50μg的右美托咪定(9.5ml 0.25%布比卡因+0.5 mL 50μ g右美托咪定)用于精索阻滞，为了掩饰目的，患者静脉注射了生理盐水。在术后的24小时内第一次要求镇痛的时间、止痛剂的用量和视觉模拟量表(瓦斯)疼痛评分用于评估。
结果：第一个要求镇痛的时间BD组与B组相比显著延迟,中位数(四分位距)范围,7(6-12)小时比上6(5 -7)小时,(p = 0.000),术后第一个24h的平均吗啡累计消耗量(mg)BD组与B组相比,8.13± 4.45比12.7±3.79,平均差(95% CI)为-4.57(-6.06 比- 3.07)(p = 0.000);显著降低，疼痛评分BD组与B组相比,在所有测试时间点也显著降低， 2小时为(1.28± 0.9 vs 1.92± 0.8), 6小时为(2.62±1.5 vs 3.93±1.2),12小时为(2.40±1.1、3.57±- 0.65), 24小时为(1.90±- 0.68、2.53±-0.62)(p = 0.000)。
结论：在使用0.25%的布比卡因做精索阻滞的阴囊内手术时加入50μg的右美托咪定，可延迟第一次加止痛剂的时间，减少了术后止痛剂的用量，并提高阻滞的成功率。
Hetta DF1, Kamal EE2, Mahran AM2, Ahmed DG1, Elawamy A3, Abdelraouf AM3
Efficacy of local dexmedetomidine add-on for spermatic cord block anesthesia in patientsundergoing intrascrotal surgeries: randomized controlled multicenter clinical trial.
J Pain Res.Nov 8, 2017;10:2621-2628. doi: 10.2147/JPR.S145305. eCollection 2017.
Study objective: The objective of this study was to evaluate the effect of adding dexmedetomidine (DEX) to bupivacaine on the quality of spermatic cord block anesthesia and postoperative analgesia.
Design: This is a randomized, double-blind study. Setting: This study was performed in an educational and research hospital.
Patients: One hundred twenty adult males were scheduled for intrascrotal surgeries.
Interventions: Patients were divided into two groups: group B received 10 mL of bupivacaine 0.25% for spermatic cord block and intravenous 50 g of DEX and group BD received 10 mL of bupivacaine 0.25% added to 50 g of DEX (9.5 mL bupivacaine 0. 25% + 0.5 mL [50 g] DEX) for spermatic cord block, and for masking purposes, the patients received isotonic saline intravenously.
Measurements: Time to first analgesic request, analgesic consumption, and visual analog scale (VAS) pain score in the first 24 hours postoperatively were assessed.
Main results: Time to first rescue analgesic was significantly delayed in group BD in comparison with group B, median (interquartile) range, 7 (6 12) hours versus 6 (5 7) hours, (p=0.000), the mean cumulative morphine consumption (mg) in the first postoperative 24 hours was significantly lower in group BD compared with group B, 8.13 4.45 versus 12.7 3.79, with a mean difference (95% CI) of 4.57( 6.06 to 3.07) (p=0.000); also, there was a significant reduction of VAS pain score in group BD in comparison with group B at all measured time points, VAS 2 hours (1.28 0.9 vs 1.92 0.8), VAS 6 hours (2.62 1.5 vs 3.93 1.2), VAS 12 hours (2.40 1.1 vs 3.57 0.65), VAS 24 hours (1.90 0.68 vs 2.53 0.62) (p=0.000)
Conclusion: The addition of 50 g of DEX to bupivacaine 0.25% in spermatic cord block for intrascrotal surgeries resulted in delay of first analgesic supplementation, reduction of postoperative analgesic consumption as well as improvement of the success rate of the block.
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