硬膜外输注右美托咪定用于腹部癌症手术患者的围手术期镇痛：随机试验。
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epidural dexmedetomidine infusion for perioperative analgesia in patients undergoing abdominal cancer surgery: randomized trial
背景与目的
评估硬膜外联合输注右美托咪定加布比卡因对接受重大腹部癌症手术患者围术期镇痛效果。
方 法
计划进行大型上腹部癌症手术的患者被分配到布比卡因组（n = 32）：患者患者术后48小时接受硬膜外输注布比卡因( 0.1% 布比卡因，6 mL/h)，以及布比卡因+右美托咪定组：患者患者术后48小时接受硬膜外输注布比卡因+右美托咪定(0.1% 布比卡因 + 右美托咪定0.5 µg/mL，6 mL/h) ，评估吗啡累计需要量、首次需要镇痛的时间、VAS评分。
结 果
与布比卡因组相比，布比卡因组+右美托咪定组的吗啡消耗量显着降低：平均值±SD为10.40±5.16 mg对比23.23±8.37 mg，估计差异（95％CI）为-12.83（-16.43，-9.24），（P <0.001）。与布比卡因组相比，布比卡因组+右美托咪定组首次需要镇痛的时间显著延长中位数（IQR）为6h vs 1h,(P<0.001). 与布比卡因组相比，布比卡因组+右美托咪定组静息和运动时整体VAS疼痛评显著降低，静息时平均值±SE分别为1.6±0.08 vs 2.38±0.08，估计差异（95％CI）为-0.8 （-1，-0.86），（P <0.001），运动时平均值±SE分别为2.17±0.07对比3.25±0.07，估计差异（95％CI）为-1.1（-1.27， - 0.89），（P <0.001） ）。
结 论
对于接受重大腹部癌手术的患者，加入右美托咪定联合布比卡因的硬膜外输注可显着减少吗啡用量，延迟首次镇痛补充时间，并在术后最初48小时内降低疼痛强度，且不会对血流动力学产生紊乱。
原始文献摘要
Objective To assess the postoperative analgesic efficacy of epidural dexmedetomidine added to bupivacaine infusion for patients undergoing major abdominal cancer surgery.
Methods Patients scheduled for major upper abdominal cancer surgery were allocated to group bupivacaine (n =32), in which patients received epidural bupivacaine infusion (6 mL/h bupivacaine 0.1%) for 48 hours postoperatively, or group bupivacaine + dexmedetomidine (n=32), in which patients received epidural dexmedetomidine added to bupivacaine infusion (6 mL/h of bupivacaine 0.1% + dexmedetomidine, 0.5 µg/mL) for 48 hours postoperatively. The cumulative morphine consumption, the time to first analgesic request, and the VAS pain score were evaluated.
Results The cumulative morphine consumption was significantly reduced in group bupivacaine + dexmedetomidine compared with group bupivacaine: mean ± SD of 10.40±5.16 mg vs 23.23±8.37 mg with an estimated difference (95% CI) of -12.83 (-16.43, -9.24), (P<0.001). The time to the first analgesic demand was significantly delayed in group bupivacaine + dexmedetomidine compared with group bupivacaine: median (IQR) of 6 (1.75, 8.25) h vs 1 (0, 4)h, (P<0.001). The mean collapsed over time of overall VAS pain scores at rest and movement was significantly reduced in group bupivacaine + dexmedetomidine compared with group bupivacaine : mean ± SE of 1.6±0.08 vs 2.38±0.08 with an estimated difference (95% CI) of -0.8 (-1, -0.86), (P<0.001), and mean ± SE of 2.17±0.07 vs 3.25±0.07 with an estimated difference (95% CI) of -1.1 (-1.27, - 0.89), (P<0.001), respectively.
Conclusion Epidural infusion of dexmedetomidine added to bupivacaine for patients undergoing major abdominal cancer surgery significantly reduced morphine consumption, delayed time to first analgesic supplementation, and decreased pain intensity during the first 48 hours postoperatively without harmful derangement on hemodynamics.
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