Low dose of dexmedetomidine as an adjuvant to bupivacaine in cesarean surgery provides better intraoperative somato-visceral sensory block characteristics and postoperative analgesia.
Low dose of dexmedetomidine as an adjuvant to bupivacaine in cesarean surgery provides better intraoperative somato-visceral sensory block characteristics and postoperative analgesia.
复制标题
DOI：
10.18632/oncotarget.18864
复制
发表时间：
2017-09-08
期刊：
影响因子：
--
通讯作者：
Zhang YZ
中科院分区：
文献类型：
--
作者：
Bi YH;Cui XG;Zhang RQ;Song CY;Zhang YZ
本研究旨在探讨右美托咪定对剖宫产术患者布比卡因鞘内注射的躯体-内脏感觉阻滞特征、术后镇痛和应激反应的有益影响，并找出哪种剂量更好。60例阿萨Ⅰ或Ⅱ级的产妇，分别用布比卡因10 mg或布比卡因+右美托咪定3 μg和5 μg鞘内麻醉行剖宫产术。监测麻醉参数、术后镇痛及应激反应。与布比卡因（10 mg）相比，右美托咪定（3 μg和5 μg）联合给药延长了运动和感觉阻滞的持续时间。右美托咪定（3 μg和5 μg）联合给药组需要较少的利多卡因和芬太尼补充剂量。右美托咪定（3 μg和5 μg）联合给药组的内脏牵拉反应和术中腹肌松弛较好。各组间血流动力学无差异。各组新生儿Apgar评分、脐pH值、氧分压、二氧化碳分压、乳酸水平差异均无统计学意义。右美托咪定（3 μg和5 μg）联合给药组的术后血浆IL-6和皮质醇水平较低。术后6小时，右美托咪定（3 μg和5 μg）联合给药组的视觉模拟评分（VAS）较小。术后6、12小时宫缩痛及术后镇痛药的使用情况三组间无差异。三组患者寒战、恶心呕吐、瘙痒等不良反应、首次肛门排气时间及术中曲马多用量无差异。右美托咪定3μg辅助布比卡因用于剖宫产手术，可提供较好的术中躯体-内脏感觉阻滞特性和术后镇痛效果，对Apgar评分、不良反应及应激反应无影响。
In this study, we aimed to investigate the beneficial effects of dexmedetomidine on somato-visceral sensory block characteristcs, postoperative analgesia and stress response of intrathecal bupivacaine administration in women undergoing cesarean section, and to find out which dose is better. Sixty parturients with the American Society of Anesthesiologists (ASA) physical status I or II were anesthetized with intrathecal bupivacaine(10mg) alone or in combination with dexmedetomidine (3 μg and 5 μg) to undergo cesarean section. The anesthetic parameters, postoperative analgesia and stress responses were monitored. Co-administration of dexmedetomidine(3 μg and 5 μg) prolonged the duration of motor and sensory block compared with bupivacaine(10mg) alone. Less supplemental dose of lidocaine and fentanyl were required in dexmedetomidine(3 μg and 5 μg) co-administration groups. Visceral traction response and abdominal muscle relaxation in operation were better in dexmedetomidine(3 μg and 5 μg) co-administration groups. No difference in haemodynamics was detected among groups. There was no significant difference in Apgar scores, neonatal umbilical pH, oxygen pressure, carbon dioxide pressure and lactate level among groups. Postoperative plasma IL-6 and cortisol levels were lower in dexmedetomidine(3 μg and 5 μg) co-administration groups. At 6 hour after operation the visual analogue scale (VAS) was smaller in dexmedetomidine(3 μg and 5 μg) co-administration groups. The uterine contraction pain at 6 and 12 hour after operation and supplemental analgesics had no difference across three groups. No difference of side effects(shivering, nausea and vomiting, itching), the first anal aerofluxus time and intraoperation tramadol dose were detected among the three groups. The use of dexmedetomidine especially at the dose of 3μg as an adjuvant to bupivacaine in cesarean surgery provides better intraoperative somato-visceral sensory block characteristcs and postoperative analgesia, which produced no influence on Apgar scores, side effects and stress response.