两种不同剂量的德克斯梅德托米丁用于下肢手术的连续外周止痛:一项随机双盲研究
Pranjali Kurhekar1, Sam Blessy Sheba2, Sathyasuba Meenakshisundaram1
1Department of Anesthesiology, Sree Balaji Medical College and Hospital, Chromepet, Chennai, Tamil Nadu, India.
Journal of anaesthesiology, clinical pharmacology
|October 11, 2024
概括
与0.5μg/kg/24h相比,在下肢手术中,连续外周用德克斯梅德托米丁1μg/kg/24h提供了优异的术后疼痛缓解. 这种较高的剂量表明改善了疼痛缓解,具有安全的血液动力学特征.
科学领域:
- 麻醉学 麻醉学
- 疼痛管理 疼痛管理
- 药理学 药理学是指药理学的学科.
背景情况:
- 玻尿管外周脱梅德托米丁提供有效的止痛药,但与高血动力学不稳定率有关.
- 关于连续外围注射德克斯梅德米丁输液的研究有限,没有研究比较不同剂量以获得最佳的安全性和有效性.
- 手术后疼痛管理仍然是手术恢复的关键方面,需要优化止痛策略.
研究的目的:
- 为了比较通过连续外周输注给术后疼痛管理的两个不同剂量德克斯梅德托米丁的止痛疗效和安全性.
- 为了确定 epidural dexmedetomidine 的最佳安全剂量,以便在下肢手术后实现有效的止痛.
主要方法:
- 一项随机研究涉及72名接受下肢手术的患者,分为两组,接受0.5微克/千克/24小时 (I组) 或1微克/千克/24小时 (II组) 的德克斯梅托米丁与0.1%的罗皮瓦卡因通过外周输液 (5毫升/小时48小时).
- 疼痛评分,救援止痛要求,血液动力学参数 (血压,心率) 和镇静评分都被仔细记录下来,并在各组之间进行了比较.
- 通过独立的t测试和Chi平方测试进行统计分析,以评估观察到的差异的意义.
主要成果:
- 与0.5微克/公斤/24小时组 (I组) 相比,接受1微克/公斤/24小时德克斯梅托米丁的组 (II组) 在所有测量间隔中表现出明显较低的疼痛分数 (P = 0.000) 和减少对救援止痛药的需求 (P = 0.03).
- 在整个术后期间,I组始终报告了更严重的疼痛.
- 虽然II组显示低血压的发病率较高,但II组仅在2名患者中观察到胸,而I组没有患者,这表明可管理的安全性.
结论:
- 连续外周输注德克斯梅德托米丁剂量为1μg/kg/24h,与0.1%的罗皮瓦卡因相结合,在下肢手术中提供优异的术后止痛.
- 这种优化剂量方案表明有效的疼痛管理和血液动力学稳定性之间的良好平衡,表明其作为手术后疼痛控制的安全和有效选择的潜力.
相关概念视频
Local Anesthetics: Clinical Application as Epidural Anesthesia
417
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
417
Local Anesthetics: Clinical Application as Spinal Anesthesia
587
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
587
Parenteral Anesthetics: Overview
106
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
106
Stages of General Anesthesia
379
Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...
379
Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia
371
Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
One of the advantages of...
371
Depolarizing Blockers: Pharmocokinetics
313
Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...
313


