鞘内吗啡与吗啡-右美托咪定联合用于全膝关节置换术后疼痛控制:一项随机对照试验。

IF 1.5 Q3 ANESTHESIOLOGY Local and Regional Anesthesia Pub Date : 2023-01-01 DOI:10.2147/LRA.S419465
Amany F Omara, Hadal Hassan Mohsen, Alaa Mohammed Abo Hagar, Ahmed F Abdelrahman
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摘要

目的:本前瞻性研究旨在比较鞘内吗啡、右美托咪定以及两者联合应用在全膝关节置换术(TKR)患者中的镇痛效果和不良反应。患者及方法:本随机前瞻性研究在坦塔大学医院骨科外科进行了为期6个月的105例美国麻醉学会身体状态II级和III级,年龄> 50岁,计划行全膝关节置换术的成人患者,随机分为吗啡组,给予0.5%重布比卡因加0.1 mg吗啡,吗啡/右美托咪定组。给予0.5%重布比卡因加吗啡0.1 mg,右美托咪定5 MCG,右美托咪定组给予0.5%重布比卡因加右美托咪定5 MCG。记录首次镇痛时间、术后疼痛严重程度、吗啡总剂量、术后并发症及患者镇静水平。结果:右美托咪定组约有一半患者在术后6小时要求首次抢救性镇痛,明显短于其他两组。另一方面,其他两组在第一组所需的镇痛方面没有显着差异。休息时,右美托咪定组VAS明显高于其他两组,需要吗啡作为救急镇痛的患者明显增加。在运动时,右美托咪定组患者术后4小时感到疼痛,VAS明显高于其他两组。同时,右美托咪定组镇静评分明显低于其他两组。吗啡组出现恶心呕吐的发生率为22.2%,三组间差异有统计学意义。结论:尽管没有明显的副作用,但我们的研究结果并不表明鞘内吗啡和右美托咪定联合使用可以增强镇痛效果。
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Intrathecal Morphine versus Morphine-Dexmedetomidine Combination for Postoperative Pain Control After Total Knee Replacement: A Randomized Controlled Trial.

Objective: This prospective study aimed to compare the analgesic efficacy and adverse effects of intrathecal morphine, dexmedetomidine, and a combination of both in patients undergoing total knee replacement (TKR).

Patients and methods: This randomized prospective study was carried out in Tanta university hospital in orthopedic surgery for 6 months on 105 adult patients with American Society of Anesthesiologists Physical Status Class II and III, aged > 50 years, and scheduled for total knee replacement surgery randomly allocated into morphine group received 0.5% heavy bupivacaine plus 0.1 mg of morphine, morphine/ dexmedetomidine group, received 0.5% heavy bupivacaine plus 0.1 mg of morphine and 5 mcg of dexmedetomidine and dexmedetomidine group received 0.5% heavy bupivacaine plus 5 mcg of dexmedetomidine. The time of the first required analgesia, postoperative pain severity, the total dose of morphine, postoperative complication, and the patient's level of sedation were recorded.

Results: About half of the patients in the dexmedetomidine group requested first rescue analgesia 6 hours after the operation, significantly shorter than the other two groups. On the other hand, the other two groups show no significant difference between them regarding the first required analgesia. At rest, the dexmedetomidine group have significantly higher VAS with a significant increase in patients who required morphine as rescue analgesia than the other two groups. While at movement, patients in the dexmedetomidine group felt pain at 4 hrs postoperatively with significantly higher VAS than the other two groups. At the same time, the sedation score was significantly lower in the dexmedetomidine group than in the other two groups. 22.2% of cases in the morphine group developed nausea and vomiting with a significant difference between the three groups.

Conclusion: Despite the absence of substantial side effects, our findings did not suggest enhanced analgesia with the combination of intrathecal morphine and dexmedetomidine.

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CiteScore
6.30
自引率
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发文量
12
审稿时长
16 weeks
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