右美托咪定与镇痛2018.pptx

1、右美托咪定与镇痛,主要内容,椎管内静脉外周神经阻滞辅助用药,A comparative study between intrathecal dexmedetomidine and fentanyl as adjuvant to intrathecal bupivacaine in lower abdominal surgeries: A randomized trial,Khan AL1, Singh RB2, Tripathi RK2, Choubey S2.Anesthesia, Essays and Researsches. 2015 May-Aug;9(2):139-48.doi: 1

2、0.4103/0259-1162.156284.,Context:Spinal anesthesia is preferred choice of anesthesia in lower abdominal surgeries since long time. However problem with this is limited duration of action, so for long duration surgeries alternative are required. Dexmedetomidine is a highly selective alpha-2-adrenergi

3、c agonist has property to potentiate the action of local anesthetic used in spinal anesthesia. Fentanyl is an opioid and it has also the same property.,Aims:To compare the efficacy, analgesic effects, and side effects of dexmedetomidine and fentanyl as adjuvant to bupivacaine for lower abdominal sur

4、gery.Subjects and Methods:After obtaining clearance from ethical committee, the enrolled patients were randomized in two groups of 40 patients each (n = 40) using random number table.Group D: Patients receiving bupivacaine with dexmedetomidine.Group F: Patients receiving bupivacaine with fentanyl.,A

5、ll the patients in both the groups were premedicated with tablet diazepam 5 mg, tablet rantac 150 mg, night prior to surgery. Record: BP, HR, SpO2T1 = Immediately before dural puncture for spinal anesthesiaT2 = Immediately after dural puncture for spinal anesthesiaT3 to T26 = Every 5 min thereafter

6、for 120 min. The sensory dermatome level was assessed by pin prick sensation using 23 gauge hypodermic needle along the mid clavicular line bilaterally. The sensory level and Bromage scale were recorded every 2 min after the spinal injection up to the 10 min and after that every 10 min until the hig

7、hest dermatome was reached. In the postanesthesia care unit (PACU), the sensory level and Bromage scale were recorded every 10 min until the patient was discharged from the PACU.,Diastolic blood pressure at different time intervals,Change in heart rate within group at different time intervals from b

8、aseline (before dural puncture),Highest level of sensory block in study population,Side effects in study population,As compared to fentanyl group, in dexmedetomidine group, mean HR and BP (SBP, DBP and MAP) was significantly lower for most of the perioperative intervalsAs compared to baseline, fenta

9、nyl group did not show a significant difference in mean HR and BP (SBP, DBP and MAP) throughout the perioperative periodMean duration of sensory and motor block and analgesic effect (time till first postoperative dose of analgesic) was significantly longer in dexmedetomidine group as compared to fen

10、tanyl groupIncidence of bradycardia and hypotension was higher in dexmedetomidine group as compared to fentanyl group yet the difference between two groups was not significant statistically.,CONCLUSION,The findings in the present study suggested that the use of intrathecal dexmedetomidine as adjuvan

11、t to Bupivacaine provides a longer sensory and motor blockade and also prolongs the postoperative analgesic effect than the Use of fentanyl with Bupivacaine. However, the potential risk of hypotension and bradycardia should not be ignored and should be adequately taken care of in the operation room.

12、,Dexmedetomidine versus remifentanil inpostoperative pain control after spinal surgery:a randomized controlled study,Hwang W1, Lee J1, Park J1, Joo J1.BMC Anesthesiol. 2015 Feb 24;15:21. doi: 10.1186/s12871-015-0004-1. eCollection 2015.,BACKGROUND:,Total intravenous anesthesia (TIVA) is used widely

13、in spinal surgery because inhalational anesthetics are known to decrease the amplitude of motor evoked potentials. Presently, dexmedetomidine is used as an adjuvant for propofol-based TIVA. We compared the effects of remifentanil and dexmedetomidine on pain intensity as well as the analgesic require

14、ments after post-anesthesia care unit (PACU) discharge in patients undergoing spinal surgery.,Comparison of postoperative VAS scores between the groups. VAS=visual analog scale; T1=before PACU discharge; T2=2hours after surgery; T3=8hours after surgery; T4=24hours after surgery; T5=48hours after sur

15、gery. *P0.05.,Comparison of postoperative PCA use between the groups. PCA=patient-controlled analgesia; T1=before PACU discharge; T2=2hours after surgery; T3=8hours after surgery; T4=24hours after surgery; T5=48hours after surgery. *P0.05.,Another reason for the superior postoperative pain control e

16、fficacy of dexmedetomidine compared to remifentanil may be related to opioid-induced hyperalgesia (OIH)OIH is characterized by a paradoxical increase in pain intensity or sensitivity in patients receiving opioids at high doses or for an extended durationA recent study demonstrated that intraoperativ

17、e high-dose remifentanil decreased the mechanical hyperalgesia threshold, enhanced the pain intensity, reduced the time to the first postoperative analgesic requirement, and increased patient morphine consumption, indicating OIH, which was alleviated efficiently using a dexmedetomidine infusion,CONC

18、LUSION,In conclusion, dexmedetomidine as an adjuvant in propofol-based TIVA displayed superior efficacy to remifentanil in alleviating pain and managing postoperative pain for 48hours following PLIF surgery. It also reduced the requirement for rescue analgesics and PONV. Therefore, dexmedetomidine m

19、ay be used as an adjuvant in propofol-based TIVA instead of remifentanil for more efficient pain and PONV management.,The Effect of Low-Dose Dexmedetomidine as an Adjuvant to Levobupivacaine in Patients Undergoing Vitreoretinal Surgery Under Sub-Tenons Block Anesthesia.,Ghali AM1, Shabana AM, El Bta

20、rny AM.Anesthesia & Analgesia. 121(5):13781382, NOV 2015DOI: 10.1213/ANE.0000000000000908,BACKGROUND:,This study evaluated the motor and sensory block durations and the postoperative analgesic effects of adding dexmedetomidine to levobupivacaine for sub-Tenons block anesthesia in patients undergoing

21、 vitreoretinal surgery. Motor and sensory block durations were considered as a primary end point.,Figure 2. Ramsay sedation scale (RSS拉姆齐镇静水平) during the surgery period (minutes) and 24 hours postoperatively (hours). *P 0.05, statistically significant compared with L group. Group L = 4 mL of 0.75% l

22、evobupivacaine plus 15 IU hyaluronidase diluted with 1 mL normal saline; Group LD = 4 mL of 0.75% levobupivacaine plus 15 IU hyaluronidase and 20 g dexmedetomidine diluted with 1 mL normal saline.,The patients in the dexmedetomidine group showed significantly (P 0.0001) higher rates of good sleep qu

23、ality on the first postoperative night (70%) compared with the patients in the levobupivacaine group (30%; Fig. 4).,CONCLUSION,This study demonstrated that the use of dexmedetomidine as an adjuvant to levobupivacaine in patients undergoing vitreoretinal surgery under sub-Tenons block anesthesia exte

24、nded the motor and sensory block durations and delivered more effective postoperative analgesia, as shown by lower diclofenac consumption and fewer patients requiring tramadol as a rescue analgesia medication. However, the patients who received dexmedetomidine achieved greater levels of sedation thr

25、oughout the surgery period and postoperatively for 12 hours.,In a study by Esmaoglu et al., the authors reported similar effects when they added 100 g of dexmedetomidine to levobupivacaine for axillary block. The authors found an increased motor and sensory block durations of 3.6 hours, which also e

26、xtended the postoperative analgesia period. Esmaoglu A, Yegenoglu F, Akin A, Turk CY. Dexmedetomidine added to levobupivacaine prolongs axillary brachial plexus block. Anesth Analg. 2010;111:154851Brummett et al. demonstrated that the use of high-dose dexmedetomidine as an adjuvant to ropivacaine fo

27、r sciatic nerve block in rats caused an approximately 75% increase in the duration of bupivacaine anesthesia and analgesia.Brummett CM, Hong EK, Janda AM, Amodeo FS, Lydic R. Perineural dexmedetomidine added to ropivacaine for sciatic nerve block in rats prolongs the duration of analgesia by blocking the hyperpolarization-activated cation current. Anesthesiology. 2011;115:83643,Thank you!,