静脉注射利多卡因、右美托咪定及其联合应用对腹部子宫切除术后疼痛和肠道功能恢复的影响。

Effects of intravenous lidocaine, dexmedetomidine and their combination on postoperative pain and bowel function recovery after abdominal hysterectomy.

机构信息

Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, China.

Department of Anesthesiology, Affiliated Anqing Hospital of Anhui Medical University, Anqing, China.

出版信息

Minerva Anestesiol. 2017 Jul;83(7):685-694. doi: 10.23736/S0375-9393.16.11472-5. Epub 2017 Jan 17.

DOI:10.23736/S0375-9393.16.11472-5

PMID:28094477

Abstract

BACKGROUND

Intravenous (IV) lidocaine and dexmedetomidine have been shown to decrease postoperative pain, reduce analgesic consumption and facilitate return of bowel function. We investigated whether lidocaine combined with dexmedetomidine infusion was superior in controlling pain and recovery of bowel function.

METHODS

A total of 240 women undergoing elective abdominal hysterectomy were randomly assigned into four groups: group CON received normal saline infusion, group LIDO received lidocaine infusion (1.5 mg/kg loading, 1.5 mg/kg/h infusion), group DEX received dexmedetomidine infusion (0.5 µg/kg loading, 0.4 µg/kg/h infusion) and group LIDO+DEX received lidocaine (1.5 mg/kg loading, 1.5 mg/kg/h infusion) and dexmedetomidine infusions (0.5 µg/kg loading, 0.4 µg/kg/h infusion). The primary outcome was visual analog pain scale (VAS) scores at 1, 4, 8, 12, 24, and 48 hours after surgery. The secondary outcomes included time to first bowel sounds and flatus, postoperative fentanyl requirement and perioperative propofol and remifentanil consumption.

RESULTS

The VAS scores were significantly lower in groups LIDO and DEX at 4, 8, and 12 hours compared to group CON after surgery (P<0.01). The VAS scores were also significantly lower in group LIDO+DEX at 1, 4, 8, 12, and 24 hours compared to other three groups after surgery (P<0.01). Time to first bowel sounds and flatus was significantly shorter in groups LIDO and LIDO+DEX than groups CON and DEX (P<0.01). Postoperative fentanyl requirement was significantly lower in group LIDO at 1 and 4 hours and in group DEX at 1, 4, 8 hours compared to group CON after surgery (P<0.01). Postoperative fentanyl requirement was also significantly lower in group LIDO+DEX at 1, 4, 8, 12, 24 and 48 hours compared to other three groups after surgery (P<0.01). Propofol and remifentanil consumption was significantly lower in groups LIDO, DEX and LIDO+DEX compared to group CON (P<0.01).

CONCLUSIONS

Lidocaine combined with dexmedetomidine infusion significantly improved postoperative pain and enhanced recovery of bowel function undergoing abdominal hysterectomy.

摘要

背景

静脉内（IV）利多卡因和右美托咪定已被证明可减轻术后疼痛，减少镇痛药的消耗并促进肠道功能恢复。我们研究了利多卡因联合右美托咪定输注是否在控制疼痛和恢复肠道功能方面更具优势。

方法

总共 240 名接受择期腹部子宫切除术的女性被随机分为四组：CON 组接受生理盐水输注，LIDO 组给予利多卡因输注（负荷剂量 1.5mg/kg，输注剂量 1.5mg/kg/h），DEX 组给予右美托咪定输注（负荷剂量 0.5μg/kg，输注剂量 0.4μg/kg/h），LIDO+DEX 组给予利多卡因（负荷剂量 1.5mg/kg，输注剂量 1.5mg/kg/h）和右美托咪定输注（负荷剂量 0.5μg/kg，输注剂量 0.4μg/kg/h）。主要结局是术后 1、4、8、12、24 和 48 小时的视觉模拟疼痛评分（VAS）。次要结局包括首次肠鸣音和肛门排气时间，术后芬太尼需求以及围手术期异丙酚和瑞芬太尼的消耗。

结果

与 CON 组相比，术后 4、8 和 12 小时，LIDO 和 DEX 组的 VAS 评分明显降低（P<0.01）。与其他三组相比，LIDO+DEX 组在术后 1、4、8、12 和 24 小时的 VAS 评分也明显降低（P<0.01）。首次肠鸣音和肛门排气时间在 LIDO 和 LIDO+DEX 组明显短于 CON 和 DEX 组（P<0.01）。术后 1 和 4 小时 LIDO 组以及术后 1、4、8 小时 DEX 组芬太尼的需求明显低于 CON 组（P<0.01）。与其他三组相比，术后 1、4、8、12、24 和 48 小时，LIDO+DEX 组芬太尼的需求明显更低（P<0.01）。LIDO、DEX 和 LIDO+DEX 组异丙酚和瑞芬太尼的消耗明显低于 CON 组（P<0.01）。