收稿日期: 2025-01-04
网络出版日期: 2025-04-23
基金资助
江苏省高校自然科学研究基金项目(22KJA32000)
Effect of dexmedetomidine mixed with ropivacaine on postoperative sleep quality in patients undergoing upper abdominal surgery with OSTAPB
Received date: 2025-01-04
Online published: 2025-04-23
目的 探讨右美托咪定混合罗哌卡因用于肋缘下腹横肌平面阻滞（oblique subcostal transversus abdominis plane block，OSTAPB）对接受上腹部手术的患者术后睡眠质量的影响。 方法 选取徐州医科大学附属医院2024年11月至2025年1月拟接受胃部手术的患者共计140例，根据随机数字表分为单纯肋缘下腹横肌平面阻滞组（A组）和右美托咪定复合肋缘下腹横肌平面阻滞组（B组）。比较术前当晚的阿森斯失眠量表评分（Asymptomatic Sleep Disturbance Scale， AIS）和焦虑程度评分（Self-rating Anxiety Scale，SAS），术后当晚及次日的AIS评分，术中瑞芬太尼使用量，术后3 d PCA按压累计次数，术后2、6、12、24、48 h的NRS疼痛数字评分量表（Numeric Rating Scale， NRS）以及术后当晚及术后第2天的恢复质量评分（Quality of Requirements-15， QoR-15）。 结果 术前两组的焦虑程度以及主观睡眠质量评分差异无统计学意义（P > 0.05）；而术中A组瑞芬太尼的使用量与B组也差异无统计学意义（P > 0.05）；两组患者术后的活动时NRS评分在48 h期间差异有统计学意义（P < 0.05），但是静息状态下自24 h后两组NRS评分差异无统计学意义（P > 0.05）；同时B组术后12 h后的PCA按压次数也明显小于A组（P < 0.05）；最后B组术后两晚的恢复质量（QoR-15评分）和睡眠质量明显高于A组（P < 0.05）。 结论 右美托咪定复合罗哌卡因行肋缘下腹横肌平面阻滞不仅可以实现优于单纯使用罗哌卡因进行肋缘下腹横肌平面阻滞的术后镇痛效果，同时也可以实现术后当晚患者的睡眠质量的改善和术后恢复质量的提升，进而有助于改善患者的整体术后恢复质量。
关键词： 右美托咪定; 肋缘下腹横肌平面阻滞; 上腹部手术; 术后睡眠障碍; 围手术期镇痛
孙跃峰 , 邓志杰 , 叶陆恒 , 李星莲 , 刘苏 , 朱珊珊 . 右美托咪定混合罗哌卡因用于肋缘下腹横肌平面阻滞对接受上腹部手术患者术后睡眠质量的影响[J]. 实用医学杂志, 2025 , 41(7) : 1030 -1035 . DOI: 10.3969/j.issn.1006-5725.2025.07.015
Objective To investigate the effect of dexmedetomidine combined with ropivacaine on postoperative sleep quality in patients undergoing upper abdominal surgery following Oblique Subcostal Transversus Abdominis Plane Block （OSTAPB）. Methods A total of 140 patients who underwent gastric surgery at the Affiliated Hospital of Xuzhou Medical University between September 2024 and November 2024 were enrolled. According to the random number table method， they were randomly allocated into two groups： the simple subcostal transversus abdominis plane block group （Group A） and the dexmedetomidine combined with subcostal transversus abdominis plane block group （Group B）， with 70 patients in each group. The study compared the Asymptomatic Sleep Disturbance Scale （AIS） scores and Self?rating Anxiety Scale （SAS） scores on the night before surgery， AIS scores on the night after surgery and the following day， the amount of remifentanil used during surgery， and the cumulative number of patient?controlled analgesia （PCA） button presses within 3 days postoperatively. Additionally， the Numeric Rating Scale （NRS） pain scores at 2 h， 6 h， 12 h， 24 h， and 48 h post?surgery， as well as the Quality of Recovery?15 （QoR?15） scores on the night of surgery and the second day post?surgery， were evaluated. Results There were no significant differences in anxiety levels or subjective sleep quality scores between the two groups prior to the operation （P > 0.05）. Additionally， there was no significant difference in the usage of remifentanil between Group A and Group B （P > 0.05）. The NRS scores for pain differed significantly between the two groups within the first 48 hours post?operation （P < 0.05）； however， no significant difference was observed in NRS scores between the two groups after 24 hours during rest. Furthermore， the number of patient?controlled analgesia （PCA） activations in Group B was significantly lower than that in Group A at 12 hours post?operation （P < 0.05）. Lastly， both the QoR?15 and sleep quality were significantly higher in Group B compared to Group A （P < 0.05）. Conclusion Dexmedetomidine combined with ropivacaine for subcostal transversus abdominis plane block not only provides superior postoperative analgesia compared to ropivacaine alone but also enhances patients' sleep quality and recovery quality on the night following surgery， thereby contributing to improved overall postoperative recovery.
| 1 | SOZZI M， SIBONI S， BONAVINA L. Sleeping on the Right Side After Esophagectomy［J］. Clin Gastroenterol Hepatol，2023，21（5）：1377-1378. doi:10.1016/j.cgh.2022.04.030 |
| 2 | YANG Y， ZHANG Y， ZHOU G， et al. Efficacy of epidural esketamine on postoperative sleep quality after laparoscopic and robotic lower abdominal surgeries： a study protocol for randomised， double-blind， controlled trial［J］. BMJ Open，2024，14（2）：e081589. doi:10.1136/bmjopen-2023-081589 |
| 3 | VARALLO G， GIUSTI E M， MANNA C， et al Sleep disturbances and sleep disorders as risk factors for chronic postsurgical pain ： A systematic review and meta-analysis［J］. Sleep Med Rev，2022，63：101630. doi:10.1016/j.smrv.2022.101630 |
| 4 | ALMOZNINO G， BENOLIEL R， SHARAV Y， et al Sleep disorders and chronic craniofacial pain ： Characteristics and management possibilities［J］. Sleep Med Rev，2017，33：39-50. doi:10.1016/j.smrv.2016.04.005 |
| 5 | WANG Y， JIN Z， XU W， et al.Clinical observation of dexmedetomidine nasal spray in the treatment of sleep disorders on the first night after undergoing maxillofacial surgery： a single-center double-blind randomized controlled study［J］. J Pharm Pharm Sci，2023，26：11699. doi:10.3389/jpps.2023.11699 |
| 6 | ZHOU Y， DU X， WANG Q， et al.Dexmedetomidine Protects against Airway Inflammation and Airway Remodeling in a Murine Model of Chronic Asthma through TLR4/NF-κB Signaling Pathway［J］. Mediators Inflamm，2023，2023：3695469. doi:10.1155/2023/3695469 |
| 7 | WANG J， XIN Y， CHU T， et al. Dexmedetomidine attenuates perioperative neurocognitive disorders by suppressing hippocampal neuroinflammation and HMGB1/RAGE/NF-κB signaling pathway［J］. Biomed Pharmacother，2022，150：113006. doi:10.1016/j.biopha.2022.113006 |
| 8 | SUI X， WANG Y， JIN M， et al. The effects of dexmedetomidine for patient-controlled analgesia on postoperative sleep quality and gastrointestinal motility function after surgery： A prospective， randomized， double-blind， and controlled trial［J］. Front Pharmacol，2022，13：990358. doi:10.3389/fphar.2022.990358 |
| 9 | NIRAJ G， KELKAR A， JEYAPALAN I， et al. Comparison of analgesic efficacy of subcostal transversus abdominis plane blocks with epidural analgesia following upper abdominal surgery［J］. Anaesthesia， 2011，66（6）：465-471. doi:10.1111/j.1365-2044.2011.06700.x |
| 10 | YANG P， LUO Y， LIN L， et al. The efficacy of transversus abdominis plane block with or without dexmedetomidine for postoperative analgesia in renal transplantation. A randomized controlled trial［J］. Int J Surg，2020，79：196-201. doi:10.1016/j.ijsu.2020.05.073 |
| 11 | 袁炳林，黄锡强，李斌飞，等. 不同剂量右美托咪定复合罗哌卡因胸椎旁阻滞用于乳腺癌改良根治术术后镇痛的效果［J］. 实用医学杂志，2021，37（3）：374-378. |
| 12 | FATAH R M N， ABDULRAHMAN B B. A sleep disturbance after total knee arthroplasty［J］. J Family Med Prim Care，2020，9（1）：119-124. doi:10.4103/jfmpc.jfmpc_595_19 |
| 13 | NIKLASSON A， FINAN P H， SMITH M T， et al. The relationship between preoperative sleep disturbance and acute postoperative pain control： A systematic review and meta-analysis［J］. Sleep Med Rev，2025，79：102014. doi:10.1016/j.smrv.2024.102014 |
| 14 | ROSENBERG J. Sleep disturbances after non-cardiac surgery［J］. Sleep Med Rev，2001，5（2）：129-137. doi:10.1053/smrv.2000.0121 |
| 15 | SONG B， CHANG Y， LI Y， et al. Effects of Transcutaneous Electrical Acupoint Stimulation on the Postoperative Sleep Quality and Pain of Patients After Video-Assisted Thoracoscopic Surgery： A Prospective， Randomized Controlled Trial［J］. Nat Sci Sleep，2020，12：809-819. doi:10.2147/nss.s270739 |
| 16 | ONG J L， LO J C， GOOLEY J J， et al. EEG Changes across Multiple Nights of Sleep Restriction and Recovery in Adolescents： The Need for Sleep Study［J］. Sleep，2016，39（6）：1233-1240. doi:10.5665/sleep.5840 |
| 17 | ONG J L， LO J C， GOOLEY J J， et al. EEG Changes Accompanying Successive Cycles of Sleep Restriction With and Without Naps in Adolescents［J］. Sleep，2017，40（4）：zsx030. doi:10.1093/sleep/zsw042 |
| 18 | BANKS S， DINGES D F. Behavioral and physiological consequences of sleep restriction［J］. J Clin Sleep Med，2007，3（5）：519-528. |
| 19 | SJ?VALL S， KOKKI M， KOKKI H. Laparoscopic surgery： a narrative review of pharmacotherapy in pain management［J］. Drugs，2015，75（16）：1867-1889. doi:10.1007/s40265-015-0482-y |
| 20 | SORT R， BRORSON S， G?GENUR I， et al. Peripheral nerve block anaesthesia and postoperative pain in acute ankle fracture surgery： the AnAnkle randomised trial［J］. Br J Anaesth，2021，126（4）：881-888. doi:10.1016/j.bja.2020.12.037 |
| 21 | MARTY P， CHASSERY C， RONTES O， et al. Combined proximal or distal nerve blocks for postoperative analgesia after total knee arthroplasty： a randomised controlled trial［J］. Br J Anaesth，2022，129（3）：427-434. doi:10.1016/j.bja.2022.05.024 |
| 22 | 吴黄兴. 纳布啡复合罗哌卡因腹横肌平面阻滞对腹腔镜全子宫切除术患者术后内脏痛及早期恢复质量的影响［D］. 合肥：安徽医科大学，2024. |
| 23 | 吴南玲，刘苏，王瑶琳，等. 头皮神经阻滞联合右美托咪定泵注对幕上肿瘤切除术患者术后恢复质量的影响［J］. 实用医学杂志，2023，39（8）：1015-1021. |
| 24 | SALMONSEN C B， LANGE K H W， ROTHE C， et al. Cutaneous sensory block area of the ultrasound-guided subcostal transversus abdominis plane block： an observational study［J］. Reg Anesth Pain Med，2024，49（4）：289-292. doi:10.1136/rapm-2023-104753 |
| 25 | BHATIA N， ARORA S， JYOTSNA W， et al. Comparison of posterior and subcostal approaches to ultrasound-guided transverse abdominis plane block for postoperative analgesia in laparoscopic cholecystectomy［J］. J Clin Anesth，2014，26（4）：294-299. doi:10.1016/j.jclinane.2013.11.023 |
| 26 | 宋尧，覃禹翱，夏雪，等. 瑞马唑仑与右美托咪定在超声引导臂丛神经阻滞断指再植术中的麻醉效果比较［J］. 实用医学杂志，2023，39（24）：3243-3248. |
| 27 | YU Y， LI Y， HAN D， et al. Effect of Dexmedetomidine on Posttraumatic Stress Disorder in Patients Undergoing Emergency Trauma Surgery： A Randomized Clinical Trial［J］. JAMA Netw Open， 2023，6（6）：e2318611. doi:10.1001/jamanetworkopen.2023.18611 |
| 28 | LIU Z， JIANG M， XU T， et al. Analgesic effect of Ropivacaine combined with Dexmedetomidine on brachial plexus block［J］. BMC Anesthesiol，2018，18（1）：107. doi:10.1186/s12871-018-0570-0 |
| 29 | ZENG H， YIN F， FAN L， et al. Combination of dexamethasone and dexmedetomidine as adjuvants of transversus abdominis plane block for postoperative analgesia in gastric cancer patients： A double-blinded randomized controlled trial［J］. J Clin Anesth， 2024，97：111543. doi:10.1016/j.jclinane.2024.111543 |
/
| 〈 |
|
〉 |