我们进行这项双盲随机对照试验，旨在探讨地塞米松与右美托咪定联合作为腹横肌平面（TAP）阻滞的佐剂是否可以改善胃癌患者的镇痛效果和持续时间。随机对照试验。麻醉后恢复室和病床病房。共纳入312例成年胃癌患者（每组104例）。患者接受双侧肋下TAP阻滞，采用三种不同的麻醉剂（60ml 0.25%罗哌卡因加10mg地塞米松和1μg·kg） -1 右美托咪定 [A] 或 10 mg 地塞米松 [B] 或 1 μg·kg-1 右美托咪定 [C])。主要结局是运动时 24 小时中度至重度疼痛的发生率。次要结局包括中度至重度疼痛的发生率、疼痛评分、阿片类药物使用、恢复质量和不良事件。A 组术后 24 小时中度至重度运动疼痛的发生率显着低于 B 组（45.19%）对比 63.46%；RR 0.71；95% CI，0.55 至 0.92）和 C 组（45.19% 对比 73.08%，RR 0.62；95% CI，0.49 至 0.79）。 24 小时时，中位移动疼痛评分显着下降（3.00 [3.00,5.00] vs 4.00 [3.00,6.00] vs 4.00 [3.00,5.00]；P < 0.001）。前 24 小时内阿片类药物的消耗量（27.5 [17.0,37.2] vs 30.0 [20.0,42.0] vs 32.0 [25.0,44.0] mg；P = 0.01）和首次救援镇痛的持续时间存在显着差异（65.5 ± 26.7 vs 45.9 ± 34.5 vs 49.2 ± 27.2 h；P = 0.04）。与地塞米松和右美托咪定联合作为 TAP 阻滞佐剂可降低中度至重度疼痛的发生率以及 24 小时运动和休息时的疼痛评分延长胃癌手术后首次救援镇痛的持续时间。ChiCTR2000037981。版权所有 © 2024 Elsevier Inc. 保留所有权利。

We conducted this double-blinded randomized controlled trial to examine whether the combination of dexamethasone and dexmedetomidine as adjuvants of transversus abdominis plane (TAP) block could improve analgesia efficacy and duration for gastric cancer patients.Randomized controlled trial.The preoperative area, operating room, postanesthesia recovery room and bed ward.A total of 312 adult patients (104 per group) with gastric cancer were included.Patients received bilateral subcostal TAP block with three different anesthetics (60 ml 0.25% ropivacaine added with 10 mg dexamethasone and 1 μg·kg-1 dexmedetomidine [A] or 10 mg dexamethasone [B] or 1 μg·kg-1 dexmedetomidine [C]).The primary outcome was the incidence of moderate-to-severe pain 24 h on movement. Secondary outcomes included incidence of moderate-to-severe pain, pain score, opioids use, recovery quality and adverse events.The incidence of moderate-to-severe pain on movement 24 h postoperatively of group A was significantly lower than group B (45.19% vs 63.46%; RR 0.71; 95% CI, 0.55 to 0.92) and group C (45.19% vs 73.08%, RR 0.62; 95% CI, 0.49 to 0.79). The median moving pain scores decreased significantly at 24 h (3.00 [3.00,5.00] vs 4.00 [3.00,6.00] vs 4.00 [3.00,5.00]; P < 0.001). There were significant differences in the opioids consumption within the first 24 h (27.5 [17.0,37.2] vs 30.0 [20.0,42.0] vs 32.0 [25.0,44.0] mg; P = 0.01) and the duration to first rescue analgesia (65.5 ± 26.7 vs 45.9 ± 34.5 vs 49.2 ± 27.2 h; P = 0.04).The combination with dexamethasone and dexmedetomidine as adjuvants for TAP block reduced the incidence of moderate-to-severe pain and pain score both on movement and at rest at 24 h with prolonged duration to first rescue analgesia after gastric cancer surgery.ChiCTR2000037981.Copyright © 2024 Elsevier Inc. All rights reserved.