تغييرات حسي حركتي بيماران تحت عمل جراحي ارتوپدي اندام تحتاني با بي حسي نخاعي به وسيله ي دو - تركيب دارويي دكسمدتوميدين روپيواكائين و فنتانيل روپيواكائين در مقايسه با روپيواكائين تنها: - - يك مطالعه ي كارآزمايي باليني

The Sensory-Motor Changes in Patients Undergoing Lower Limb Orthopedic Surgery with Spinal Anesthesia by Two Drug Combinations of Ropivacaine Plus Dexmedetomidine and Ropivacaine Plus Fentanyl: A Clinical Trial Study

ﻣﻘﺪﻣﻪ: اﯾﻦ ﻣﻄﺎﻟﻌﻪ، ﺑﺎ ﻫﺪف ﺑﺮرﺳﯽ ﺗﻐﯿﯿﺮات ﺣﺴﯽ- ﺣﺮﮐﺘﯽ ﺑﯿﻤﺎران ﺗﺤﺖ ﻋﻤﻞ ﺟﺮاﺣﯽ ارﺗﻮﭘﺪي اﻧﺪام ﺗﺤﺘﺎﻧﯽ ﺑﺎ ﺑﯽ ﺣﺴﯽ ﻧﺨﺎﻋﯽ ﺑﻪ وﺳﯿﻠﻪ ي دو ﺗﺮﮐﯿﺐ داروﯾﯽ دﮐﺴﻤﺪﺗﻮﻣﯿﺪﯾﻦ- ﻓﻨﺎﺗﻨﯿﻞ و دﮐﺴﻤﺪﺗﻮﻣﯿﺪﯾﻦ- روﭘﯿﻮاﮐﺎﺋﯿﻦ اﻧﺠﺎم ﮔﺮﻓﺖ. روش ﻫﺎ: در ﯾﮏ ﻣﻄﺎﻟﻌﻪ ي ﮐﺎرآزﻣﺎﯾﯽ ﺑﺎﻟﯿﻨﯽ، 90 ﺑﯿﻤﺎر ﺗﺤﺖ اﻋﻤﺎل ﺟﺮاﺣﯽ ارﺗﻮﭘﺪي اﻧﺪام ﺗﺤﺘﺎﻧﯽ ﺑﺎ ﺑﯽ ﺣﺴﯽ ﻧﺨﺎﻋﯽ در ﺳﻪ ﮔﺮوه 30 ﻧﻔﺮه ﺗﻮزﯾﻊ ﺷﺪﻧﺪ. ﺑﻪ ﮔﺮوه اول، 4/5 ﻣﯿﻠﯽ ﻟﯿﺘﺮ روﭘﯿﻮاﮐﺎﺋﯿﻦ 0/5 درﺻﺪ اﯾﺰوﺑﺎرﯾﮏ + 5 ﻣﯿﮑﺮوﮔﺮم دﮐﺴﻤﺪﺗﻮﻣﯿﺪﯾﻦ در 0/5 ﺳﯽ ﺳﯽ ﺳﺮم، ﺑﻪ ﮔﺮوه دوم 4/5 ﺳﯽ ﺳﯽ روﭘﯿﻮاﮐﺎﺋﯿﻦ اﯾﺰوﺑﺎرﯾﮏ + 25 ﻣﯿﮑﺮوﮔﺮم ﻓﻨﺘﺎﻧﯿﻞ در 0/5 ﺳﯽ ﺳﯽ ﺳﺮم و ﺑﻪ ﮔﺮوه ﺳﻮم 4/5 ﻣﯿﻠﯽ ﻟﯿﺘﺮ روﭘﯿﻮاﮐﺎﺋﯿﻦ 0/5 درﺻﺪ اﯾﺰوﺑﺎرﯾﮏ اﯾﻨﺘﺮاﺗﮑﺎل در 0/5 ﺳﯽ ﺳﯽ ﺳﺮم ﺗﺰرﯾﻖ ﮔﺮدﯾﺪ و ﺷﺪت درد و وﯾﮋﮔﯽ ﻫﺎي ﺣﺴﯽ- ﺣﺮﮐﺘﯽ ﺑﯿﻤﺎران در ﺳﻪ ﮔﺮوه ﺗﻌﯿﯿﻦ و ﻣﻘﺎﯾﺴﻪ ﺷﺪ. ﯾﺎﻓﺘﻪ ﻫﺎ: ﻣﯿﺎﻧﮕﯿﻦ زﻣﺎن ﺷﺮوع ﺑﻠﻮك ﺣﺴﯽ- ﺣﺮﮐﺘﯽ در ﺳﻪ ﮔﺮوه روﭘﯿﻮاﮐﺎﺋﯿﻦ- دﮐﺴﻤﺪﺗﻮﻣﯿﺪﯾﻦ، روﭘﯿﻮاﮐﺎﺋﯿﻦ-ﻓﻨﺘﺎﻧﯿﻞ و روﭘﯿﻮاﮐﺎﺋﯿﻦ ﺗﻨﻬﺎ، ﺑﻪ ﺗﺮﺗﯿﺐ 3/0 ± 9/1، 3/2 ± 11/2 و 4/3 ± 12/5 دﻗﯿﻘﻪ )0/001 = P( و ﻣﯿﺎﻧﮕﯿﻦ زﻣﺎن ﺑﻠﻮك ﺣﺮﮐﺘﯽ ﻧﯿﺰ در ﺳﻪ ﮔﺮوه ﭘﯿﺶ ﮔﻔﺘﻪ ﺑﻪ ﺗﺮﺗﯿﺐ 3/3 ± 10/9، 5/1 ± 14/7 و 4/8 ± 15/8 دﻗﯿﻘﻪ ﺑﻮد و در ﮔﺮوه درﯾﺎﻓﺖ ﮐﻨﻨﺪه ي دﮐﺴﻤﺪﺗﻮﻣﯿﺪﯾﻦ + روﭘﯿﻮاﮐﺎﺋﯿﻦ، ﮐﻮﺗﺎه ﺗﺮ ﺑﻮد )0/001 < P( ﻧﺘﯿﺠﻪ ﮔﯿﺮي: زﻣﺎن ﺷﺮوع ﺑﻠﻮك ﺣﺴﯽ- ﺣﺮﮐﺘﯽ در ﮔﺮوه ﺗﺤﺖ ﺗﺰرﯾﻖ روﭘﯽ واﮐﺎﺋﯿﻦ- دﮐﺴﻤﺪﺗﻮﻣﯿﺪﯾﻦ، ﮐﻮﺗﺎه ﺗﺮ ﺑﻮد.

Background: The present study aimed to evaluate the sensory-motor changes in patients undergoing lower limb orthopedic surgery with spinal anesthesia by two drug combinations of ropivacaine plus dexmedetomidine and ropivacaine plus fentanyl. Methods: In a clinical trial study, 90 patients underwent lower extremity orthopedic surgery with spinal anesthesia were selected and randomly allocated in three groups of 30. In the first group, 4.5 ml of ropivacaine 0.5% isobaric plus 5 micrograms of dexmedetomidine in 0.5 cc of distilled water, in the second group, 4.5 cc of isobaric ropivacaine plus 25 micrograms of fentanyl in 0.5 cc distillated water, and in the third group, 4.5 ml ropivacaine 0.5% isobaric in 0.5 cc distillated water was injected. The severity of pain and sensory and motor characteristics of patients were determined and compared between the three groups. Findings: The mean time of onset of sensory motor block in the three groups of ropivacaine-dexmedetomidine, ropivacaine-fentanyl and ropivacaine alone was 9.1 ± 3.0, 11.2 ± 3.2, and 12.5 ± 4.3 minutes, respectively (P = 0.001). The mean time of motor block in the three groups was 10.9 ± 3.3, 14.7 ± 5.1, and 15.8 ± 4.8 minutes, and this time was shorter in the groups of ropivacaine-dexmedetomidine (P < 0.001). Conclusion: The onset of sensory and motor block was shorter in the ropivacaine-dexmedetomidine group.