1、p鎮(zhèn)痛p鎮(zhèn)靜p精準(zhǔn)麻醉p可視化操作p刺激交感系統(tǒng)p增加心肌氧耗p延緩患者自主活動(dòng)恢復(fù)p改變免疫系統(tǒng)p誘發(fā)慢性疼痛 2 2 Agonists: Chemical StructuresAgonists: Chemical StructuresNNHNClClDexmedetomidineClonidineCH3CH3NNCH3Hq高效、高選擇性和特異性高效、高選擇性和特異性的的 2 2受體激動(dòng)劑受體激動(dòng)劑q抑制交感神經(jīng)活性抑制交感神經(jīng)活性q鎮(zhèn)靜、催眠和麻醉作用鎮(zhèn)靜、催眠和麻醉作用q鎮(zhèn)痛作用鎮(zhèn)痛作用p藍(lán)斑是大腦內(nèi)負(fù)責(zé)調(diào)解覺醒與睡眠的關(guān)鍵部位p藍(lán)斑是下行延髓- 脊髓去甲腎上腺素能通路的起源，其在傷害性

2、神經(jīng)遞質(zhì)的調(diào)控中起重要作用l2-受體激動(dòng)劑作用于去甲腎上腺素能神經(jīng)元突觸前膜2-受體，減少去甲腎上腺素釋放，從而產(chǎn)生鎮(zhèn)靜作用。 2 2 激動(dòng)劑激動(dòng)劑初級(jí)傳入纖維初級(jí)傳入纖維皮層皮層丘腦丘腦中腦中腦延髓延髓p鎮(zhèn)痛作用的位點(diǎn)可能位于脊髓，脊髓中存在腎上腺素能下行抑制系統(tǒng)。2-受體激動(dòng)劑激動(dòng)脊髓背角2-受體，產(chǎn)生鎮(zhèn)痛作用。 p作用于中樞，抑制交感神經(jīng)發(fā)放沖動(dòng)，從而使血壓下降、心率減慢。p作用于外周血管平滑肌的2B-受體，可使血管收縮，出現(xiàn)一過性的血壓升高，小劑量緩慢注射可避免這一現(xiàn)象的出現(xiàn)。 p呼吸系統(tǒng) 無明顯呼吸抑制p腎臟功能 利尿作用p內(nèi)分泌系統(tǒng) 減少去甲腎上腺素、胰島 素、皮質(zhì)醇的釋放。pDE

3、X作為關(guān)節(jié)腔的注射用藥在術(shù)后鎮(zhèn)痛中的應(yīng)用pDEX作為神經(jīng)阻滯的復(fù)合用藥在術(shù)后鎮(zhèn)痛中的應(yīng)用pDEX作為阿片類藥物的輔助用藥術(shù)后鎮(zhèn)痛中的應(yīng)用Sixty patients ， double-blind placebo controlled . control group: i.v. 20ml saline and intra-articular 20ml saline the intra-articular group: i.v. 20ml saline and intra-articular 20ml saline+dexmedetomidine1ug/kg the i.v. group : i.

4、v. 20ml saline+dexmedetomidine1ug/kg and intra-articular 20ml saline. significant reduction in pain scores for 6 h after operation in the intra-articular group but only for 1 h in the i.v. group. The time to first postoperative analgesic request was longer in the intra-articular group 312.0 (SD 120.

5、7) min compared with the control group 71.0 (50.1) min and the i.v. group 102.1 (54.4) min (P0.001). total diclofenac requirement was significantly lower in the intra-articular group 90.0 (46.2) mg than in the control group 165.0 (52.2) mg and in the i.v. group 129.3 (54.3) mg (P4. Time of first ana

6、lgesia request and total rescue analgesic used in 24 hours were calculated.RESULTS: Time for requirement of first postoperative rescue analgesia in Group A was 380.61 22.973 min, in Group B was 326.82 17.131 min and in Group C was 244.09 20.096 minutes. Total rescue analgesia requirement was less in

7、 Group A (1.394 0.496) compared to Group B (1.758 0.435) and Group C (2.546 0.546). Group A had higher mean VAS score at 6(th) and 24(th) postoperative hours. No side effects found among the groups.CONCLUSION: intra-articular ropivacaine gives better postoperative pain relief increased time of first

8、 analgesic request decreased need of total postoperative analgesia compared to fentanyl and dexmedetomidine.There was also evidence of a decrease in pain intensity at 24 h; the weighted mean difference was -0.7 cm (-1.2 to -0.1) on a 10-cm visual analog scale with clonidine and -0.6 cm (-0.9 to -0.2

9、) with dexmedetomidine. There was also evidence of a decrease in pain intensity at 12 h; the weighted mean difference was -1.5 cm (-2.1 to -1.0) on a 10-cm visual analog scale with clonidine and -1.4 cm (-2.7 to -0.2) with dexmedetomidine at 1h . The incidence of early nausea was decreased with both

10、 (number needed to treat, approximately nine). Clonidine increased the risk of intraoperative (number needed to harm, approximately nine) andpostoperative hypotension (number needed to harm, 20). Dexmedetomidine increased the risk of postoperative bradycardia (number needed to harm, three). R CONCLU

11、SIONS:Perioperative systemic 2 agonists decrease postoperative opioid consumption, pain intensity, and nausea. Recovery times are not prolonged. Common adverse effects are bradycardia and arterial hypotension. The impact of 2 agonists on chronic pain or hyperalgesia remains unclear because valid dat

12、a are lacking.METHODS:double-blinded, randomized, controlled study, 100 women undergoing abdominal total hysterectomy were allocated Group M： receive either morphine 1 mg /ml Group D: morphine 1 mg/ ml plus dexmedetomidine 5 ug /ml postoperative i.v. PCA, which was programmed to deliver 1 ml per dem

13、and with a 5 min lockout interval and no background infusion. Cumulative PCA requirementspain intensitiescardiovascular and respiratory variables PCA-related adverse events were recorded for 24 h after operation.Compared with Group M, patients in Group D required 29% less morphine during the 0-24 h

14、postoperative period and reported significantly lower pain levels from the second postoperative hour onwards and throughout the study. decreases in heart rate from presurgery baseline at 1, 2, and 4 h after operation were significantly greater in Group D (by a range of 5-7 beats min(-1) respectively

15、).decreases in mean blood pressure from presurgery baseline at 1, 2, and 4 h after operation were significantly greater in Group D (by a range of 10-13%, respectively).Whereas levels of sedation were similar between the groups at each observational time point, The 4-24 h incidence of nausea was sign

16、ificantly lower in Group D (34% vs 56.3%, P0.05). There was no bradycardia, hypotension, oversedation, or respiratory depressionCONCLUSIONS:The addition of dexmedetomidine to i.v. PCA morphine resulted in superior analgesia significant morphine sparing less morphine-induced nausea devoid of addition

17、al sedation and untoward haemodynamic changes.PATIENTS:One hundred and twenty parturients (American Society of Anesthesiologists class 1 or 2) scheduled for elective caesarean delivery under spinal anaesthesia randomly allocated into three groups (n=40 each).INTERVENTIONS:Group 1: physiological sali

18、ne bolus after delivery and sufentanil PCA, Group 2: dexmedetomidine bolus (0.5gkg) after delivery and sufentanil PCAGroup 3: dexmedetomidine bolus (0.5gkg) after delivery and sufentanil with dexmedetomidine PCA (background infusion of 0.045gkgh with a bolus of 0.07gkg).PTh and PTTh were significant

19、ly increased 1h after drug administration in groups 2 (1.590.45, 2.570.46mA) and 3 (1.740.37, 2.560.48mA) compared with group 1 (1.490.49, 2.420.62mA) (P0.05). Sufentanil consumption in group 3 was 43.919.2g, significantly lower than in group 1 (54.523.9g) and group 2 (56.320.6g) (P0.05). Compared w

20、ith group 3, VAS was increased at 4, 8 and 24h after surgery in groups 1 and 2 (P0.05); there was no difference between groups 1 and 2 *Proc (Bayl Univ Med Cent). 2014 Jan;27(1):3-10.METHODS:Thirty-eight thoracotomy patients were administered dexmedetomidine intraoperatively and overnight postoperat

21、ively and then randomized to receive placebo or dexmedetomidine titrated from 0.1 to 0.5 gkgh(-1) the day following surgery for up to 24 hours on a telemetry floor. Opioids via a patient-controlled analgesia pump were available for both groups, and vital signs including transcutaneous carbon dioxide

22、, pulse oximetry, respiratory rate, and pain and sedation scores were monitored. .The dexmedetomidine group used 41% less opioids but achieved pain scores equal to those of the placebo group. The mean respiratory rate and oxygen saturation were similar in the two groups. Mild hypercarbia occurred in

23、 both groups, but periods of significant respiratory depression were noted only in the placebo group. Significant hypotension was noted in one patient in the dexmedetomidine group in conjunction with concomitant administration of a beta-blocker agent. The placebo group reported a higher number of op

24、ioid-related adverse events. 結(jié)果4*Evaluation of dexmedetomidine and postoperative pain management in patients with adolescent idiopathic scoliosis: conclusions based on a retrospective study at a tertiary pediatric hospital.Jones JS1, Cotugno RE, Singhal NR, Soares N, Semenova J, Nebar S, Parke EJ, S

25、hrader MW, Hotz J. Pediatr Crit Care Med. 2014 Jul;15(6):e247-52. 結(jié)果4*DESIGN: This was a retrospective chart review. Patients were separated into two groups: those that received opioid via patient-controlled analgesia pain therapy alone those that received opioid via patient-controlled analgesia pai

26、n therapy with dexmedetomidine.PATIENTS: One hundred sixty-three children with adolescent idiopathic scoliosis.*MEASUREMENTS AND MAIN RESULTS: Measurements included patient demographics, American Society of Anesthesiologists Physical Status Classification System, levels of spinal fusion, length of h

27、ospital stay, complications, numeric pain scores, opioid requirement, elastomeric pain pump use, length of time until ambulation, adverse effects, and naloxone use. Data were collected through the first 72 hours of the perioperative period. One hundred six patients received opioids via patient-contr

28、olled analgesia therapy with dexmedetomidine and 57 received opioids via patient-controlled analgesia alone.Within the groups, there were 46 patients who received local anesthetic infusions via elastomeric pumps in the patient-controlled analgesia with dexmedetomidine group and 16 patients had pumps

29、 in the patient-controlled analgesia-alone group. There was no overall difference in postoperative use of morphine (or equivalents) between the two groups. However, the use of elastomeric pain pumps demonstrated a statistically significant decrease in mean overall opioid consumption (42.6 mg vs 63.1

30、 mg, p 0.001).*CONCLUSIONS: There was no difference in opioid use related to dexmedetomidine on any postoperative day. The only variable showing a significant opioid sparing effect was the use of local anesthetic infusions via elastomeric pumps. Using continuous local anesthetic infusions instead of

31、 dexmedetomidine could eliminate the need for ICU admission, require shorter hospital stays, and reduce costs while still providing safe and effective pain control.*Comparison of patient-controlled analgesia with and without dexmedetomidine following spine surgery in children.Sadhasivam S1, Boat A,

32、Mahmoud M.J Clin Anesth. 2009 Nov;21(7):493-501*DESIGN: Retrospective comparison.SETTING: University-affiliated childrens hospital.MEASUREMENTS: The medical charts of 131 children with idiopathic scoliosis (IS) and NMS who had major spine surgery were reviewed. Out of 131, postoperatively 94 children received PCA with morphine alone (PCA group) and the remaining 37 children received