Abstract: Objective To evaluate the clinical outcome of TAP block by adding dexmedetomidine as an adjuvant in patients with liver cancer surgery. Methods A total of 60 patients undergoing elective open liver carcinoma resection were enrolled, and were randomly divided into three groups （20 cases in each）, including group R, group D0.5 and group D1.0, according to the dose of dexmedetomidine mixed into local anesthetic solution used for TAP block. All patients underwent bilateral subcostal TAP block under local anesthesia guided by ultrasound. 40 mL 0.5% ropivacaine was injected into the TAP in group R; 40 mL 0.5% ropivacaine mixed with 0.5 μg/kg dexmedetomidine was injected in group D0.5; 40 mL 0.5% ropivacaine mixed with 1.0 μg/kg dexmedetomidine was injected in group D1.0. After TAP block completion, the onset time, duration, Narcotrend Index and hemodynamics were recorded. Recovery time, dosage of analgesic and incidence of complications were compared between groups. Results The onset time of TAP block in group R, group D0.5 and group D1.0 was 13.1±2.9 min,11.6±2.3 min,7.7±2.1 min, respectively, with significant difference between any two groups （P<0.05）. The duration of TAP block in group R, group D0.5 and group D1.0 was 10.7±3.0 h, 13.6±3.1 h,17.3±4.2 h, respectively, with significant difference between any two groups （P<0.05）. Narcotrend Index, arterial pressure and heart rate in group D0.5 or group D1.0 were lower than those of group R （P<0.05）, with those of group D1.0 lower than those of group D0.5 （P<0.05）. The recovery time was not significantly different among the three groups. The dosage of postoperative analgesic within 48 h in group D1.0 was lower than that of group R or group D0.5 （P<0.05）, with no difference between group R and group D0.5. All patients enrolled didn't suffer any complications related to TAP block. Conclusion Mixed with local anesthetic, dexmetomidine can accelerate the onset time and prolong the duration of TAP block, and also play the role of sedation and stabling circulation through it's absorption into blood.

Key words: dexmedetomidine, TAP block, liver cancer surgery, clinical outcome

摘要： 目的 评估右美托咪定作为佐剂用于肝癌手术患者腹横肌平面（TAP）阻滞的临床效果。方法 选择择期行开腹肝癌切除术患者60例,根据局麻药液中右美托咪定剂量的大小,随机分为R、D0.5和D1.0三组,每组20例。所有患者均在局麻下行超声引导双侧肋缘下TAP阻滞,R组注入0.5%罗哌卡因40 mL,D0.5组注入等量的局麻药和右美托咪定0.5 μg/kg,D1.0组注入等量的局麻药和右美托咪定1.0 μg/kg。观察TAP阻滞的起效时间、持续时间、患者意识深度（NI）和血流动力学的变化,记录术后苏醒速度、镇痛药用量和并发症的发生情况。结果 R、D0.5、D1.0三组TAP阻滞的起效时间分别为13.1±2.9 min、11.6±2.3 min、7.7±2.1 min,持续时间分别为10.7±3.0 h、13.6±3.1 h、17.3±4.2 h,以上指标组间两两比较有统计学差异（P<0.05）。TAP阻滞后,三组的NI、平均动脉压和心率的变化趋势一致：D1.0组<D0.5组<R组（P<0.05）;但三组的术后苏醒速度无统计学差异。D1.0组术后48小时内的镇痛药用量少于D0.5组和R组（P<0.05）,D0.5组和R组之间无统计学差异。所有患者均未发生TAP阻滞相关并发症。结论 右美托咪定与局麻药混合后用于TAP阻滞能加快起效和延长作用时间,同时通过右美托咪定的缓慢吸收入血而发挥镇静和稳定循环的作用。

关键词: 肝癌手术, TAP阻滞, 临床效果, 右美托咪定