维拉帕米和/或吗啡用于臂丛阻滞辅助镇痛的研究

VERAPAMIL AND/OR MORPHINE FOR SUPPLEMENTARY ANALGESIA IN BRACHIAL PLEXUS BLOCK

目的 :研究维拉帕米和 /或吗啡用于臂丛阻滞辅助镇痛效应。方法 :选择ASAⅠ～Ⅱ级上肢择期手术成年患者 4 8例 ,随机分为四组 :Ⅰ组 (对照组 )应用 1%利多卡因溶液 ;Ⅱ组 (吗啡组 )应用含有吗啡 5mg的 1%利多卡因溶液 ;Ⅲ组 (维拉帕米组 )应用含有维拉帕米 5mg的 1%利多卡因溶液 ;Ⅳ组 (吗啡和维拉帕米组 )应用含有维拉帕米 5mg和吗啡 5mg的 1%利多卡因溶液。每位患者均接受 1%利多卡因 4 0ml(内含 5 μg/ml肾上腺素 )腋路臂丛阻滞。结果 :四组患者感觉阻滞起效时间、术后各时点疼痛视觉模拟评分 (VAS)无显著性差异 (P >0 .0 5 ) ;臂丛阻滞液中应用吗啡的患者术后镇痛维持时间明显延长 (P <0 .0 1) ,而应用维拉帕米的患者麻醉维持时间延长 (P <0 .0 5 )。结论 :臂丛阻滞液中应用吗啡能增加术后镇痛维持时间 ,而应用维拉帕米能延长麻醉维持时间 ,但对术后镇痛无意义。

Objective: To investigate the supplementary analgesic effects of verapamil and/or morphine used in brachial plexus block. Methods: Fourty eight ASA gradeⅠ～Ⅱ patients undergoing selective upper limbs operation were randomly divided into four groups (n=12): GroupⅠ (Control group) received 1% lidocaine solution; GroupⅡ(Morphine group) received 1% lidocaine solution containing morphine 5mg; GroupⅢ (Verapamil group) received 1% lidocaine solution containing verapamil 5mg; Group Ⅳ (Morphine and Verapamil group) received 1% lidocaine solution containing morphine 5mg and verapamil 5mg. All patients received axillary brachial plexus block with 40 ml of 1% lidocaine solution and 5μg/ml epinephrine. Results: There were no significant stastistic differences among four groups with respect to the onset time of sensory block or visual analog score (VAS) at all postoperative time intervals. The duration of postoperative analgesia was significantly prolonged in patients receiving brachial plexus blocks with morphine (GroupⅡ and Ⅳ ) ( P <0.01). The duration of anesthesia was significantly prolonged in those patients receiving brachial plexus blocks with verapamil (Group Ⅲ and Ⅳ) ( P <0.05). Conclusion: Adding morphine into the anesthetic solution for brachial plexus block could prolong the duration of postoperative analgesia. Although adding verapamil into the anesthetic solution of brachial plexus block could prolong the duration of anesthesia, it had no effect on the duration of analgesia.