左旋布比卡因用于腋路臂丛神经阻滞的疗效观察

Effect of Levobupivacaine in Axillary Brachial Plexus Block

目的观察左旋布比卡因40ml用于腋路臂丛神经阻滞的临床效果。方法ASAⅠⅡ级60例拟行肘以下骨科手术患者,随机分为左旋布比卡因组(LB组n=30)和布比卡因组(B组n=30),两组臂丛用药分别为0.375%左旋布比卡因或0.375%布比卡因40ml(150mg)。记录注药后15、30min感觉及运动阻滞效果、术后24h感觉阻滞持续时间及运动完全恢复时间、病人的总体满意度和术中不良反应。结果两组注药后15min感觉及运动阻滞效果比较无显著性差异(P>0.05);注药后30min,LB组感觉阻滞完善(Ⅲ级)的病例数明显增加(P<0.01),而且肘关节活动曲伸活动完全无力(Ⅲ级)的病例(47%)比B组(67%)低(P<0.01);LB组和B组感觉阻滞持续时间为(17.2±7.1)h及(18.9±7.3)h,运动阻滞完全恢复时间为(20.2±8.2)h及(20.5±8.4)h,两组比较无显著性差异(P>0.05);在术中LB组和B组需加用局部浸润的病例分别为4例、2例。两组比较无显著性差异(P>0.05),两组各有1例因为药物阻滞时间过长感到不适,其它病例对麻醉效果均感到满意,未发现局麻药中毒等不良反应。结论腋路臂丛神经阻滞中使用0.375%左旋布比卡因40ml,其作用与同容量的布比卡因相似。

Objective: To observe the effect of levobupivacaine in axil la ry brachial plexus block. Methods:In 60 patients scheduled for hand and forearm surgery,a perivascular axillary brachial block was performed with 40 ml(150 mg)o f 0.375% of either levobupivacaine or bupivacaine.Sensory and motor block were s cored.The patients were interviewed in the following morning. Time to normal fun ction of the arm was registered.Results:After similar onsets of sensory block,th e sum of completely anaesthetized innervation areas of the four main nerves at 3 0 min was greater in the levobupivacaine group than in the bupivacaine group(P <0.01).Simultaneously,complete motor block at the elbow was more frequent in t he bupivacaine group (67%)than that in the levobupivacaine group (47%)(P<0.0 1).Mean duration of the blocks was similar in the bupivacaine and levobupivacain e groups at 18.9 h and 17.2 h respectively.Two patients(one in the levobupivacai ne group and the other in the bupivacaine group) were dissatisfied with the long block duration.Conclusion:Levobupivacaine at 40 ml(150 mg)of 0.375% could produ ce slightly better sensory block intensity than bupivacaine at the same dose. Ge neral success in relation to surgery and in the duration of blocks was similar i n the two groups.