3种浓度罗哌卡因用于肌间沟臂丛阻滞麻醉的临床观察

Clinical observation on the intersclance brachial plexus block anesthesia with three concentrations of ropicaine

目的借助神经刺激器定位肌间沟臂丛阻滞,观察3种浓度罗哌卡因的阻滞效果和不良反应,为临床寻找一种合适浓度配方。方法选择行上肢手术的成人患者60例,随机分为3组,每组20例。A、B、C3组分别采用0·25%、0.375%和0.5%3种浓度罗哌卡因各30ml。采用神经刺激器定位肌间沟臂丛神经阻滞麻醉。观察感觉神经阻滞时间、运动阻滞时间及阻滞程度、镇痛持续时间、不良反应。结果与A组比较,B组和C组感觉神经阻滞时间延长差异有显著性(P<0.05),C组运动阻滞时间延长和镇痛持续时间差异有显著性(P<0.05),B组和C组运动阻滞程度明显增强(P<0.01)。A组有3例术中有疼痛不适,需要用杜冷丁镇痛,B组发生1例霍纳氏综合征,C组发生3例霍纳氏综合征和2例呼吸困难,经面罩吸氧1h后缓解。未发生其它并发症。结论借助神经刺激器定位肌间沟臂丛阻滞,3种浓度罗哌卡因均可满足手术的要求,但0.375%罗哌卡因更适合于肌间沟臂丛阻滞麻醉。

Objective To observe the properties of three concentration of ropivacaine to find a best concentration of ropivacaine suitable for interscalence brachial plexus block with nerves stimulator. Methods Sixty adult patients undergoing upper limb surgery were randomly divided into 3 groups (each consisted of 20 patients):group A and B and C separately receiving 0.25%,0.375%,0.5%ropivacaine 30 ml in interscalence brachial plexus block with nerves stimulator. The onset time of sensory and motor block ,the degree of motor block ,analgesia maintenance time were recorded. Results The onset time of sensory block was significantly longer in group B and C(P<0.05);the onset time of motor block and analgesia maintenance time in group C was significantly longer (P< 0.05),the degree of motor block was significantly increased in group B and C (P< 0.01). Conclusion 0.375%ropicaine is more suitable for interscalence brachial plexus.