不同浓度罗哌卡因术后臂丛神经镇痛效果的观察

Observation for antalgic effects of ropivacaine to brachial plexus nerves

目的比较三种不同浓度罗哌卡因伍用吗啡和利多卡因用于上肢手术后臂丛神经镇痛的效果。方法90例择期上肢手术病人随机分为0.30%罗哌卡因组(Ⅰ组)(含罗派卡因75 mg、吗啡1 mg、利多卡因200 mg、生理盐水15m l),0.25%罗派卡因组(Ⅱ组)(含罗派卡因75 mg、吗啡1 mg、利多卡因200 mg、生理盐水20 m l),20%罗哌卡因组(Ⅲ组)(含罗派卡因75 mg、吗啡1 mg、利多卡因200 mg、生理盐水25 m l),术后臂丛神经镇痛(PCRA)负荷剂量15 m l,总剂量15 m l/24h,镇痛时间约50 h。以VAS评分比较三组术后PCRA镇痛效果,B rom age评分评定运动阻滞情况。结果术后6、12、24、48h VAS评分,Ⅲ组显著高于Ⅰ、Ⅱ组,B rom age评分Ⅰ组显著高于Ⅱ、Ⅲ组。无明显不良反应。结论0.25%罗哌卡因复合吗啡和利多卡因对上肢手术病人术后镇痛效果确切,适合临床应用。

Objective To compare the antalgic effects of ropivacaine in various doses to brachial plexus nerves. Methods ninety patients undergoing elective upper arm surgery were enrolled in this study. The patients were unpremeditated. The patients were randomized to receive Ropivacaine of 0. 375, 0.25 or 0.20% （ Group Ⅰ ,.Ⅱ and Ⅲ） with Morphine of 0.1 mg/ml and Lidocaine of 10 mg/ml. In order to antalgic of brachial plexus nerves, the rejecting of load dose is firstly 10ml, the total dose is 10ml/24h interval every time, the antalgic time of effective is about 50 hours. To compare the antalgic effects of ropivacatine in various doses basing on standard of VAS. Basing on standard of Bromage assess the situation of motor neuron blocking. Results in according to standard of VAS in 6, 12,24 and 48 hours after underwent surgery, the Group Ⅲ is obviously antalgic more effective than Group Ⅰand Group Ⅱ ; in according to standard of Bromage, the Group Ⅰ is obviously antalgic more effective than Group Ⅱ and Group Ⅲ. It is not adverse reactions to drug of patients. Conclusion 0.20% of ropivacaine with morphine of 0.1 mg/ml and Lidocaine of 10 mg/ml have obtained good antalgic effects for patients after undergoing upper arm surgery,it is fit for applying in chnic.