布托啡诺超前镇痛对罗哌卡因臂丛阻滞效果影响的临床评价

Effects of Butorphanol preempitive analgesia on brachial plexus block with Ropivacaine

目的评价布托啡诺超前镇痛对罗哌卡因臂丛阻滞效果的影响。方法选择80例拟行前臂与手部手术的成年男性患者,ASAⅠ、Ⅱ级。随机分为四组(n=20),每组均用4mg/ml罗哌卡因40mL作腋路臂丛神经阻滞,各组局麻药均不加肾上腺素。A组:对照组,臂丛神经阻滞前5min静注安慰剂。B组、C组、D组分别在臂丛神经阻滞前5min静注布托啡诺0.5mg、1mg、2mg。在麻醉后5、10、15、20、30、45、60min对麻醉质量进行评价,记录麻醉起效时间、麻醉维持时间、手术时间、围术期各时间点的疼痛评分、不良反应发生率。结果麻醉维持时间A组略短于B组,但两组比较差异无显著性(P>0.05);C组、D组明显长于A组、B组(P<0.01)。术后8h、12h、24h时疼痛评分(VAS),A组、B组高于C组、D组(P<0.01)。C组、D组辅助用药量明显低于A组和B组。结论布托啡诺超前镇痛效果确切,能够增强罗哌卡因臂丛神经阻滞效果,延长术后镇痛时间,不良反应发生率低,值得临床采用。

[Objective] To evaluate the clinical effects of Butorphanol preempitive analgesia on brachial plexus block with Ropivacaine. [Methods] Eighty adult male patients（ASA Ⅰ, Ⅱ ） undergoing forearm or hand surgery were divided randomly into four groups. Every group received 4 mg/mL Ropivacaine 40 mL in axillary approach brachial plexus block. Group A （control group） intravenous injected the patient with placebo before 5 min brachial plexus block. Group B, group C and group D （test group） respectively intravenously injected the patient with Butorphanol 0.5 mg, 1 mg and 2 mg before 5 min brachial plexus block. All bloks were performed by the same anaesthetist. The degree of nerve blockade was evaluated at 5, 10, 15, 20, 30, 40 and 60 min after local anesthtic infusion. The onset time of both feeling and motor block;the duration time of nerve blockade; intra- and postoperative VAS （the visual analogue scale） scores,complications and side effects were recorded. [Results] The duration of nerve blockade in group B was longer than that in group A （P 〉0.05）, The duration of nerve blockade in group C and D was obviously longer than that in group A and B （P 〈0.01）. At the same time, the scores of VAS at postoperative 8 h, 12 h, 24 h in group A and B was higher than that in group C and D （P 〈0.01）. The dosage of adjuvant in group C and D was less than that in group A and B. [Conclusion] The effect of Butorphanol preempitive analgesia on brachial plexus block is confirmed. It can potentiate the effects of nerve block and prolong the time of postoperative analgesia and little side-effect, deserve the clinic adoption.