左旋布比卡因行腰丛联合坐骨神经阻滞用于膝关节镜手术麻醉的临床研究

Clinical research on the effects of levobupivacaine on combined lumbar plexus and sciatic nerve block for knee arthroscopy

目的:探讨左旋布比卡因行腰丛联合坐骨神经阻滞用于膝关节镜手术的麻醉效果。方法:选择80例择期行单侧膝关节镜手术患者并随机分为4组,0.5%左旋布比卡因组(L1组,n=20),0.375%左旋布比卡因组(L2组,n=20),0.5%罗哌卡因组(R1组,n=20)和0.375%罗哌卡因组(R2组,n=20)。施行神经刺激器定位下腰丛联合坐骨神经阻滞。观察各组患者术前、手术开始、手术30min,术毕时的平均动脉压、心率。观察患者感觉和运动阻滞起效时间和维持时间,以及麻醉满意度。结果:L1及L2组感觉及运动阻滞起效时间明显短于R1及R2组(P<0.05)。L1组感觉及运动阻滞维持时间明显长于其他3组(P<0.05),L2组感觉和运动阻滞维持时间与R1组无显著性差异(P>0.05),但显著长于R2组(P<0.05)。结论:左旋布比卡因行腰丛联合坐骨神经阻滞用于膝关节镜手术麻醉起效快,维持时间长,适合于麻醉要求,推荐药物浓度为0.375%。

Objective： To study the effects of levobupivacaine for combined lumbar plexus and sciatic nerve block for knee arthroscopy . Methods; 80 patients scheduled for knee arthroscopy surgery were randomly divided into 4 groups （n = 20 each）： group L1 received 0. 5% levobupivacaine, group L2 received 0. 375% levobupivacaine, group R1 received 0. 5% ropivacaine and group R2 received 0. 375% ropivacaine. The combined lumbar plexus and sciatic nerve block were performed with the help of nerve stimulator. The MAP and HR were observed during the operation. The onset time and duration of sensory and motor block were recorded. The patients＇ satisiactlon was evaluated as well. Results ： The onset time of sensory and of motor block in group L1 and L2 was much shorter than that of group R1 and R2 （P〈0. 05）. The duration of sensory and of motor block in group L1 was longer than those of the other 3 groups （P〈0.05）. There was no significant difference in the duration of sensory and motor block between group L2 and RL （P〉0.05）, while the duration of sensory and of motor block between group L2 was longer than that of group R2 （P〈0.05）. Conclusion.. Levobupivacaine for combined lumbar plexus ahd sciatic nerve block is quick in its effect and long in duration, thus qualified for anesthesia of knee arthroscopy. We recommend the concentration of 0. 375 % for the practical use of levobupivacaine in clinic.