布托啡诺合用罗派卡因对经锁骨下入路臂丛阻滞效果的影响

Effects of Butorphanol on Infraclavicular Brachial Plexus Block with Ropivacaine

目的:观察不同剂量布托啡诺合用罗派卡因对锁骨下臂丛神经阻滞效果、麻醉维持时间、术后镇痛等方面的影响。方法:120例成年患者,随机分成4组,每组30例均用0.5%罗派卡因30mL(含1:200000肾上腺素)。其中,A组无布托啡诺,B组、C组和D组分别在局麻药中加入布托啡诺0.5mg、1mg、2mg。然后分别记录各组患者麻醉起效时间、麻醉维持时间以及术后镇痛维持时间。结果:麻醉的起效时间各组间无显著差异(P>0.05)。麻醉维持时间C组、D组明显长于A组和B组(P<0.01);在术后的8h、12h、24h、36h时,A组和B组的视觉模拟疼痛评分明显高于C组和D组(P<0.01)。恶心、呕吐及头晕的发生率D组明显大于其它分组。结论:不同剂量的布托啡诺合并罗派卡因行锁骨下入路臂丛神经阻滞,在不同程度上增强了麻醉效能和术后的镇痛效能,尤其是加入布托啡诺1mg时,既能获比较满意的镇痛效果,患者又无明显的不良反应。

Objective：To evaluate the clinical effects of butorphanol on infraclavicular brachial plexus block with ropivacaine.Methods：120 adult patients（ASAⅠ-Ⅱ） undergoing forearm or hand surgery were divided randomly into four groups.Every group was received 0.5%ropivacaine 30ml in infraclavicular brachial plexus block with PNS.Group B,group C and group D were also received butorphanol 0.5mg,1.0mg,2.0mg with ropivacaine in brachial plexus block except group A.The degree of nerve blockade was evaluated at 5,10,15,20,30 min after local anesthetic infusion.The onset time,the duration time of nerve blockade and intra-and postoperative VAS scores,side effects were recorded by another doctor.Results：The onset time of both four groups has no difference（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）.And the scores of VAS at postoperative 8h,12h,24h,36h in group A ang B was higher than that in group C and D（P〈0.01）.But the side effects in group D were more popular than anyother groups.Conclusion：The effect of butorphanol on infraclavicular brachial plexus block with ropivacaine is beneficial.It can prolong the time of postoperative analgesia obviously.Especially with the dosage in 1mg.