相同剂量不同浓度罗哌卡因用于肌间沟臂丛阻滞观察

Observation of the intersclance brachial plexus block anesthesia with same dosage and different concentrations of ropivacaine

目的探讨同一剂量的罗哌卡因（150 mg）用于肌间沟径路臂丛阻滞时容量、浓度与临床效果间的关系。方法选择240例ASAⅠ-Ⅱ级择期行上肢骨科手术患者,随机分成三组,神经刺激仪定位行肌间沟径路臂丛神经阻滞,所用药液分别为：A组20 ml（0.75%）,B组30 ml（0.5%）,C组40 ml（0.375%）,单盲法观察各组病例的感觉、运动阻滞情况,记录麻醉期间的生命体征变化及出现的各种并发症。结果①三组患者行臂丛阻滞前后生命体征均较平稳;②感觉阻滞：A组起效快,但阻滞节段范围窄,主要阻滞C5-7节段,持续时间长;C组起效慢,但阻滞节段较宽,多分布于C4-T1,恢复快。③三组患者均产生了肘关节的运动阻滞,起效上：A〉B〉C。④三组患者中C组总体不良反应率略高。结论在剂量为150 mg的罗哌卡因在肌间沟臂丛麻醉时药液浓度高,起效就快,且感觉运动阻滞时间长,容量增大时起效稍慢,但阻滞平面更广,阻滞成功率更高,然而在容量增大的同时其不良反应发生率也可能增加。

Objective To investigate the relation among volume,concentration and clinical effect when using intersclance brachial plexus block anesthesia with the same dosage of 150 mg ropivacaine.Methods 240 cases of ASA I to II undergoing upper limb surgery were randomly divided into 3 groups.150 mg of ropivacaine in 20 ml（0.75%）,30 ml（0.5%）,and 40 ml（0.375%） were administered to group A,B and C separately in interscalence brachial plexus block with nerves stimulator.The degree of sensory and motor block were observed with single blind method,and the vital sign variations and complications were recorded during anesthetic duration.Results The vital signs in the three groups were stable.The onset time of sensory in the group A was quicker than in group C.The segments of C5 to C7 were mainly blocked in group A,while C4 to T1 were blocked in Group C.The anlgesia recovery time in group C was significantly shorter than group B and group A.The elbow joint motor was blocked partly in the three groups,the onset time in the group A was shorter than group B,the group B was shorter than group C,and the recovery time in the group C was shortest.The patients＇ adverse effect rate in the group A was minimum,while the group C was the highest.Conclusion The onset time was quicker and the duration of sensory and motor blocks prolonged as the ropivacaine concentration increased in the intersclance brachial plexus block anesthesia with the dosage of 150 mg.The blocked segments widen,the succeed rate increases.The adverse effect may increase when the volume increased.