高乌甲素、吗啡混合局部麻醉药用于臂丛神经阻滞术术后镇痛效果的观察

Effect of morphine and lappaconite combined with local anesthetics on postoperative analgesia in brachial plexus block

[目的]比较高乌甲素/或和吗啡与局部麻醉药混合用于臂丛神经阻滞的上肢手术术后的镇痛疗效及不良反应。[方法]120例ASAⅠ-Ⅱ级患者,经肌间沟入路臂丛神经阻滞下行上肢手术。病人随机分为4组(每组n=30):对照组(C组):2%利多卡因15 mL与0.5%左旋布比卡因10 mL混合液,其他3组在应用C组局麻药同时加入如下药物:高乌甲素组(L组):局麻药中加入高乌甲素16 mg;吗啡组(M组):局麻药中加入吗啡4 mg;高乌甲素+吗啡组(L+M)组:局麻药中加入高乌甲素8 mg和吗啡2 mg。手术结束后观察4组术后镇痛的效果及不良反应。[结果]L组、M组、(L+M)组镇痛效果均优于对照组,其术后6、8、12、24 h VAS评分均较C组低,差异有显著性意义(P<0.05),(L+M)组和M组术后8、12、24、48 h BCS评分均高于C组,差异有显著性意义(P<0.05),恶心、呕吐及皮肤瘙痒的发生率(L+M)组(20%、13.3%、10%)明显低于M组(P<0.05),但与L组及C组比较差异无显著性意义。[结论]高乌甲素、吗啡混合局部麻醉药用于臂丛神经阻滞术,其术后镇痛效果优于单纯使用局麻药或局麻药内混合吗啡,且不良反应少。

[Objective] To compare the effects of morphine and Lappaconite combined with local anesthetics on postoperative analgesia and adverse outcomes in brachial plexus block for upper extremity surgery.[Methods] One hundrewd twenty patients with ASAⅠ-Ⅱ,undergoing upper extremity surgery under interscalene brachial plexus block,were randomly divided into four groups with 30 cases each.A mixture of 2% lidocaine 15 mL and 0.5% levobupivacaine 10 mL was used for the brachial plexus block.The patients using local anesthetic mixture were treated as control（group C）.The patients in the other groups were treated with local anesthetic mixture combined with Morphine and/or Lappaconite.Group L was given with Lappaconite 16mg,group M with morphine 4 mg and group（L＋M） with Lappaconite 8mg and Morphine 2 mg.The postoperative analgesic effect was determined using Visual Analog Scoring system at 2,4,6,12,24 and 48 hours after the surgical procedures and the adverse outcomes were detected simultaneously.[Results] The postoperative analgesia was satisfactory in group L,group M and group（L＋M）,but not in group C.The VAS scores in the three groups were lower than those in group C at 6,8,12,24 h after surgical procedures respectively,（P0.05）.The BCS scores were higher in group（L＋M） and group M than those in group C at 8,12,24,48 h after surgical procedures respectively（P 0.05）.There was no difference in the rates of nausea,emesis and itches among the group（L＋M）,group L and group C.However,the rates were lower in group（L＋M） than those in group M.[Conclusion] Local anesthetics combined with morphine and/or lappaconite used in brachial plexus block for upper extremity surgery provides satisfactory postoperative analgesia than local anesthetics alone,but the adverse outcome was higher with morphine than those with lappaconite