罗哌卡因复合地佐辛对臂丛神经阻滞麻醉效果的影响

Influence of Ropivacaine-dezocine Combination on Brachial Plexus Block

目的观察罗哌卡因复合地佐辛用于臂丛神经阻滞麻醉的效果。方法对75例ASAⅠ-Ⅱ级拟行上肢手术患者按随机数字表法分为Ⅰ、Ⅱ、Ⅲ3组,每组25例。Ⅰ组患者采用0.4%罗哌卡因25mL肌间沟注射行臂丛神经阻滞麻醉;Ⅱ组患者采用0.4%罗哌卡因复合地佐辛10mg的混合液25mL肌间沟注射行臂丛神经阻滞麻醉;Ⅲ组患者先采用0.4%罗哌卡因25mL肌间沟注射行臂丛神经阻滞麻醉,然后静脉注射地佐辛10mg辅助麻醉。观察3组患者麻醉后血压[收缩压(SBP)、舒张压(DBP)]、平均动脉压(MBP)、心率(HR)、脉搏血氧饱和度(SpO2)和麻醉起效时间、感觉阻滞持续时间、镇痛持续时间及不良反应(恶心、呕吐和头昏、呼吸抑制、尿潴留、瘙痒)等情况。结果 3组患者麻醉后SBP、DBP、MBP、HR、SpO2值比较差异均无统计学意义(均P>0.05)。Ⅱ组感觉阻滞持续时间和镇痛持续时间均明显长于Ⅰ、Ⅲ2组(均P<0.05)。3组患者均未出现尿潴留、瘙痒及呼吸抑制。Ⅲ组患者恶心、呕吐及头昏发生率明显高于Ⅰ、Ⅱ2组(P<0.05或P<0.01)。结论采用0.4%罗哌卡因复合地佐辛10mg的混合液25mL行肌间沟臂丛神经阻滞麻醉能明显增强臂丛神经感觉阻滞效果,延长镇痛时间,不良反应少,呼吸循环平稳。

Objective To observe the effect of ropivacaine-dezocine combination on brachial plexus block.Methods Seventy-five ASA grade Ⅰ-Ⅱ patients scheduled for upper extremity surgery were randomly divided into three groups,with 25 patients in each group.Patients in groupⅠreceived a local bolus injection of 0.4% ropivacaine（25 mL） for interscalene brachial plexus block.Patients in groupⅡ received a local bolus injection of a mixture of 0.4% ropivacaine and 10 mg dezocine（25 mL）.Patients in group Ⅲ received an intravenous injection of 10 mg dezocine after a local bolus injection of 0.4% ropivacaine（25 mL）.Systolic blood pressure（SBP）,diastolic blood pressure（DBP）,mean arterial blood pressure（MBP）,heart rate（HR）,pulse oxygen saturation（SpO2）,onset time of anesthesia,duration of sensory block,duration of analgesia and adverse reactions（nausea,vomiting,dizziness,respiratory depression,urinary retention and pruritus） were recorded in all groups.Results There were no significant differences in SBP,DBP,MBP,HR and SpO2 after anesthesia among the three groups（P〈0.05）.Compared with group Ⅱ,the duration of sensory block and duration of analgesia significantly decreased in groupⅠ and groupⅢ（P〈0.05）.No urinary retention,pruritus and respiratory depression occurred in all patients.Compared with group Ⅲ,the incidence of nausea,vomiting and dizziness obviously decreased in groupⅠand groupⅡ（P〈0.05 or P〈0.01）.Conclusion The local bolus injection of a mixture of 0.4% ropivacaine mixture 25 mL and 10 mg dezocine for interscalene brachial plexus block can significantly enhance the effect of sensory block and extend the duration of analgesia with fewer adverse reactions and stable respiration and circulation.