一项随机、前瞻性、双盲试验：比较3％氯普鲁卡因随即0．5％布比卡因与2％利多卡因随即0．5％布比卡因用于肌间沟臂丛阻滞

背景早前曾将2-氯普鲁卡因和布比卡因（C／B）联合用于区域麻醉，但因效果不确定而放弃。在这项前瞻性、双盲、随机研究中，我们比较了C／B联合-9利多卡因／布比卡因（L／B）联合的肌间沟阻滞的起效。方法30例拟在肌间沟阻滞下行肩关节镜术患者被分为2组，每组15例。一组（C／B）接受含有碳酸氢钠和肾上腺素的3％2．氯普鲁卡因，随即接受含肾上腺素的0．5％布比卡因；另一组（L／B）接受2％利多卡因而不用3％2．氯普鲁卡因。每15秒评估一次运动和感觉阻滞。主要的观察终点是完全运动阻滞的起效时间。使用时间-事件（生存率）统计分析检验。结果L／B组1例阻滞失败，被排除。C／B和L／B运动阻滞的中位数时间分别为90秒（15—575秒）和180秒（15．3720秒）（P=0．0325），C／B和L／B的感觉阻滞中位数时间分别为90秒（30～600秒）和210秒（30—3900秒）（P=0．0185）。生存分析显示，在第5分钟，C／B组15例患者中13例产生了成功的运动阻滞，而L／B组14例患者中只有7例。在第10分钟，C／B组15例患者全部产生了成功的运动阻滞，而L／B组14例中只有10例。对L／B组阻滞成功或失败的评价需时60分钟。结论本研究证明，肌间沟阻滞C／B比L／B较快达到成功阻滞。

BACKGROUND： The combination of 2-chloroprocaine and bupivacaine （C/B） for regional anesthesia has been described, but its use was largely abandoned due to equivocal results in efficacy. In this prospective, double-blind, randomized study, we compared the onset of an interscalene block using C/B versus a combination of lidocaine and bupivacaine （L/B）. METHODS： Thirty patients scheduled for shoulder arthroscopy under interscalene block were divided into two groups of 15 each. One group （C/B） received 3% 2-chloroprocaine combined with bicarbonate and epinephrine, immediately followed by 0.5% bupivacaine and epinephrine, whereas the other group （L/B） received 2% lidocaine instead of 3% 2-chloroprocaine. Motor and sensory block were assessed every 15 s. The primary end-point was the time of onset to complete motor block. Time-to-event （survival） statistical analysis tests were applied. RESULTS： One L/B patient had a failed block, and was excluded. The median time to motor block for C/B and L/B was 90 （15 -575） and 180 （15 -3720） s, respectively （P =0.0325）, and to sensory block for C/B and L/B was 90 （30 -600） and 210 （30 -3900） s, respectively （P =0.0185 ）. Survival analysis showed that in 5 min, 13 of 15 patients from the C/B group but only 7 of 14 from the L/B group had a successful motor block. In 10 min, 15 of 15 patients from the C/B group but only 10 of 14 from the L/B group had a successful motor block. It took as long as 60 rain to assess block success/failure for blocks in the L/B group. CONCLUSIONS ： This study demonstrates that a successful block was more rapid using C/B than L/B for interscalene blocks.