舒芬太尼复合左旋布比卡因在连续臂从神经阻滞术后镇痛的浓度探讨

Application of sufentanil plus levobupivacaine in postoperative patient-controlled analgesia after interscalene brachial plexus block

目的:探讨舒芬太尼复合左旋布比卡因在连续臂从神经阻滞术后镇痛的合适浓度。方法:上肢手术患者90例,采用套管针行改良肌间沟法连续臂从神经阻滞,并保留套管针术后接患者自控镇痛泵。A组0.4μg/ml舒芬太尼加0.125%左旋布比卡因术后镇痛;B组0.5μg/ml舒芬太尼加0.125%左旋布比卡因术后镇痛;C组0.6μg舒芬太尼加0.125%左旋布比卡因术后镇痛。3组背景剂量均为4ml/h,自控药量每次2ml,锁定时间15min。观察术后镇痛效果、运动阻滞程度、镇静程度、镇痛泵使用情况及恶心、呕吐、呼吸抑制等不良反应。结果:A组镇痛效果较B、C两组差,B、C两组镇痛效果无显著性差异。3组运动阻滞程度、镇静程度和不良反应无显著性差异。结论:0.5μg/ml舒芬太尼联合0.125%左旋布比卡因用于连续臂丛神经阻滞术后镇痛即可获得满意镇痛效果,同时不增加不良反应发生率。

0bjective：To search the suitable concentration of sufentanil combined levobupivacaine used in postoperative patient-controlled analgesia（PCA）after continuous brachial plexus nerve block（BPNB）.Methods：Ninety patients undergoing upper extremity surgery under modified interscalene BPNB were randomly divided into three groups with 30 cases each.The patients in group A were given postoperative PCA with 0.4μg/ml sufentanil plus 0.125% levobupivacaine and group B with 0.5μg/ml sufentanil plus 0.125% levobupivacaine and group C with 0.6μg/ml sufentanil plus 0.125% levobupivacaine in a basal dose of 4 ml/h,PCA dose of 3 ml and lookout time of 20min.Postoperative analgesia、movement block degree 、sedation degree 、utilization of analgesia pump and postoperative nausea、vomiting、respiratory depress were observed.Results： Analgesic effect and utilization of analgesia pump was better ingroup B and C than that in group A at 8h、12h、24h and 48 h after operation（P〈0.05）.Analgesic effect and utilization of analgesia pump was no difference in group B and C.The difference of movement block degree、sedation degree and side effect were not significant among the three groups. Conclusion：0.5μg/ml sufentanil combined with 0.125% levobupivacaine on postoperative patient-controlled analgesia after continuous brachial plexus nerve block can obtain content analgesia effect,moreover not increase incidence rate of side effect.