右美托咪定对左旋布比卡因腋路臂丛神经阻滞的影响

The effect of administration dexmedetomidine to levobupivacaine for axillary brachial plexus block

目的观察右美托咪定对左旋布比卡因腋路臂丛神经阻滞的影响。方法 50例ASAⅠ或Ⅱ级需于腋路臂丛神经阻滞下行前臂或手部手术的患者随机均分为两组,分别以40ml0.5%左旋布比卡因联合1ml(100μg)右美托咪定(LD组)和1ml等渗氯化钠(LS组)行腋路臂丛神经阻滞,比较两组感觉和运动阻滞起效时间、持续时间、镇痛时间以及HR、MAP、SpO2等。结果感觉和运动阻滞起效时间LD组明显短于LS组(P<0.05),感觉和运动阻滞持续时间LD组明显长于LS组(P<0.05),镇痛时间LD组长于LS组(P<0.05)。MAP在给药后的15、30、45、60、90和120minLD组较LS组显著下降(P<0.05),HR在给药后所有时点LD组均显著慢于LS组(P<0.05)。结论右美托咪定100μg联合左旋布比卡因在腋路臂丛神经阻滞中可以缩短其感觉和运动阻滞起效时间,延长阻滞持续时间及镇痛时间,但可能导致心动过缓。

Objective To investigate the effect of adding dexmedetomidine to levobupivacaine for axillary brachial plexus blockade. Methods Fifty patients scheduled for elective forearm or hand surgery were randomly divided into 2 groups. In group LS （n=25）, 40 ml of 0. 5% levobupivacaine ＋1 ml saline and in group LD （n=25）, 40 ml of 0. 5% levobupivacaine＋1 ml dexmedetomidine were given. Motor and sensory block onset times, block durations, duration of analgesia and mean arterial blood pressure （MAP）, heart rate （HR）, SpO2 were recorded. Results Sensory and motor block onset times were shorter in group LD than in group LS （P〈0. 05）. Sensory and motor blockade durations were longer in group LD than in group LS （P〈0. 05）. Duration of analgesia was longer in group LD than in group LS （P〈0.05）. MAP levels in group LD at 15, 30, 45, 60, 90, and 120 minutes were significantly lower than those in group LS （P〈0. 05）. HR levels in group LD, except basal measurements, were significantly lower than those in group LS （P〈0. 05）. Conclusion Adding dexmedetomidine to levobupivacaine shortens the onset time and prolongs the duration of the block and postoperative analgesia for axillary brachial plexus block. But it may lead to bradycardia.