右美托咪定腋鞘给药用于缓解罗哌卡因臂丛神经阻滞时止血带痛的效果

Efficacy of dexmedetomidine injected into axillary sheath in alleviating tourniquet pain during brachial plexus block with ropivacaine

目的 评价右美托咪定腋鞘给药用于缓解罗哌卡因臂丛神经阻滞时止血带痛的效果.方法 选择断指再植术患者60例,年龄18～60岁,ASA分级Ⅰ或Ⅱ级,体重52 ～ 85 kg.采用随机数字表法,将其分为2组（n=30）：罗哌卡因组（R组）和含右美托咪定的罗哌卡因组（DR组）.在神经刺激器引导下行腋路臂丛神经阻滞.R组注射0.5％罗哌卡因40 ml,DR组注射含右美托咪定100 μg的0.5％罗哌卡因40 ml.止血带充气压力200～ 250 mm Hg,压迫时间120 min.于止血带压迫状态120min时以VAS评分法评估患者止血带痛程度,记录患者止血带耐受情况、心血管不良事件及其他不良反应的发生情况,并以Ramsay评分评价DR组镇静程度.结果与R组比较,DR组止血带耐受率升高,止血带痛程度减轻,心血管不良事件发生率降低（P＜0.01）.2组均未见严重止血带相关并发症,DR组未见镇静过度.结论 腋鞘内注射右美托咪定100μg用于罗哌卡因臂丛神经阻滞可安全、有效缓解止血带痛.

Objective To evaluate the efficacy of dexmedetomidine injected into axillary sheath in alleviating the tourniquet pain during brachial plexus block with ropivacaine.Methods Sixty ASA physical status Ⅰ or Ⅱ patients,aged 18-60 yr,weighing 52-85 kg,scheduled for the replantation of amputated finger,were randomly divided into 2 equal groups （n =30 each）：ropivacaine group （group R） and dexmedetomidine mixed with ropivacaine group （group DR）.All patients underwent axillary brachial plexus block guided by a nerve stimulator.When the intensity of electric stimulation ≤ 0.4 mA,flexion of fingers or wrist still existed,and the local anesthetic was injected into the axillary sheath.0.5％ ropivacaine 40ml was injected in group R.0.5％ ropivacaine mixed with 100μg dexmedetomidine 40ml was injected in group DR.The pressure of inflation was set at 200-250mmHg,and the stress duration was 120 min.Tourniquet pain and the level that the patients could tolerate was evaluated using visual analog scale （VAS） at 120 min of stress status.The patient＇ s satisfaction with anesthesia was rated and the development of adverse cadiovascular events and local and systemic adverse reactions were recorded.Excessive sedation was measured with Ramsay score in group DR.Results Compared with group R,the tourniquet pain that the patients could tolerate was significantly increased,the severity of tourniquet pain was reduced and the incidence of adverse cadiovascular events was decreased in group DR （P ＜ 0.01）.No serious tourniquet-related complications were observed in both groups.No patients developed excessive sedation in group DR.Conclusion Dexmedetomidine 100μg injected into the axillary sheath can safely and effectively alleviate the tourniquet pain when used during brachial plexus block with ropivacaine.