局麻药高浓度低容量坐骨神经阻滞和低浓度高容量腰丛阻滞的临床研究

Clinical efficacy of local anesthetic of sciatic nerve blockade with high concentration and low volume combined with lumber plexus blockade with low concentration and high volume

目的观察利多卡因复合罗哌卡因高浓度低容量坐骨神经阻滞和低浓度高容量腰丛阻滞的临床效果。方法 80例行下肢手术的患者随机均分为高浓度低容量坐骨神经阻滞+低浓度高容量腰丛阻滞组(Ⅰ组)和相同容量浓度阻滞组(Ⅱ组)。Ⅰ组患者坐骨神经给予1.5%利多卡因10 ml+0.75%罗哌卡因10 ml,腰丛给予1%利多卡因15 ml+0.3%罗哌卡因25 ml;Ⅱ组坐骨神经和腰丛均给予0.6%利多卡因+0.3%罗哌卡因混合液25 ml。观察并记录坐骨神经和腰丛神经支配区域针刺感觉消失时间、趾跖曲和背曲运动消失时间、屈膝运动消失时间和抬腿运动消失时间。结果Ⅰ组麻醉成功率明显高于Ⅱ组(P<0.05),坐骨神经支配区域感觉阻滞起效时间明显短于Ⅱ组(P<0.05),腰丛起效时间与II组差异无统计学意义。Ⅰ组趾跖曲和背曲运动消失时间明显短于Ⅱ组(P<0.05),屈膝运动消失时间和抬腿运动消失时间与Ⅱ组差异无统计学意义。结论利多卡因复合罗哌卡因高浓度低容量坐骨神经阻滞和低浓度高容量腰丛阻滞能够获得更高的阻滞成功率及更短的起效时间。

Objective To observe the clinical efficacy of local anesthetic of sciatic nerve blockade with high concentration and low volume combined with lumber plexus blockade with low concentration and high volume.Methods Eighty patients scheduled for lower extremity surgery were equally randomized into sciatic nerve blockade with high concentration and low volume ＋plexus blockade with low concentration and high volume lumber group （group I） and the same concentration and volume group （group Ⅱ）.One point five percent of 10 ml lidocaine and 0.75% of 10 ml ropivacaine were given for sciatic nerve blockade; and 1% of 10 ml lidocaine and 0.3% of 25 ml ropivacaine were given for lumber plexus blockade in group Ⅰ.Zero point six percent lidocaine and 0.3% ropivacaine mixed liquor of 25 ml were given for lumber plexus blockade and sciatic nerve blockade,respectively.The time of pinprick sensation loss in the distribution of sciatic nerve and lumber plexus,plantar or dorsal flexion movement loss,knee bend loss and leg-raising loss were recorded.Results Compared with group Ⅱ,the success rate of anesthesia increased and the time of pinprick sensation loss in the distribution of sciatic nerve decreased in group Ⅰ （P〈0.05） ; while the onset time of blockade for lumber plexus had no significant difference.The time of plantar or dorsal flexion movement loss decreased in group Ⅰ （P〈0.05）; while the time of knee bend loss and legraising loss had no significant difference.Conclusion Lidocaine and ropivacaine mixed liquor with high concentration and low volume for sciatic nerve blockade in combination of low concentration and high volume for lumber plexus blockade may provide a high anesthesia success rate and a short onset time