右美托咪啶复合罗哌卡因对神经刺激仪引导下臂丛神经阻滞效果的影响

Efficacy and safety of dexmedetomidine added to ropivacaine for interscalene brachial plexus block guided by neural stimulator

目的：观察右美托咪啶复合罗哌卡因在神经刺激仪引导下经肌间沟臂丛神经阻滞的有效性和安全性。方法选取68例ASA I~Ⅱ级择期行单侧臂丛神经阻滞麻醉下手部及上肢手术患者，随机数字表法分为右美托咪啶复合罗哌卡因组（D组）和单纯罗哌卡因组（C组）。神经刺激仪引导下穿刺成功后，D组注入内含1μg/kg右美托咪啶的0.5%罗哌卡因25ml，C组仅注入0.5%罗哌卡因25ml。观察两组患者感觉神经和运动神经阻滞的起效时间和持续时间；观察麻醉后不良事件发生情况。结果 D组感觉及运动神经阻滞的起效时间均短于C组（P＜0.05），持续时间均长于C组（P＜0.05）；D组心动过缓发生率高于C组（P＜0.05）。结论右美托咪啶复合罗哌卡因可安全有效地应用于臂丛神经阻滞，与单纯应用罗哌卡因比较，前者起效更迅速，维持更持久，镇静作用良好，但须注意发生心动过缓。

Objective To evaluate the efficacy and safety of dexmedetomidine added to ropivacaine for interscalene brachial plexus blockade. Methods Sixty eight patients scheduled for elective forearm and hand surgery were randomly as-signed to receive 25ml（125mg） of 0.5%ropivacaine＋1μg/kg dexmedetomidine（group D, n=34） or 25ml（125mg） of 0.5%ropiva-caine （group C, n=34） for interscalene brachial plexus block. The nerves in the interscalene were identified using neural stimulator. The onset times of motor and sensory block, block duration, and adverse events after local anesthesia were documented. Results The onset times of sensory and motor block were shorter in group D than those in group C （P＆lt;0.05）. The durations of sensory and motor blockade were longer in group D than those in group C （P＆lt;0.05）. The incidence of bradycardia was significantly higher in group D than that in group C（P＆lt;0.05）. Conclusion Dexmedetomidine added to ropivacaine for interscalene brachial plexus block guided by neural stimulator shortens the onset time and prolongs the duration of the block;however, it may lead to bradycardia.