不同浓度罗哌卡因对超声引导腋路臂丛神经阻滞效果的影响

Effects of different concentration of ropivacaine on ultrasound-guided axillary brachial plexus block

目的探讨不同浓度罗哌卡因对超声引导腋路臂丛神经阻滞效果的影响。方法 ASAⅠ～Ⅱ级拟择期行前臂或者手部手术的病人120例,在超声引导下行腋路臂丛神经阻滞,随机分为四组：A组给予0.25%的罗哌卡因,B组给予0.33%的罗哌卡因,C组给予0.4%的罗哌卡因,D组给予0.5%的罗哌卡因,每组30例,均给予罗哌卡因32 ml。记录臂丛神经阻滞起效时间、镇痛持续时间；评估臂丛神经阻滞效果；观察记录不良反应。结果随着罗哌卡因浓度的增高,起效时间逐渐缩短,镇痛维持时间逐渐延长,每两组之间比较,差异均有统计学意义（P〈0.05）。四组阻滞效果差异无统计学意义（P〉0.05）。A组优秀率83.3%,优良率93.3%；B组优秀率90.0%,优良率96.7%；C组优秀率96.7%,优良率100%；D组优秀率100%。四组病人均未出现不良反应。结论超声引导下行腋路臂丛神经阻滞,0.25%～0.50%罗哌卡因都是可行的,从“较低的浓度达到100%阻滞成功率”的角度评价,0.4%罗哌卡因效果最好。

Objective To investigate the effects of different concentration of ropivacaine on axillary brachial plexus block under the guidance of ultrasound. Methods 120 patients undergoing elective surgery of forearm or hand were randomly divided into four groups： group A with0. 25% ropivacaine 32 ml,group B with 0. 33% ropivacaine 32 ml,group C with 0. 4 % ropivacaine 32 ml,group D with 0. 5% ropivacaine 32 ml. The onset time and duration of analgesia were recorded. the effects of brachial plexus block were evaluated. The adverse reactions were observed. Results With the increase of concentration of ropivacaine,the onset time became shorter（ P 〈 0. 05） and duration of analgesia became longer（ P 〈 0. 05）. There were no significant difference in the effects of brachial plexus block（ P 〉 0. 05）. The rates of excellent block effects were 83. 3%,90. 0%,96. 7%,100%,respectively. The rates of good block effects were 93. 3%,96. 7%,100. 0%,100%,respectively. No complications occurred in four goups. Conclusion 0. 25% ～ 0. 50% ropivacaine can be used in axillary brachial plexus block under guidance of ultrasound. 0. 4% ropivacaine may achieve perfect block effects though lower concentration..