右美托咪定对左布比卡因颈丛阻滞效应的影响

Effects of adding dexmedetomidine to levobupivacaine in cervical plexus block

目的观察右美托咪定加入左布比卡因对颈丛神经阻滞效应的影响。方法 40例ASAⅡ或Ⅲ级拟行颈动脉内膜剥脱术的患者,随机分成两组,每组20例。左布比卡因组(L组)给予0.375%左布比卡因20 mL,左布比卡因-右美托咪定组(LD组)给予0.375%左布比卡因20 mL+右美托咪定1μg·kg-1,分别行颈浅丛神经阻滞,余麻醉方法相同。记录两组患者心率(HR)、平均动脉压(MAP)和Ramsay镇静评分,并观察感觉阻滞起效时间、持续时间、术中镇痛药用量及不良反应发生情况。结果 LD组感觉阻滞起效时间短于L组,而持续时间长于L组,均有显著差异(P<0.05)。注药结束后10、20、30、60、90 min时,LD组Ramsay镇静评分高于L组,而MAP、HR水平均低于L组,均有显著差异(P<0.05)。LD组术中利多卡因和芬太尼用量少于L组(P<0.05)。两组均无严重不良反应发生,LD组发生心动过缓3例。结论右美托咪定加入左布比卡因用于颈丛神经阻滞可缩短感觉阻滞起效时间,延长感觉阻滞持续时间,并有一定可唤醒的镇静作用。

AIM To study the effects of adding dexmedetomidine to levobupivacaine in cervical plexus block. METHODS A total of 40 adult patients of ASA Ⅱ/Ⅲ scheduled to undergo carotid endarterectomy were enrolled. The patients were randomly divided into 2 groups （n = 20）. In group L, cervical plexus block was performed with 0.375% levobupivacaine 20 mL. In group LD, cervical plexus block was performed with 0.375% levobupivacaine 20 mL plus dexmedetomidine 1 μg· kg^-1. While the other anesthesia were the same. Mean arterial pressure （MAP）, heart rate （HR）, Ramsay sedation score, sensory block onset time, time to first analgesic request, total analgesic need, and adverse reactions were recorded. RESULTS Compared with the group L, sensory block onset time was shorter in the group LD （P 〈 0.05） and the time to first analgesic request was longer （P 〈 0.05）. The Ramsay sedation score at 10, 20, 30, 60 and 90 minutes after local anesthetic administration in the group LD was significantly higher than that in the group L （P 〈 0.05）, while MAP and HR values were significantly lower in the group LD （P 〈 0.05）. Bradycardia was observed in three patients of the group LD and no serious adverse reaction occurred in both groups. CONCLUSION Adding dexmedetomidine 1μg· kg^-1 to levobupivacaine for cervical plexus block can shorten the sensory block onset time, extend the duration of analgesia, and provide conscious sedation.