不同剂量地塞米松用于超声引导神经刺激器定位肌间沟臂丛神经阻滞效果的观察

Efficacy of different dosages of Dexamethasone on the ultrasound and nerve stimulator guided interscalene brachial plexus block

目的比较相同浓度罗哌卡因中加入不同剂量地塞米松用于超声引导神经刺激器定位肌间沟臂丛神经阻滞感觉及运动阻滞效果的差异。方法 选择北京积水潭医院运动医学科2013年12月~2014年5月66例于肌间沟臂丛神经阻滞下行肩关节手术患者,并将其随机分为三组：使用0.5%罗哌卡因20 m L（A组,n=22）;0.5%罗哌卡因加入地塞米松0.05 mg/kg混合液20 m L（B组,n=22）;0.5%罗哌卡因加入地塞米松0.1 mg/kg混合液20 m L（C组,n=22）。分别记录3组患者感觉及运动阻滞起效及恢复时间。记录不良反应发生情况及患者对麻醉的满意程度。结果 三组患者比较感觉及运动起效时间比较差异无统计学意义（P〉0.05）;与A组比较,加入地塞米松可以明显延长0.5%罗哌卡因感觉[A组：（15.3±5.3）h比B组：（28.9±6.9）h,P=0.000;A组：（15.3±5.3）h比C组：（31.3±4.9）h,P=0.000]及运动[A组：（10.3±3.8）h比B组：（17.3±4.4）h,P=0.000;A组：（10.3±3.8）h比C组：（18.8±2.5）h,P=0.000]阻滞持续时间。但加入不同剂量地塞米松对感觉（B组比C组,P=0.198）及运动（B组比C组,P=0.343）阻滞时间影响相似。B、C两组患者术后12、24、36 h静息疼痛数字评分（NRS）明显低于A组患者,但B、C两组患者术后各时点NRS评分比较差异无统计学意义（P〉0.05）。三组患者术后恶心、呕吐发生率及对术后镇痛满意度比较差异无统计学意义（P〉0.05）。结论 地塞米松可以延长0.5%罗哌卡因感觉及运动阻滞时间,但是使用0.05 mg/kg或0.1 mg/kg效果无明显差异。

Objective To compare the differences of sensory block and motor block effects of the same concentration of Ropivacaine with deferent dosages of Dexamethasone for ultrasound and nerve stimulator guided intersealene bronchial plexus block. Methods Sixty six cases of patients underwent shounder surgery under interscalene brachial plexus block in Department of Sport Medicine of Beijing Jishuitan Hospital from December 2012 to May 2014 were chosen and ran- domly divided into three groups： using Ropivacaine 0.5% 20 mL （group A, n = 22）, Ropivacaine 0.5% with Dexam- ethasone 0.05 mg/kg 20 mL （group B, n = 22）, Ropivacaine 0.5% with Dexamethasone 0.1 mg/kg 20 mL （group C, n = 22）. Onset time and duration time of sensory and motor block, adverse reactions and patients＇ satisfaction for anesthesia among the three groups were recorded. Results There were no significant differences in onset time of sensory or motor block among the three groups （P 〉 0.05）. Compared with group A, Dexamethasone can significantly lengthen the dura- tion time of sense block [group A： （15.3±5.3） h vs group B： （28.9±6.9） h, P = 0.000; group A： （15.3±5.3） h vs group C： （31.3±4.9） h, P = 0.000] and motor block [group A： （10.3±3.8） h vs group B： （17.3±4.4） h, P = 0.000; group A： （10.3± 3.8） h vs group C： （18.8±2.5） h, P =0.000] of Ropivacaine 0.5%; but there was no significant difference of different dosages of Dexamethasone for sensory block （group B vs group C, P = 0.198） and motor block （group B vs group C, P = 0.343）. The resting numerical rating scale （NRS） at postoperative 12, 24, 36 h in group B and group C were lower than those of group A, but there were no significant differences between group B and C at any time （P 〉 0.05）. There were no significant differences of postoperative incidence of nausea and vomiting and satisfaction for postoperative analgesia a- mong the three groups （P 〉 0.05）. Conclusion Dexamethasone car, lengthen the duration time of sense block and motor block of Ropivaeaine 0.5%, but there are no significant differences by using 0.05 mg/kg or 0.1 mg/kg Dexamethasone.