低浓度左旋布比卡因复合舒芬太尼用于改良骶管阻滞的效果

The effect of low concentration levo bupivacaine combined with sufentanil on the modified sacral block

目的观察低浓度左旋布比卡因复合舒芬太尼用于改良骶管阻滞的效果。方法选择100例拟在改良骶管阻滞下行肛管手术患者,随机分为舒芬太尼组和对照组,每组50例。舒芬太尼组于骶管注入0.25%左旋布比卡因复合舒芬太尼15μg混合液30ml,对照组注入0.25%左旋布比卡因30ml。观察并记录患者MAP、HR、感觉阻滞起效时间、维持时间、术后24h内镇痛效果、及补救镇痛药(布桂嗪)使用例数及不良反应发生情况。结果舒芬太尼组感觉阻滞起效时间为(4.0±1.1)min,明显短于对照组的(9.6±2.2)min(P<0.05);感觉阻滞维持时间为(8.2±1.1)h,明显长于对照组的(5.1±0.9)h(P<0.05)。术后4、8、12h舒芬太尼组VAS评分明显低于对照组,且术后24h内使用布桂嗪例数13例(27.7%),明显少于对照组的40例(83.3%)(P<0.05)。两组MAP、HR及不良反应发生率差异均无统计学意义。结论与单纯低浓度左旋布比卡因比较,低浓度左旋布比卡因复合舒芬太尼用于改良骶管阻滞时,能缩短感觉阻滞起效时间,延长感觉阻滞维持时间,改善术后24h内镇痛效果,减少术后镇痛药的使用。

Objective To observe the effect of low concentration of levo bupivacaine combined with sufentanil on the modified sacral block.Methods One hundred cases of patients,undergoing anal surgery with the modified sacral block,were randomly divided into sufentanil group and control group（n=50）.The 30 ml mixture of 0.25%levo bupivacaine combined with sufentanil 15μg was injected into sacral canal in sufentanil group,and the 0.25% levobupivacaine 30 ml was injected in control group.The MAP,HR,sensory block onset and maintenance time,analgesia effect within 24 hafter surgery,the cases with rescue analgesics bucinnazine and the adverse reaction were observed and recorded.Results The onset time of sensory block in sufentanil group[（4.0 ± 1.1）min]was significantly shorter than in the control group [（9.6 ±2.2）min]（P〈0.05）.Sensory block maintenance time[（8.2 ±1.1）h]in sufentanil group was significantly longer than in the control group[（5.1 ±0.9）h]（P〈0.05）.The VAS scores in sufentanil group were significantly lower than in the control group（P〈0.05）at 4,8,12 hafter surgery.The cases with rescue analgesics bucinnazine in sufentanil group（13cases,27.7%）was less than in the control group（40cases,83.3%）（P〈0.05）.There was no significant difference in MAP,HR and adverse reaction between the two groups.Conclusion Compared with the single low concentration of bupivacaine,bupivacaine combined with sufentanil used in modified sacral block can shorten the onset time of sensory block,prolong the duration of sensory block,improve the analgesia effects within 24 hafter surgery and reduce the use of postoperative analgesics.