超声引导下不同温度罗哌卡因臂丛神经连续阻滞的麻醉与术后镇痛效果

Efficacy of ultrasound guided continuous brachial plexus block with ropivacaine in different temperatures during operative anesthesia and postoperative analgesia

目的探讨超声引导下不同温度罗哌卡因臂丛神经连续阻滞的临床麻醉与术后镇痛效果。方法超声引导下不同温度0．5％罗哌卡因（0．5ml／kg）臂丛神经阻滞上肢手术患者60例，随机分为3组（每组20例）：A组（安瓿20℃），B组（安瓿30℃）和c组（安瓿37℃），A组患者单次阻滞，B、c组患者留置导管。记录切皮前T1（注射后5min），T2（注射后10min），T3（注射后15min），T4（注射后20min）时和术中麻醉效果评分，记录术后24h时VAS评分和PCA按压次数。结果与T1时比较，T2，T3，T4时各组患者各神经支效果评分明显增高（P〈0．05）；与A组患者比较，C组患者T1时肌皮神经效果评分明显增高，T4时正中神经、桡神经、肌皮神经效果评分明显增高（P〈0．05）。与A组患者比较，B、C组患者术中麻醉效果评分明显增高，术后24h疼痛评分、PCA按压次数显著降低（P〈0．05）。B组与C组麻醉效果比较差异无统计学意义（P〉0．05）。结论37℃罗哌卡因药液臂丛神经阻滞术中麻醉效果评分明显增高，超声引导臂丛神经连续阻滞是成人上肢手术安全有效的麻醉选择，术后镇痛效果良好。

Objective To investigate the efficacy of ultrasound guided continuous brachial plexus block with ropivacaine in different temperatures during operative anesthesia and postoperative analgesia. Methods Sixty patients undergoing upper extremity surgery under brachial plexus block guided by ultrasound with ropivacaine in different temperatures were randomly divided into three groups （20 patients in each group） ： group A （ 20℃）, group B （30 ℃） and group C （ 37℃ ）. Ropivacaine was injected at ampule 20,30 and 37℃ in group A, B and C respectively. Patients in group A were injected without catheter; patients in group B and C were placed a catheter through the needle. The effective scores before the operation at T1 （5 rain after injection） , T2 （ 10 min after injection）, T3 （ 15 min after injection）, T4 （20 min after injection） , the effective scores of intra-operation, VAS in 24 h after the operation and bolus times of PCA pumps of all patients were recorded. Results Compared with T1, the effective scores of every nerve branch of all patients in T2, T3 and T4 were increased significantly （P 〈 0.05）. Compared with the patients in group A at T1, the effective scores of musculocutaneous nerve in group C were increased significantly; the scores of median nerve, radial nerve, musculocutaneous nerve in group C were significantly increased at T4 （P 〈 0.05）. Compared with patients in group A, the effective scores of intraoperation in group B and group C were increased significantly, and VAS of 24 h after the operation, bolus times of PCA pumps were decreased significantly （P 〈 0.05）. There were no significant differences in the effective scores between group B and C. Conclusion Warming of ropivacaine to the body temperature increases the operative anesthetic effectiveness of the continuous bracbial plexus block guided by ultrasound is a safe and effective anesthesia option for upper extremity surgical operation in adult patients with good effect of postoperative analgesia.