不同容量0.25%布比卡因用于小儿手外伤超声引导下腋路臂丛神经分支阻滞效果比较

Effect Comparison of Different Volumes of 0.25% Bupivacaine for Ultrasound-guided Axillary Approach Brachial Plexus Divisional Block in Children with Hand Injuries

目的比较不同容量0.25%布比卡因在小儿手外伤手术超声引导下腋路臂丛神经分支阻滞中的效果。方法选择解放军白求恩国际和平医院2013年6月—2015年1月择期在腋路臂丛麻醉下行手外伤手术患儿120例,随机分为0.25%左旋布比卡因0.35 ml/kg组、0.30 ml/kg组、0.25 ml/kg组和0.20 ml/kg组,每组30例。术前30 min口服咪达唑仑,入室靶控输注丙泊酚,待患儿睫毛反射消失和对言语指令无反应时行超声引导下腋路臂丛神经阻滞,4组各神经分支（中神经、肌皮神经、桡神经和尺神经）分别注射0.25%左旋布比卡因0.35、0.30、0.25、0.20 ml/kg,术中根据阻滞效果追加氯胺酮。观察各组神经阻滞效果、持续时间、全麻药物应用情况。结果 4组阻滞时所需丙泊酚用量差异无统计学意义（P〉0.05）,阻滞30 min后0.35、0.30、0.25 ml/kg组各神经支配区阻滞效果近似（P〉0.05）,与上述3组比较,0.2 ml/kg组术中需追加氯胺酮患儿比例最高、术后阻滞效果持续的时间最短、阻滞效果明显降低（P〈0.05）。结论采用剂量为0.25~0.35 ml/kg的0.25%布比卡因用于小儿上肢手术超声引导下腋路臂丛各神经分支阻滞,能够获得较满意的效果。

Objective To compare the effect of different volumes of 0.25% Bupivacaine for ultrasound-guided axillary approach brachial plexus divisional block in children with hand injuries. Methods A total of 120 children with hand injuries undergoing surgery during June 2013 and January 2015 were randomly divided into group A （0.35 ml/kg, n=30）, group B （0.30 ml/kg, n=30）, groupC （0.25 mL/kg, n=30） and groupD （0.20 ml/kg, n=30）. Midazo- lam was administered orally 30 min before the surgery, and Propofol was given by target controlled infusion （TCI） at the time of entering operating room, and then ultrasound-guided axillary approach brachial plexus divisional block was per- formed when the patients had no eyeash reflex and no reaction to verbal instructions. The median nerve, musculocutane- ous nerve, radial nerve and ulnar nerve were respectively injected with 0.35 ml/kg, 0. 30 ml/kg, 0.25 ml/kg and 0.20 ml/kg of 0.25% Levobupivacaine, and Ketamine was added during the surgery according to block condition. Nerve block effect, duration and general anesthesia drugs doses in all the groups were observed. Results The differences of Propofol doses in the 4 groups were not statistically significant （P 〉 0.05）. Group A, B and C had similar block effect after being blocked for 30 min （P 〉 0.05）. Compared with those in group A, B and C, group D had the highest rate of intraoperative Ketamine need, the shortest unremitting duration of postoperative block effect and significantly decreasing block effect. Conclusion The 0.25-0.35 ml/kg of 0.25% Bupivaeaine for ultrasound-guided axillary approach braehial plexus divisional block in children with upper limbs surgery can achieve satisfactory effect.