超声引导下肌间沟臂丛神经阻滞罗哌卡因容量与效果观察

Clinical Observation on Interscalene Brachial Plexus Block by Ultrasound- Guided with Different Volume of Ropivacaine in an Equal Concentration

目的通过观察超声引导肌间沟臂从神经阻滞中注入等浓度不同容量罗哌卡因的效果,以期寻找超声引导下肌间沟臂丛阻滞的最佳容量。方法 150例拟行超声引导肌间沟臂从神经阻滞患者随机分成I、Ⅱ、Ⅲ三组,每组各50例,分别注入0.5%罗哌卡因15 m L、20 m L、25 m L。观察各组起效时间,维持时间,感觉阻滞效果,肌肉松弛阻滞效果,术中呼吸、血压、心电图动态改变。结果在感觉、肌松阻滞效果及起效时间观察上,I、II、Ⅲ组比较差异无统计学意义。在维持时间方面比较:I组与Ⅱ、Ⅲ组比差异有统计学意义,Ⅱ、Ⅲ组比差异无统计学意义。观察资料表明超过20ml在臂丛阻滞麻醉中并无增强作用。低至15 m L的容量也可产生完善的麻醉效果,但会缩短麻醉维持时间。术中监护中,未发现心律失常及药物不良反应及并发症。结论罗哌卡因在肌间沟臂丛阻滞麻醉中是能较安全使用的局部麻醉药,在超声引导肌间沟臂丛神经阻滞中其最佳使用容量是20 m L。

Objective To compare the efficacy and safety of interscalene brachial plexus block by ultrasound guided with different volume of ropivacaine in an equal concentration and find out the optimal capacity of ropivacaine. Methods One hundred and fifty patients undergoing upper limb surgery were randomly divided into three groups. Patients in groups I,Ⅱ and Ⅲ were received the interscalene brachial plexus block by ultrasound guided with 15 m L,20 m L,25 m L of 0. 5%ropivacaine respectively. The effects of blockade,duration of analgesia,sensory and motor block,the degree of motor block and the dynamic change of blood pressure,respiration and ECG were recorded and evaluated. Results There were no significant differences among the three groups in the effects of sensory and motor block and the initial time. Compared with Ⅱ andⅢ groups,the duration of block was shorter in group I. In addition,there was no enhancement of block when using more than 20 m L of ropivacaine in interscalene brachial plexus block. And using 15 m L of ropivacaine could also obtain perfect block,but the duration of block was shorter. Conclusion Ropivacaine could be safely used in interscalene brachial plexus block. Ultrasound guided interscalene brachial plexus block with 20 m L of ropivacaine can provide excellent block.