硫酸镁对罗哌卡因锁骨上臂丛神经阻滞的影响

The effect of magnesium sulfate on the branchial plexus block induced by ropivacaine

目的:观察硫酸镁作为罗哌卡因锁骨上臂丛神经阻滞的辅助用药,对其麻醉效果以及术后疼痛和恶心、呕吐的影响。方法:80例在锁骨上臂丛神经阻滞麻醉下行择期行前臂和手手术的患者随机分为两组,对照组(C组)和试验组(M组),C组患者采用30 ml 0.5%罗哌卡因加1 ml生理盐水,共31 ml麻醉液,M组采用30 ml 0.5%罗哌卡因加150 mg硫酸镁(溶于1 ml生理盐水)配制成31 ml麻醉液。观察两组患者感觉、运动阻滞开始记持续时间,以及术后疼痛及恶心、呕吐发生情况。结果:两组患者感觉和运动阻滞起始时间比较,差异无统计学意义(P>0.05),M组患者感觉和运动阻滞时间均长于C组,差异有统计学意义(P<0.05),C组患者术后镇痛药物用量高于M组,差异有统计学意义(P<0.05)。两组患者术后镇痛药(地佐辛)使用次数比较:术后未使用镇痛药的患者M组多于C组,差异有统计学意义(P<0.05),M组使用2次镇痛药的患者数少于C组,差异有统计学意义(P<0.05),使用过1次镇痛药的患者在两组之间无统计学差异(P>0.05)。两组患者术后恶心呕吐的发生比较,差异无统计学意义(P>0.05)。结论:150 mg硫酸镁作为0.5%罗哌卡因行锁骨上臂丛神经阻滞的辅助用药,能够延长其感觉和运动阻滞时间,减少术后镇痛药物的需求,并不增加术后恶心、呕吐的发生。

Objective This study was designed to observe the effect of magnesium sulfate on the branchial plexus block induced by ropivacaine. Method 80 patients posted for elective forearm and hand surgeries under supraclavicular brachial plexus block were randomly divided into 2 groups（ Groups C and M）. In group M（ n = 40）,30 ml 0. 5% ropivacaine plus 150 mg（ in1 ml 0. 9% saline） magnesium sulfate and in group C（ n = 40）,30 ml 0. 5% ropivacaine plus 1 ml normal saline were administered in supraclavicular block. Sensory and motor block onset times and block durations,time to first analgesic use,total analgesic need,postoperative visual analog scale（ VAS） and side effects were recorded for each patient. Results The block（ sensory and motor） onset time were similar between two groups,but the sensory and motor block duration and time to first analgesic use were significantly longer and the total need for rescue analgesics was less in group M than group C（ P〈0. 05）. The incidence of postoperative nausea and vomiting was not significantly different（ P〈0. 05）. Conclusion It can be concluded that adding magnesium sulfate to supraclavicular brachial plexus block may increase the sensory and motor block duration and time to first analgesic use,and decrease total analgesic needs,with no side effects.