硫酸镁对罗哌卡因股神经阻滞镇痛效果的影响

INFLUENCE OF MAGNESIUM SULPHATE ON THE EFFECT OF FEMORAL NERVE BLOCK ANALGESIA WITH ROPIVACAINE

目的观察硫酸镁对罗哌卡因单次股神经阻滞镇痛的影响。方法全身麻醉下单侧人工全膝关节置换术术后采用股神经阻滞镇痛病人60例,随机分为硫酸镁复合罗哌卡因组(M组)和单纯罗哌卡因组(C组),各30例。M组阻滞药物为2g/L罗哌卡因复合1.5g/L硫酸镁混合液20 mL,C组阻滞药物为2g/L罗哌卡因20mL。采用视觉模拟评分(VAS)法评定病人术后的疼痛情况,记录病人补充镇痛的吗啡使用率和吗啡的累计用量,观察病人镇痛的相关并发症。结果两组病人术后4、8、12、24h静息状态下VAS评分比较差异无显著性(P>0.05)。与C组比较,M组在12、24h进行膝关节持续被动活动时VAS评分降低,差异有显著性(t=2.800、2.934,P<0.05);M组行膝关节持续被动活动12h时吗啡的使用率和12、24h累计用量均明显减少,差异有显著性(χ~2=12.381,t=7.960、2.632,P<0.05)。两组病人均未出现明显的镇痛相关并发症。结论硫酸镁能增强罗哌卡因股神经阻滞镇痛的效果,减少病人术后吗啡的用量,且无相关不良反应。

Objective To investigate the influence of magnesium sulphate on the effect of femoral nerve block analgesia with ropivacaine.Methods A total of 60 patients who were given nerve block analgesia after unilateral total knee arthroplasty under general anesthesia were enrolled and randomly divided into magnesium sulphate-ropivacaine group（group M）and ropivacaine alone group（group C）,with 30 patients in each group.The patients in group M were given 20 mL mixed solution of 2 g/L ropivacaine and 1.5 g/L magnesium sulphate for nerve block,and those in group C were given 20 mL 2 g/L ropivacaine alone.Visual Analogue Scale（VAS）was used to evaluate postoperative pain,the use rate and cumulative amount of morphine for analgesia were recorded,and complications related to analgesia were observed.Results At 4,8,12,and 24 hafter surgery,there was no significant difference in resting VAS score between the two groups（P〈0.05）.Compared with group C,group M had a significant reduction in VAS score during continuous passive movement of the knee joint at 12 and 24 hafter surgery（t=2.800 and 2.934,P〈0.05）,as well as significant reductions in the use rate and cumulative amount of morphine used during continuous passive movement of the knee joint（χ2=12.381,t=7.960 and 2.632,P〈0.05）.No patient experienced marked complications related to analgesia.Conclusion Magnesium sulphate can enhance the effect of femoral nerve block analgesia with ropivacaine and reduce the amount of morphine used without marked complications.