不同浓度罗哌卡因在连续臂丛神经阻滞下对肩关节镜术后快速康复的影响

Effect of Different Concentration of Ropivacaine on Rapid Rehabilitation after Shoulder Arthroscopy under Continuous Brachial Plexus Block

目的:探讨不同浓度罗哌卡因在连续臂丛神经阻滞下对肩关节镜术后快速康复的疗效。方法:选取2018年3月-2019年2月在笔者所在医院行肩关节镜手术治疗的118例肩袖受损患者,按照随机数字表法分为A组(59例)和B组(59例)。两组均予以肌间沟臂丛神经置管联合全身麻醉,A组罗哌卡因浓度为0.375%,B组浓度为0.20%。比较两组在肩关节镜术后的麻醉效果。结果:B组患者丙泊酚、七氟烷和瑞芬太尼等麻醉药物剂量均与A组比较,差异均无统计学意义(P>0.05);B组术后1、6、12、24、48 h疼痛VAS评分与A组比较,差异均无统计学意义(P>0.05);B组患者术后1、6、12、24、48 h前臂运动评分均明显低于A组,差异均有统计学意义(P<0.05);B组患者术后48 h精神状态和镇静评分明显优于A组,差异均有统计学意义(P<0.05);两组患者手术麻醉期间和术后均未见不良反应发生。结论:0.375%与0.20%罗哌卡因在连续臂丛神经阻滞中均有良好效果,但0.20%罗派卡因术后前臂运动恢复更快及精神状态越佳。

Objective: To explore the effect of different concentration of Ropivacaine on rapid rehabilitation after shoulder arthroscopy under continuous brachial plexus block. Method: A total of 118 patients with rotator cuff injury who underwent arthroscopic shoulder surgery in our hospital from March 2018 to February 2019 were divided into group A(59 cases) and group B(59 cases) according to random number table method. Both groups were given intermuscular sulcus brachial plexus catheterization combined with general anesthesia. In group A, patients were given 0.375% Ropivacaine. In group B, patients were given 0.20% Ropivacaine. Anesthesia effect of two groups after shoulder arthroscopy were compared. Result: There were no significant differences in Propofol, Sevoflurane and Remifentanil dosage between group B and group A(P>0.05). There were no significant differences in VAS score of pain between group B and group A at 1, 6, 12, 24 and 48 hours after operation(P>0.05). The forearm motor scores of group B at 1, 6, 12, 24 and 48 hours after operation were significantly lower than those of group A, the differences were statistically significant(P<0.05). The mental state and the sedation score were significantly better than those of group A, the differences were statistically significant(P<0.05). There were no adverse reactions during and after anesthesia in both groups. Conclusion: The 0.375% and 0.20% Ropivacaine have good effects in continuous brachial plexus block, but 0.20% Ropivacaine has faster recovery of forearm movement and better mental state after operation.