不同浓度罗哌卡因用于超声引导下肌间沟臂丛神经阻滞的效果观察

Anaesthesia effect of ropivacaine in different concentrations on intermuscular sulcus brachial plexus block under ultrasound guidance

目的探讨在超声引导下肌间沟臂丛神经阻滞中应用不同浓度罗哌卡因的麻醉效果。方法采用随机数字表法将2016年4月至2018年4月金华市中医医院行上肢骨科手术患者120例(均实施超声引导下肌间沟臂丛神经阻滞)分为甲组(40例,应用0.375%罗哌卡因)、乙组(40例,应用0.50%罗哌卡因)、丙组(40例,应用0.75%罗哌卡因)。对比三组患者的麻醉效果、感觉阻滞起效时间、运动阻滞起效时间、镇痛持续时间、运动阻滞恢复时间、血清肌钙蛋白水平、肌酸激酶同工酶水平及不良反应发生率。结果三组患者麻醉优良率均为100.0%,差异无统计学意义(P>0.05);丙组感觉阻滞起效时间[(5.29±1.32)min]、运动阻滞起效时间[(7.42±1.36)min]均较甲组[(9.32±1.52)min、(13.32±2.46)min]、乙组[(7.89±1.63)min、(9.12±2.20)min]短(F=4.652、6365,均P<0.05),且镇痛持续时间[(10.71±1.52)h]较甲组[(6.89±2.23)h]、乙组[(8.69±2.12)h]长(F=5.120,P<0.05),但运动阻滞恢复时间较甲组、乙组长(均P<0.05);丙组患者注药后24 h血清肌钙蛋白水平、肌酸激酶同工酶水平均明显高于甲、乙组(均P<0.05),且乙组患者注药后24 h血清肌钙蛋白水平、肌酸激酶同工酶水平均明显高于甲组(均P<0.05);随着浓度升高,患者不良反应发生率逐渐升高,但组间差异无统计学意义(P>0.05)。结论随着罗哌卡因浓度升高,麻醉起效时间更短,镇痛时间更长,但不良反应发生率亦越高,综合考虑,可在超声引导下肌间沟臂丛神经阻滞中应用0.50%罗哌卡因实施麻醉。

Objective To explore the anesthetic effect of different concentrations of ropivacaine in intramuscular sulcus brachial plexus block under ultrasound guidance.Methods From April 2016 to April 2018,120 patients with upper limb orthopedic surgery who received muscle under the ditch brachial plexus block guided by ultrasound in Jinhua Hospital of Traditional Chinese Medicine were randomly divided into group A(40 cases,application of 0.375%ropivacaine),group B(40 cases,application of 0.50%ropivacaine),group C(40 cases,application of 0.75%ropivacaine).The anesthetic effect,onset time of sensory block,onset time of motion block,duration of analgesia,recovery time of motion block,serum troponin level,creatine kinase isozyme level and incidence of adverse reactions in the three groups were compared.Results The excellent and good anesthesia rate of group A,group B and group C was 100.00%,and there was no statistically significant difference among the three groups(P>0.05).The onset time of sensory block[(5.29±1.32)min],the onset time of motion block[(7.42±1.36)min]in group C were shorter than those in group A[(9.32±1.52)min,(13.32±2.46)min]and group B[(7.89±1.63)min,(9.12±2.20)min](F=4.652,6.365,all P<0.05).The analgesic duration in group C[(10.71±1.52)h]was longer than that in group A[(6.89±2.23)h]and group B[(8.69±2.12)h](F=5.120,P<0.05),but the recovery time of motion block in group C was longer than that in group A and group B(P<0.05).The serum troponin level and creatine kinase isozyme level at 24 h after injection in group C were significantly higher than those in group A and group B(P<0.05),and the serum troponin level and creatine kinase isozyme level in group B were significantly higher than those in group A(P<0.05).With the increase of concentration,the incidence of adverse reactions gradually increased,but there was no statistically significant difference among the three groups(P>0.05).Conclusion With the increase of ropivacaine concentration,the onset time of anesthesia is shorter and the analgesic time is longer,but the incidence of adverse reactions is also higher.In a comprehensive consideration,0.50%ropivacaine can be applied to patients with intermuscular sulcus brachial plexus block under ultrasound guidance.