喉罩全身麻醉复合小剂量局部麻醉药臂丛神经阻滞用于上肢手术的麻醉效果

General Anesthesia with Laryngeal Mask Airway and Brachial Plexus Block with Low-Dose Local Anesthetic for Upper Extremity Surgery

目的比较喉罩全身麻醉(全麻)复合不同剂量的局部麻醉(局麻)药行超声引导锁骨上臂丛神经阻滞的麻醉效果,探讨喉罩全麻下合适的局麻药剂量。方法选择90例上肢择期手术患者,ASAⅠ—Ⅱ级,将其按随机数字表法分为0.4%盐酸罗哌卡因5 mL组、0.4%盐酸罗哌卡因10 mL组和0.4%盐酸罗哌卡因15 mL组,每组30例。3组患者的麻醉方式均采用喉罩全麻复合超声引导锁骨上臂丛神经阻滞,局麻药为0.4%盐酸罗哌卡因(3组用量分别为5、10和15 mL)。记录3组患者切皮前5 min、手术切皮时和缝合皮肤时的心率(HR)、平均动脉压(MAP)和镇痛持续时间;评价镇痛效果[视觉模拟评分(VAS)]及术后1 h肌力分级的情况。结果3组患者切皮前5 min、手术切皮时和缝合皮肤时的HR和MPA、VAS评分及术后1 h肌力分级比较差异无统计学意义(P>0.05);15 mL组和10 mL组的镇痛持续时间长于5 mL组(均P<0.05)。结论喉罩全麻复合0.4%盐酸罗哌卡因10 mL臂丛神经阻滞用于上肢手术是合适的,不应过度追求小剂量的局麻药而造成术后镇痛持续时间的减少。

Objective To compare the efficacies of general anesthesia with laryngeal mask airnay combined with different doses of local anesthetic in ultrasound-guided brachial plexus block,and to explore the appropriate local anesthetic dose under general anesthesia with laryngeal mask airway.Methods Ninety ASAⅠ-Ⅱpatients scheduled for upper extremity operation were randomly given general anesthesia with laryngeal mask airway and ultrasound-guided brachial plexus block with different doses of 0.4%ropivacaine(5,10 or 15 mL).The heart rate(HR)and mean arterial pressure(MAP)were recorded at 5 minutes before skin incision,during skin incision and during skin closure.In addition,analgesic duration,VAS score and 1-hour postoperative muscle strength were measured in the three groups(30 patients in each).Results There were no significant differences in the HR,MAP,VAS score and 1-hour postoperative muscle strength among the three groups(P>0.05).The analgesic duration in 10 or 15 mL ropivacaine group was longer than that in 5 mL ropivacaine group(P<0.05).ConclusionThe combination of general anesthesia with laryngeal mask airway and ultrasound-guided brachial plexus block with 10 mL 0.4%ropivacaine is appropriate for upper extremity operation.However,low dose of local anesthetic should not be excessively pursued to reduce the duration of postoperative analgesia.