小剂量右美托咪定改善臂丛神经阻滞效果的随机对照研究

Low dose of dexmedetomidine as an adjunction to ropivacaine in supraclavicular brachial plexus block:a randomized controlled trial

目的观察右美托咪定作为佐剂对罗哌卡因在锁骨上入路臂丛神经阻滞效果的影响。方法将55例上肢择期手术的受试者随机分为右美组和对照组。右美组:30μg右美托咪定(0.3 mL)+0.5%罗哌卡因,对照组:生理盐水(0.3 mL)+0.5%罗哌卡因。在臂丛神经阻滞操作后,按步骤评估和记录臂丛感觉、运动阻滞程度和起效时间。在术中定期监测和记录生命体征、不良事件的发生。手术后评估和记录术毕24小时生命体征、术后镇痛时间、臂丛神经感觉、运动阻滞的持续时间、术后恶心呕吐评分、补救镇痛药物用量和不良事件等数据。结果在臂丛神经的感觉和运动起效时间、感觉和运动阻滞持续时间、术后镇痛时间方面,右美组长于对照组,存在统计学差异(P<0.05)。两组间在术后生命体征变化、补救镇痛药物用量、术后恶心呕吐评分、不良事件等数据的比较,未见明显统计学差异(P>0.05)。结论右美托咪定(30μg)作为佐剂能加快罗哌卡因在锁骨上入路对臂丛神经阻滞的起效时间,增加其术后镇痛时间和对臂丛神经的感觉、运动阻滞时间,同时较少影响患者生命体征,具备一定的有效性和临床安全性。

Objective To observed the effect of dexmedetomidine as an adjunction with ropivacaine in supraclavicularbrachial plexus block.Methods 55 subjects with elective upper extremity operation were randomly divided into two groups:DEX group and control group.The drugs in DEX group was 30μg dexmedetomidine(0.3 mL)+0.5%ropivacaine,20 mL in total.And the one in control group was normal saline(0.3 mL)+0.5%ropivacaine,20 mL in total.After the operation of brachial plexus block,the value of sensory and motor block of brachial plexus and the onset time were evaluated and recorded according to the protocol.Vital signs and adverse events were monitored and recorded regularly during the operation.Postoperative vital signs,postoperative analgesia time,duration of brachial plexus sensationsensory and motion block,postoperative nausea and vomiting score,dosage of remedial analgesics and adverse events were assessed and recorded in 24 hours after surgery.Results In terms of sensory and motor onset time of brachial plexus,duration of sensory and motor block and postoperative analgesia,DEX group was longer than the control group,with statistical differences(P<0.05).There were no significant statistical differences between the two groups in postoperative vital signs,the amount of remedial analgesic drugs,postoperative nausea and vomiting scores,adverse events etc(P>0.05).Conclusion As an adjuvant,dexmedetomidine(30μg)can accelerate the onset time of ropivacaine in the supraclavicular approach of brachial plexus block.It can also increase the postoperative analgesia time and sensory and motor block time of brachial plexus.With less impact on the vital signs of patients,the efficacy and clinical safety of dexmedetomidinecan be found in our study.