不同浓度局麻药对超声引导下锁骨上臂丛神经阻滞效果的影响

The effect of different concentrations of local anesthetics on the ultrasound-guided supraclavicular brachial plexus block

目的探讨不同浓度局麻药(罗哌卡因)对超声引导下锁骨上臂丛神经阻滞效果的影响。方法前瞻性收集2017年1月至2018年12月本院超声引导下锁骨上臂丛神经阻滞患者80例,采用随机数字表法将患者分为A组、B组、C组、D组,每组20例。A组给予1.00%罗哌卡因,B组给予0.75%罗哌卡因,C组给予0.50%罗哌卡因,D组给予0.375%罗哌卡因,四组均注射10 ml罗哌卡因。结果所有患者均获得完整随访,平均(11.3±2.4)个月。A组年龄22~72岁,男性12例,女性8例;B组年龄20~74岁,男性8例,女性12例;C组年龄23~75岁,男性10例,女性10例;D组年龄21~74岁,男性11例,女性9例。A组、B组、C组桡神经、尺神经、正中神经、肌皮神经感觉和运动阻滞起效时间及麻醉完善时间明显快于D组,A组[(557.2±61.4)min]、B组[(556.0±61.0)min]、C组[(553.7±60.2)min]麻醉维持时间明显长于D组[(476.5±52.6)min](P<0.05),A组、B组、C组麻醉效果优良率为100.00%、95.00%、95.00%,明显高于D组的70.00%(x2=9.614,P=0.004),A组、B组不良反应率为35.00%、30.00%,明显高于C组、D组的5.00%、5.00%(x2=9.972,P=0.003)。结论不同浓度局麻药(罗哌卡因)对超声引导下锁骨上臂丛神经阻滞效果的影响存在差异,其中0.50%罗哌卡因既具有良好的阻滞效果,不会增加不良反应。

Objective To discuss the effect of different concentrations of local anesthetics(ropivacaine) on the ultrasound-guided supraclavicular brachial plexus block. Methods Eighty patients with ultrasound-guided supraclavicular brachial plexus block were selected prospectively in our hospital from January2017 to December 2018, they were divided into the group A, group B, group C and group D according to the random number table, there were 20 cases in each group. The group A was given 1.00% ropivacaine, the group B was given 0.75% ropivacaine, the group C was given 0.50% ropivacaine, the group D was given0.375% ropivacaine, and the four groups were injected with 10 ml ropivacaine. Results All patients were followed up for an average of(11.3±2.4) months. In group A, there were 12 males and 8 females, the aged was 22-72. In group B, there were 8 males and 12 females, the aged was 20-74. In group C, there were 10 males and 10 females, the aged was 23-75. In group D, there were 11 males and 9 females, the aged was 21-74. The sensory and motor block onset time of radial nerve, ulnar nerve, median nerve, musculocutaneous nerve and the anesthesia completion time in the group A, group B and group C were significantly faster than those in the group D, and the duration of anesthesia in the group A [(557.2±61.4)min], group B [(556.0±61.0)min] and group C [(553.7±60.2)min] were significantly longer than those in group D [(476.5±52.6)min](P<0.05). The excellent and good rate of anesthesia effect in the group A, group B and group C were 100.00%,95.00% and 95.00%, which were significantly higher than the 70.00% in the group D, the difference was statistically significant(x2=9.614, P=0.004). The adverse reaction rate in the group A and group B were 35.00%and 30.00%, they were significantly higher than the 5.00% in the group C and the 5.00% in the group D, the difference was statistically significant(c2=9.972, P=0.003). Conclusions Different concentrations of local anesthetics(ropivacaine) have different effects on ultrasound-guided supraclavicular brachial plexus block,and among them, the 0.50% ropivacaine not only has the good blocking effect, but also does not increase the adverse reactions.