盐酸氢吗啡酮联合罗哌卡因臂丛神经阻滞麻醉对上肢骨折术后镇痛效果的影响

Effect of Hydromorphone Hydrochloride combined with Ropivacaine brachial plexus block anesthesia on postoperative analgesia of upper limb fractures

目的 探讨盐酸氢吗啡酮联合罗哌卡因臂丛神经阻滞麻醉对上肢骨折术后的镇痛效果。方法 选取2018年10月至2020年4月中国人民解放军联勤保障部队第九〇四医院收治的122例桡骨下端骨折患者,依据随机数字表法分为研究组(61例)、对照组(61例)。对照组实施罗哌卡因臂丛神经阻滞麻醉,研究组在对照组的基础上使用盐酸氢吗啡酮。记录两组术后患者自控镇痛(PCA)使用情况及疼痛情况,比较两组血清疼痛介质及药物安全性。结果 两组术后12、24 h的PCA使用总量高于术后8 h,术后24 h PCA使用总量高于术后12 h,差异有统计学意义(P <0.05)。研究组术后8、12、24 h PCA使用总量低于对照组,差异有统计学意义(P <0.05)。两组术后12、24 h的视觉模拟评分法(VAS)评分高于术后4 h,术后24 h的VAS评分高于术后12 h,差异有统计学意义(P <0.05)。研究组术后4、12、24 h的VAS评分低于对照组,差异有统计学意义(P <0.05)。术后24 h,两组前列腺素E2(PGE2)、P物质(SP)、多巴胺(DA)高于术前,研究组PGE2、SP、DA低于对照组,差异有统计学意义(P <0.05)。两组不良反应总发生率比较,差异无统计学意义(P> 0.05)。结论 盐酸氢吗啡酮联合罗哌卡因臂丛神经阻滞麻醉可减轻上肢骨折患者术后疼痛,减少疼痛介质释放,且安全性良好。

Objective To explore the effect of Hydromorphone Hydrochloride combined with Ropivacaine brachial plexus block anesthesia on postoperative analgesia of upper limb fractures. Methods A total of 122 patients with lower radius fractures admitted to 904th Hospital of the Joint Logistic Support Force of the Chinese People’s Liberation Army from October 2018 to April 2020. They were divided into study group(61 cases) and control group(61 cases) according to random number table method. The control group received Ropivacaine brachial plexus block anesthesia, and the study group used Hydromorphone Hydrochloride on the basis of the control group. The use of patient-controlled analgesia(PCA) and pain in two groups were recorded after surgery, serum pain mediators and drug safety of two groups were compared. Results The total PNA usage of both groups at 24 and 12 h after surgery was higher than that at 8 h, the total PCA usage at 12 h in both groups after surgery was higher than that at 12 h, and the differences were statistically significant(P < 0.05). The total PCA usage in study group at 8, 12, and 24 h after surgery was lower than that in control group, and the difference was statistically significant(P < 0.05). Visual analogue scale(VAS) scores of two groups at 24 and 12 h after surgery were higher than those at 4 h, VAS scores of two groups at 24 h after surgery were higher than those at 12 h, and the differences were statistically significant(P < 0.05). VAS of study group at 4, 12, and 24 h after surgery were lower than those of control group, and the differences were statistically significant(P < 0.05). At 24 h after surgery, the levels of prostaglandin E2(PGE2), substance P(SP) and dopamine(DA) in two groups were higher than those before surgery, PGE2, SP, and DA of study group were lower than those of control group, and the differences were statistically significant(P < 0.05). There was no significant difference in the total incidence of adverse reactions between two groups(P > 0.05). Conclusion Hydromorphone Hydrochloride combined with Ropivacaine brachial plexus block anesthesia can reduce postoperative pain in patients with upper limb fractures, reduce the release of pain mediators, and have good safety.