吗啡、右美托咪定及地塞米松对罗哌卡因锁骨上路臂丛神经阻滞的影响

Comparison of Adding Morphine,Dexmedetomidine and Dexamethasone to Ropivacaine in Supraclavicular Brachial Plexus Block

目的观察吗啡、右美托咪定及地塞米松在超声引导下锁骨上路臂丛神经阻滞中的应用效果。方法将择期行肱骨骨折手术治疗的135例患者随机分为吗啡组、右美托咪定组、地塞米松组3组,每组45例。3组分别在30mL+0.33%罗哌卡因中加入2mg吗啡、25μg右美托咪定及10mg地塞米松进行麻醉。比较3组神经阻滞镇痛持续时间、感觉及运动神经阻滞起效时间及不良反应发生情况。结果镇痛持续时间上,吗啡组(14.38±3.16)h在3组中最长(P<0.05),而右美托咪定组(11.16±3.04)h与地塞米松组(12.04±2.37)h之间差异无统计学意义(P>0.05);在感觉及运动神经阻滞起效方面,右美托咪定组最快而吗啡组最慢(均P<0.05)。3组中不良反应发生率分别为4.7%、2.2%及0%,差异无统计学意义(P>0.05)。结论吗啡作为罗哌卡因佐剂可明显延长臂丛神经阻滞作用时间,而右美托咪定则可明显缩短臂丛神经阻滞起效时间,且两者均不增加术中不良反应的发生率。

Objective To compare morphine,dexmedetomidine,and dexamethasone as an additive to ropivacaine in ultrasound-guided supraclavicular brachial plexus block(SBPB)for humeral fracture surgeries.Methods 135 patients undergoing elective humeral fracture surgeries were randomly divided into 3 groups:group A(n=45,morphine 2mg)and group B(n=45,dexmedetomidine 25μg)and group C(n=45,dexamethasone 10mg).The additives were added to 30ml of 0.33%ropivacaine solution and administered in SBPB.The duration of analgesia and the onset time of motor and sensory block were recorded.The complications were also recorded.Results The duration of analgesia was longer in group A(14.38±3.16 hours)than in other two groups(P<0.05).Compared with group A and C,sensory and motor block onset time were shorter in group B(P<0.05).No significant difference in the incidence of adverse reactions during operation was observed among the three groups(4.7%,2.2%and 0%)(P>0.05).Conclusion Morphine is an ideal adjuivant to ropivacaine in brachial plexus block to prolong duration of analgesia,while dexmedetomidine has a quicker onset of sensory and motor blocked.