地塞米松辅助罗哌卡因臂丛阻滞用于手部手术的麻醉效果

Comparison of assistant effects of dexamethasone and butorphanol on ropivacaine axillary brachial plexus block

目的评价地塞米松辅助罗哌卡因臂丛阻滞用于手部手术的麻醉效果。方法择期拟采用腋路臂丛神经阻滞行手部手术患者80例,BMI 21~26 kg/m^(2),年龄18~65岁,ASAⅠ~Ⅱ级。采用随机数字表法分为2组,各40例。麻醉前5 min,D组输注地塞米松(负荷量8 mg+维持量1 mg/h,极量设定为13 mg)。B组给予布托啡诺(负荷量0.8 mg+维持量0.2 mg/h)。随后2组均在超声引导下应用0.5%罗哌卡因40 mL行腋路臂丛神经阻滞。记录麻醉起效时间、感觉和运动阻滞维持时间;评价神经阻滞后4 h、6 h、8 h、10 h、12 h、24 h患者的视觉模拟评分法(VAS)评分,以及手部运动能力MBS评分。统计阻滞成功率、麻醉后24 h内休息受干扰程度评分,以及不良反应发生率。结果D组的麻醉起效时间显著缩短于B组,痛觉阻滞维持时间与运动阻滞维持时间显著长于B组,麻醉后24 h内的不良反应发生率和休息受干扰程度显著低于B组。以上差异均有统计学意义(P<0.05)。2组的阻滞成功率差异无统计学意义(P>0.05)。结论地塞米松辅助罗哌卡因臂丛阻滞用于手部手术的麻醉,有助于提升麻醉效果。

Objective To observe the influence of intravenous application of dexamethasone and butorphanol on ultrasound-guided axillary brachial plexus block with 0.5% ropivacaine.Methods Allocated 80 patients who scheduled to have hand surgery under axillary brachial plexus block and divided them randomly into B and D group.5 minutes before nerve block,patients in D group began to receive dexamethasone(8 mg+1 mg/h,the maximum dose was 13mg),and patients in group B began to receive butorphanol(0.8 mg+0.2 mg/h,the maximum dose was 1.8 mg),then the two groups received ultrasound-guided axillary brachial plexus block with 0.5% ropivacaine 40 mL.Record the sensory block onset time,the duration time of sensory block and motor block,the score of VAS,MBS(at the time of 4 h,6 h,8 h,10 h,12 h,24 h after nerve block),successful block rate,the score of rest disturbance degree and adverse reaction incidence within 24 h after nerve block.Results The onset time of nerve block was significantly shorter in group D than those in that of group B,P<0.05;The duration of sensory block and motor block was significantly longer in group D than those in that of group B,P<0.05;The incidence of adverse reaction was significantly lower in group D than those in that of group B;The score of rest disturbance degree within 24 h after nerve block was significantly lower in group D than that of group B,P<0.05;There was no statistical difference in success block rate between group D and group B,P>0.05.Conclusion Compared with butorphanol,the intravenous application of dexamethasone produced a stronger assistant influence for ultrasound-guided 0.5% ropivacaine brachial plexus block.