静脉应用中等剂量地塞米松对罗哌卡因腋路臂丛神经阻滞效果的影响

Influence of intravenous medium-dose dexamethasone on ropivacaine axillary brachial plexus block

目的:观察静脉应用中等剂量的地塞米松对超声引导下罗哌卡因腋路臂丛神经阻滞效果的影响。方法:收集2020年11月至2021年6月60例在我院行手部手术拟采用腋路臂丛神经阻滞的患者,随机分为观察组和对照组。在臂丛神经阻滞前5 min,观察组开始给予地塞米松(负荷量8 mg+维持量1 mg/h,极量设定为13 mg),对照组给予相同体积的生理盐水,随后2组患者均在超声引导下应用0.5%罗哌卡因40 ml进行腋路臂丛神经阻滞。记录麻醉起效时间,痛觉阻滞维持时间和运动阻滞维持时间,神经阻滞后4、6、8、10、12、24 h疼痛程度评分(VAS)及手部运动能力评分(MBS),阻滞成功率,麻醉后24 h内休息及睡眠受干扰程度评分及不良反应发生率。结果:与对照组比较,观察组痛觉阻滞维持时间以及痛觉和运动阻滞维持时间显著延长(P<0.01),观察组麻醉后24 h内休息受干扰程度评分显著降低(P=0.018);麻醉后24 h内,观察组相较于对照组,镇痛效果明显更好,其镇痛优势甚至不止局限于麻醉后24 h;观察组手部运动能力恢复时间虽然相对延迟,但是在麻醉后24 h时,2组患者在运动能力方面不再有显著差异;2组在麻醉起效时间、阻滞成功率,以及麻醉后24 h内不良反应发生率方面差异无统计学意义(P>0.05)。结论:静脉应用中等剂量的地塞米松能够显著延长超声引导下0.5%罗哌卡因腋路臂丛神经阻滞的镇痛维持时间,并且能够使患者麻醉后24 h内休息质量得到提高。

Objective:To investigate the influence of intravenous medium-dose dexamethasone on ultrasound-guided ropivacaine axillary brachial plexus block. Methods:A total of 60 patients who underwent hand surgery with axillary brachial plexus block in our hospital from Nov 2020 to Jun 2021 were enrolled and randomly divided into the observation group and the control group,30 cases in each group. At 5 minutes before nerve block,the observation group was infused with dexamethasone(8mg+1 mg/h,and the maximum dose was 13 mg),the control group was infused with the same volume of normal saline,and then the two groups received ultrasound-guided axillary brachial plexus block with 0.5% ropivacaine 40 ml. Sensory block onset time, duration of sensory block and motor block, scores of VAS and MBS at 4, 6, 8, 10, 12, 24 h after nerve block,successful block rate,score of rest and sleep disturbance degree and incidence of adverse reactions within 24 h after anesthesia were recorded. Results: Compared with the control group, the duration of sensory block and motor block was obviously extended(P<0.01), and the score of rest and sleep disturbance degree was obviously lower in the observation group(P=0.018). Within 24 h after nerve block,the effect of sensory block was obviously better in the observation group than that in the control group, and this advantage could last even more than 24 h. The maintenance of motor block in the observation group was extended compared with the control group,but this difference was not statistically significant at 24h after nerve block. There was no significant difference between the two groups in sensory block onset time,successful block rate,and incidence of adverse reaction within 24 h after nerve block(P>0.05). Conclusion:Intravenous medium-dose dexamethasone can extend the maintenance of sensory block of 0.5% ropivacaine axillary brachial plexus block,and improve the quality of patients′ rest and sleep within 24 h after nerve block.