超声引导下锁骨上臂丛神经阻滞中应用罗哌卡因联合右美托咪定对上肢手术的镇痛效果及安全性分析

Analgesic Effect and Safety Analysis of Ropivacaine Combined with Dexmedetomidine for Upper Limb Surgery in Ultrasound-guided Supraclavicular Brachial Plexus Block

目的探讨超声引导下锁骨上臂丛神经阻滞中采用罗哌卡因联合右美托咪定麻醉对上肢手术患者的镇痛效果及安全性。方法纳入2016年7月至2019年10我院收治的行超声引导下锁骨上臂丛神经阻滞麻醉的患者100例,按照随机数字表法分为罗哌卡因组(BS组)和罗哌卡因联合右美托咪定组(BD组),各50例;两组患者均接受超声引导下锁骨上臂丛神经阻滞麻醉,BS组予以20 mL 0.5%罗哌卡因+0.75 mL生理盐水,BD组予以20 mL 0.5%罗哌卡因+0.75右美托咪定(75μg);比较两组患者感觉阻滞起效时间(OTSB)、运动阻滞起效时间(OTMB)、感觉阻滞持续时间(DSB)、运动阻滞持续时间(DMB)和镇痛时间(DA);记录T_(0)(麻醉前5 min)、T_(1)(麻醉后5 min)、T_(2)(麻醉后10 min)、T_(3)(麻醉后30 min)、T_(4)(麻醉后60 min)、T_(5)(麻醉后90 min)、T_(6)(麻醉后120 min)时间点两组患者平均动脉压(MAP)、心率(HR)变化情况;记录两组患者麻醉期间发生窦性心动过缓、低血压、恶心呕吐等不良反应情况。结果(1)两组患者在OTSB、OTMB方面比较无统计学意义(P>0.05),BD组DSB、DMB及DA长于BS组,差异具有统计学意义(P<0.05);(2)BD组在T_(2)~T_(6)时间点MAP、HR水平低于BS组,差异具有统计学意义(P<0.05);(3)两组患者均未出现低血压、窦性心动过缓情况,两组均未出现神经血管损伤等情况,BS组出现2例恶心,BD组出现3例恶心,组间比较无统计学意义(P>0.05)。结论在超声引导下锁骨上臂丛神经阻滞中使用罗哌卡因联合右美托咪定进行麻醉可有效延长麻醉阻滞时间,延长术后镇痛时长,减少术后镇痛药物使用,安全有效。

OBJECTIVE To investigate the analgesic effect and safety of ropivacaine combined with dexmedetomidine anesthesia for upper limb surgery patients under ultrasound-guided supraclavicular brachial plexus block.METHODS 100 patients underwent ultrasound-guided supraclavicular brachial plexus block anesthesia admitted to our hospital from July 2016 to October 2019 were included and divided into ropivacaine group(BS group) and Ropivacaine combined with dexmedetomidine group(BD group),50 cases each;Both groups of patients underwent ultrasound-guided anesthesia for supraspinal brachial plexus block.The BS group was given 20 mL 0.5% ropivacaine+0.75 mL saline, and the BD group was given 20 mL 0.5% ropivacaine+0.75 dexmedetomidine(75 μg);Compare the onset time of sensory anesthesia block(OTSB),onset time of exercise block(OTMB),duration of sensory block(DSB),duration of exercise block(DMB) and analgesic time(DA) between the two groups.Record T_(0)(5 min before anesthesia),T_(1)(5 min after anesthesia),T_(2)(10 min after anesthesia),T_(3)(30 min after anesthesia),T_(4)(60 min after anesthesia),T_(5)(90 min after anesthesia),T_(6)(120 min after anesthesia) the changes in mean arterial pressure(MAP) and heart rate(HR) of the two groups of patients;Record the adverse reactions of sinus bradycardia, hypotension, nausea and vomiting occurred during anesthesia in the two groups of patients.RESULTS(1)The two groups of patients were not statistically significant in terms of OTSB and OTMB(P>0.05),the DSB,DMB and DA in the BD group were longer than in the BS group, and the difference was statistically significant(P<0.05);(2)The MAP and HR levels of the BD group were lower than those of the BS group at T_(2)-T_(6),and the difference was statistically significant(P<0.05);(3)There was no hypotension and sinus bradycardia in the two groups of patients, and no neurovascular injury occurred in the two groups.There were 2 cases of nausea in the BS group and 3 cases of nausea in the BD group.There was no statistical difference between the groups(P>0.05).CONCLUSION The use of ropivacaine combined with dexmedetomidine for anesthesia in ultrasound-guided supraclavicular brachial plexus block effectively prolongs the anesthesia block time, prolongs the postoperative analgesia, reduces postoperative analgesic drug use, and is safe effective.