罗哌卡因复合右美托咪定用于儿童超声引导下臂丛神经阻滞的临床效果

Clinical efficiency of ropivacaine combined with dexmedetomidine for ultrasound-guided brachial plexus block in children

目的观察罗哌卡因复合右美托咪定用于儿童超声引导下肌间沟径路臂丛神经阻滞的镇痛效果。方法将超声引导臂丛神经阻滞下行拇长屈肌腱腱鞘炎松解术1~3岁患儿100例随机均分为四组。臂丛神经阻滞药物:C组采用0.25%罗哌卡因,D1组采用0.25%罗哌卡因+右美托咪定0.75μg/kg,D2组采用0.25%罗哌卡因+右美托咪定1.00μg/kg,D3组采用0.25%罗哌卡因+右美托咪定1.25μg/kg。记录麻醉诱导前(T0)、切皮(T1)、松解肌腱(T2)、缝皮结束(T3)和包扎完毕(T4)时的HR、RR、SpO2和MAP,记录手术时间以及神经阻滞操作时间、麻醉起效时间、感觉阻滞时间和运动阻滞时间,观察神经阻滞效果和并发症的发生情况。结果与T0时相比,四组T1~T4时HR、RR和MAP降低,SpO_(2)升高(P<0.05);D3组T1时HR低于T2~T4时(P<0.05),且低于其余三组(P<0.05)。与C组相比,D1组、D2组和D3组麻醉起效时间缩短,感觉阻滞时间和运动阻滞时间延长(P<0.05)。四组间手术时间、神经阻滞操作时间、神经阻滞不成功率以及喉返神经阻滞、霍纳综合征、呼吸抑制、窦性心动过缓发生率比较差异无统计学意义(P>0.05)。结论罗哌卡因复合右美托咪定0.75和1.00μg/kg可安全用于1~3岁患儿,不仅加快麻醉起效时间,亦可延长镇痛时间。

Objective To observe the analgesic efficiency of ropivacaine combined with dexmedetomidine for ultrasound-guided brachial plexus block(BPB)in children.Methods A total of 100 children aged 1-3 years old undergoing tenosynovitis release surgery of flexor pollicis longus tendon were equally randomized into four groups.Ultrasound-guided BPB was performed with 0.25%ropivacaine in group C,with 0.25%ropivacaine combined with dexmedetomidine 0.75μg/kg in group D1,with 0.25%ropivacaine combined with dexmedetomidine 1.00μg/kg in group D2,and with 0.25%ropivacaine combined with dexmedetomidine 1.25μg/kg in group D3.The HR,RR,SpO_(2) and MAP were recorded before anesthesia induction(T0),after skin incision(T1),after tendon relaxation(T2),at the end of skin suture(T3)and after wrapping(T4).The whole operation time,operation time of nerve block,onset time of anesthesia,sensory block time and motor block time were recorded as well.The effect of nerve block and incidence of complications were observed.Results Compared with TO,HR,RR and MAP were decreased,while SpOz was increased at T1-T4 in four groups(P<0.05).HR at T1 in group D3 was lower than that at T2-T4 and in the other three groups(P<0.05).Compared with group C,the onset time of anesthesia was shortened,and the sensory block time and motor block time were prolonged in groups of D1,D2 and D3(P<0.05).There were no statistical differences in the whole operation time,operation time of nerve block,failure rate of nerve block and incidences of recurrent laryngeal nerve block,Horner's syndrome,respiratory depression and sinus bradycardia among groups of D1,D2,D3 and C(P>0.05).Conclusion Ropivacaine combined with dexmedetomidine 0.75 and 1.00μg/kg can be safely used in the children aged 1-3 years old with faster onset of anesthesia and longer analgesic duration.