静脉滴注小剂量利多卡因改善臂丛神经阻滞后反跳痛的效果观察

Observation on the effect of intravenous infusion of low-dose lidocaine in improving rebound pain after brachial plexus block

目的观察静脉滴注小剂量利多卡因改善臂丛神经阻滞后反跳痛的效果。方法招募2023年7月至11月于中国人民解放军联勤保障部队第904医院择期在臂丛神经阻滞麻醉下行单侧上肢骨折切开复位内固定的患者80例,采用随机数字表法将其分为对照组(于臂丛神经阻滞成功后静脉滴注生理盐水)和观察组(于臂丛神经阻滞成功后静脉滴注利多卡因100 mg),每组40例。对照组阻滞不全1例,术后失访1例;观察组阻滞不全1例。经剔除后,最终对照组纳入38例,观察组纳入39例。比较两组神经阻滞48 h内反跳痛发生情况和持续时间、镇痛泵药物消耗量、感觉阻滞时间、补救镇痛率及不良反应发生情况。比较两组术前及术后不同时间点静息状态和活动状态的数字评定量表(NRS)评分。结果与对照组相比,观察组反跳痛发生率更低(17.95%vs 39.47%),镇痛泵药物消耗量更少[(105.62±11.21)mL vs(114.29±15.45)mL],差异有统计学意义(P<0.05)。两组感觉阻滞时间比较差异无统计学意义(P>0.05)。在发生反跳痛的患者中,观察组反跳痛持续时间较对照组更短,差异有统计学意义[(2.43±1.27)h vs(3.87±1.19)h;t=2.589,P=0.018]。与对照组比较,观察组神经阻滞后12 h、24 h静息状态的NRS评分更低,神经阻滞后12 h活动状态的NRS评分更低,差异有统计学意义(P<0.05),其余时间点两组NRS评分比较差异无统计学意义(P>0.05)。观察组术后48 h内补救镇痛率显著低于对照组(P<0.05)。两组恶心呕吐、头晕发生率比较差异无统计学意义(P>0.05)。结论静脉滴注小剂量利多卡因可降低患者臂丛神经阻滞后反跳痛的发生率和持续时间,减少术后镇痛泵药物的消耗量和补救镇痛率,不良反应少,有利于患者快速康复。

Objective To observe the effect of intravenous infusion of low-dose lidocaine in improving rebound pain after brachial plexus block.Methods A total of 80 patients with unilateral upper limb fracture who underwent elective open reduction and internal fixation under brachial plexus block anesthesia were recruited in the 904th Hospital of Joint Logistics Support Force of Chinese People′s Liberation Army from July 2023 to November 2023.The patients were divided into the control group(after successful brachial plexus block,receiving intravenous infusion of normal saline)and the observation group(after successful brachial plexus block,receiving intravenous infusion of lidocaine at a dose of 100 mg)by using random number table method,with 40 cases in each group.In the control group,there was 1 case of incomplete block and 1 case was lost to follow up after operation.In the observation group,there was 1 case of incomplete block.After the patients with incomplete block and loss to follow up after operation were excluded,38 cases were included in the control group and 39 cases in the observation group finally.The occurrence and duration of rebound pain,drug consumption of the analgesic pump,time of sensory block,rate of remedial analgesics and adverse reactions were compared between the two groups within 48 hours of nerve block.The Numerical Rating Scale(NRS)scores of resting state and activity state were compared between the two groups at different time points before and after surgery.Results Compared with the control group,the observation group had lower incidence of rebound pain(17.95%vs 39.47%),less drug consumption of the analgesic pump[(105.62±11.21)mL vs(114.29±15.45)mL],and the differences were statistically significant(P<0.05).There was no significant difference in the time of sensory block between the two groups(P>0.05).Among the patients with rebound pain,the duration of rebound pain in the observation group was shorter than that in the control group,and the difference was statistically significant[(2.43±1.27)h vs(3.87±1.19)h;t=2.589,P=0.018].Compared with the control group,the observation group had lower NRS scores of resting state 12 hours and 24 hours after nerve block,and lower NRS scores of activity state 12 hours after nerve block,and the differences were statistically significant(P<0.05),and there were no statistically significant differences in NRS scores between the two groups at the other time points(P>0.05).The rate of remedial analgesics within 48 hours after operation in the observation group was significantly lower than that in the control group(P<0.05),and there were no significant differences in the incidence rate of nausea and vomiting and the incidence rate of dizziness between the two groups(P>0.05).Conclusion Intravenous infusion of low-dose lidocaine can reduce the incidence rate and duration of rebound pain after brachial plexus block,reduce drug consumption of the analgesic pump and rate of remedial analgesics after operation,with fewer adverse reactions,which is conducive to rapid recovery of the patients.