罗哌卡因添加不同佐剂行锁骨上臂丛神经阻滞的对比研究

doi:10.5246/jcps.2023.12.080

中国药学(英文版) ›› 2023, Vol. 32 ›› Issue (12): 998-1005.DOI: 10.5246/jcps.2023.12.080

罗哌卡因添加不同佐剂行锁骨上臂丛神经阻滞的对比研究

姜忠奎¹^,^*(), 蔺长平¹, 汪三岳¹, 薛允国², 俞游柳³

1. 建德市第一人民医院麻醉科, 浙江建德 311600
2. 黑龙江省鸡西市人民医院麻醉科, 黑龙江鸡西 158100
3. 绍兴市上虞中医医院麻醉科, 浙江绍兴 312300

收稿日期:2023-06-26 修回日期:2023-07-07 接受日期:2023-07-23 出版日期:2024-01-04 发布日期:2023-12-31
通讯作者: 姜忠奎
作者简介:
+ Tel.: +86-13902328685, E-mail: shuixian0103@126.com

Comparative study of supraclavicular brachial plexus block with different adjuvants added to ropivacaine

Zhongkui Jiang¹^,^*(), Changping Lin¹, Sanyue Wang¹, Yunguo Xue², Youliu Yu³

1 Department of Anesthesiology, the First People’s Hospital of Jiande City, Jiande 311600, Zhejiang, China
2 Department of Anesthesiology, People's Hospital of Jixi City, Heilongjiang Province, Jixi 158100, Heilongjiang, China
3 Department of Anesthesiology, Shangyu Hospital of Traditional Chinese Medicine, Shaoxing City, Shaoxing 312300, Zhejiang, China

Received:2023-06-26 Revised:2023-07-07 Accepted:2023-07-23 Online:2024-01-04 Published:2023-12-31
Contact: Zhongkui Jiang

摘要/Abstract

摘要：

本研究探讨了罗哌卡因以及联合佐剂地塞米松或右美托咪定对上肢近端骨折择期行超声引导下锁骨上臂丛神经阻滞的患者的镇痛效果及不良反应。选取于我院行全身麻醉下上肢近端骨折内固定手术的患者120例, 按照随机数字法分为罗哌卡因组(R组), 右美托咪定组(DexM组)和地塞米松组(DexA组), 每组40例, 所有患者在术后行超声引导下患侧SBPB: R组接受0.33%罗哌卡因20 mL, DexM组接受0.33%罗哌卡因20 mL联合1 μg/kg右美托咪定, DexA组接受0.33%罗哌卡因20 mL联合10 mg地塞米松。三组均行患者自控静脉镇痛(patient controlled intravenous analgesia, PCIA)。记录术后48 h各个时间点疼痛NRS评分, 记录感觉阻滞时间、术后48小时内PCIA第一次按压时间及吗啡用量、术后当晚阿森斯失眠量表(Athens insominia scale, AIS)评分和不良反应发生情况及炎性指标CRP、TNF-α变化情况。结果表明与R组比较, DexM组和DexA组两组术后T1–T4各个时间点NRS评分较低, 术后感觉阻滞持续时间和第一次按压镇痛泵的时间较长, 48小时吗啡用量少, AIS评分低, 差异均有统计学意义(P < 0.05); DexM组与DexA组比较, 后者T1–T4各个时间点NRS评分较低, 第一次按压镇痛泵的时间较短, 吗啡用量较少(P < 0.05), 但感觉阻滞时间和AIS评分两组差异无统计学意义(P > 0.05)。CRP, TNF-α两值DexM组、DexA组与R组比较差异均有统计学意义(P < 0.05)。锁骨上臂丛神经阻滞局麻药联合地塞米松或右美托咪定均可以延长镇痛效果, 抑制炎性反应且无明显不良反应。而在本试验条件下, 与右美托咪定相比, 地塞米松显示出其更加优越的镇痛延长效果。

关键词: 锁骨上臂丛神经阻滞, 罗哌卡因, 佐剂, 骨折

Abstract:

The study aimed to investigate the analgesic effect and adverse reactions of ropivacaine alone and its combination with adjuvants dexamethasone or dexmedetomidine in patients undergoing selective ultrasound-guided supraclavicular brachial plexus nerve block (SBPB) for proximal upper limb fractures. A total of 120 patients who underwent internal fixation surgery for proximal upper limb fractures under general anesthesia were randomly divided into three groups: ropivacaine (R), dexmedetomidine (DexM), and dexamethasone (DexA), with 40 patients in each group. After surgery, all patients underwent ultrasound-guided SBPB on the affected side using different interventions: the R group received 20 mL of 0.33% ropivacaine, the DexM group received 20 mL of 0.33% ropivacaine combined with 1 μg/kg of DexM, and the DexA group received 20 mL of 0.33% ropivacaine combined with 10 mg of DexA. Patient-controlled intravenous analgesia (PCIA) was used for postoperative pain management. The study recorded various outcomes, including pain scores using the Numeric Rating Scale (NRS) at different time points, duration of sensory block, first press time of PCIA, morphine consumption, Athens Insomnia Scale (AIS) scores, the occurrence of adverse reactions, and changes in inflammatory indicators. The results demonstrated that compared to the R group, both the DexM and DexA groups had lower postoperative NRS scores at different time points, longer duration of sensory block, delayed first press of the analgesic pump, lower morphine dosage at 48 h, and lower AIS scores, all of which were statistically significant. Compared to the DexA group, the DexM group had lower NRS scores at various time points, a shorter time to first press the analgesic pump, and lower morphine dosage. However, there was no significant difference in sensory block duration and AIS scores between the DexM and DexA groups. The combination of DexA or DexM with ropivacaine for SBPB was found to prolong the analgesic effect, inhibit inflammatory reactions, and show no significant adverse reactions. In this study, DexA exhibited superior analgesic and prolonging effects compared to DexM.

Key words: Upper clavicular brachial plexus block, Ropivacaine, Adjuvant, Fracture

Supporting:

姜忠奎, 蔺长平, 汪三岳, 薛允国, 俞游柳. 罗哌卡因添加不同佐剂行锁骨上臂丛神经阻滞的对比研究[J]. 中国药学(英文版), 2023, 32(12): 998-1005.

Zhongkui Jiang, Changping Lin, Sanyue Wang, Yunguo Xue, Youliu Yu. Comparative study of supraclavicular brachial plexus block with different adjuvants added to ropivacaine[J]. Journal of Chinese Pharmaceutical Sciences, 2023, 32(12): 998-1005.

图/表 5

Table 1. Compared with R group, *P < 0.05; Compared with DexM group, #P < 0.05.

Table 2. Comparison of postoperative NRS scores among three groups of patients (scores, x ± s).

Table 3. Other analgesic indicators of three groups of patients (x ± s).

Table 4. Comparison of CRP values among three groups of patients (mg/L, x ± s).

Table 5. TNF of three groups of patients-α value comparison (ng/L, x ± s).

参考文献 14

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罗哌卡因添加不同佐剂行锁骨上臂丛神经阻滞的对比研究

Comparative study of supraclavicular brachial plexus block with different adjuvants added to ropivacaine

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