罗哌卡因联合利多卡因应用于腰丛-坐骨神经阻滞的临床研究  

PROSPECTIVE DOUBLE-BLIND RANDOMIZED RESEARCH ON THE MINIMUM CONCENTRATION OF LIDOCAINE REQUIRED TO STRENGTHEN THE EFFECT OF ROPIVACAINE IN LUMBAR PLEXUS AND SCIATIC NERVE BLOCKADE

作　　者：廖志敏[1] 林艳君[2] 张兰[3] 

机构地区：[1]四川大学华西第二医院麻醉科,成都610041 [2]清华大学玉泉医院麻醉科 [3]四川省骨科医院麻醉科

出　　处：《现代预防医学》2011年第17期3625-3628,共4页Modern Preventive Medicine

摘　　要：[目的]将利多卡因与罗哌卡因联合应用于腰丛-坐骨神经阻滞,拟获得可加快阻滞起效时间、增强运动阻滞效果、但不影响运动功能恢复的利多卡因浓度。[方法]ASAⅠ～Ⅱ级择期下肢手术患者115例,随机分I组(0.22%罗哌卡因)、II组(0.22%罗哌卡因+0.17%利多卡因)、III组(0.22%罗哌卡因+0.25%利多卡因)、IV组(0.22%罗哌卡因+0.33%利多卡因)及V组(0.3%罗哌卡因)。腰丛-坐骨神经阻滞,注入试验药物60ml,阻滞后30min内间断行感觉、运动功能评分,记录术中麻醉药物用量、肌松满意度、不良反应发生率、感觉及运动恢复时间。[结果]2～15minIII、IV组股神经感觉VAS评分明显低于I、II、V组(P﹤0.05),2～10minIII-V组股神经感觉完全阻滞率明显高于I、II组(P﹤0.05),25min时5组均为100%;坐骨神经感觉VAS评分及完全阻滞率5组各时点比较差异均无统计学意义(P﹥0.05);10～15minII～IV组运动完全阻滞率明显高于I、V组(P﹤0.05);术中肌松满意度、感觉与运动恢复时间5组比较差异无统计学意义(P﹥0.05)。[结论]0.22%罗哌卡因行腰丛和坐骨神经阻滞可达到与0.3%罗哌卡因相同的阻滞效果,联合利多卡因可加快感觉与运动阻滞起效时间,但并不能改变其阻滞效果和延长阻滞时间。[Objective]To compare the combined effect of different concentration of lidocaine and 0.22% ropivacaine,and finally find a suitable compounding with fast effect,satisfactory muscle relaxation,and without influence on recovery of motor function.[Methods]115 ASA physical status I-II patients,aged 16-70 yr,scheduled for elective single lower limb operation under lumbar plexus and sciatic nerve blockade were randomly divided into five groups：Group I（0.22% ropivacaine,n=22）,Group II（0.22% ropivacaine ＋ 0.17% lidocaine,n=21）,Group III（0.22% ropivacaine＋0.25%lidocaine,n=22）,Group IV（0.22% ropivacaine ＋ 0.33% lidocaine,n=22）,and Group V（0.3% ropivacaine,n=23）.The VAS score of sensory block and Bromage scale of motor block were tested at the time points of 0 min,2min,5min,10min,15min,20min,25min and 30min after injection at different predetermined skin sites of lumbar plexus and sciatic nerve.The vital sign of each patient and additional analgesics or sedatives were observed and recorded in the whole operation.After operation,the patient and surgeons degree of satisfaction about the quality of blockade and postoperative analgesics were asked.[Results]In the distribution sites of femoral nerve,the VAS scores of Group III and Group IV were lower than those of Group I,II and Group V during 2～15 min after injection（P﹤0.05）;The differences of VAS scores of sciatic nerve were not significant in 30min after injection among groups.At 30min,differences of the total sensory blockade ratio of the sciatic nerve were not significant among groups（P﹥0.05）.The difference of the duration of sensory block were not significant among groups（P﹥0.05）.The Bromage scale was significantly lower in Group I than in Group II,Group III and Group IV at 10-20min after injection（P﹤0.05）.At 10～15min the totally motor blockade of Group II-IV were much higher than which of Group I and Group V（P﹤0.05）.The differences of the duration of motor blockade among groups were not significant（P﹥0.05�

关 键 词：罗哌卡因 利多卡因 腰丛神经 坐骨神经 神经阻滞 

分 类 号：R614[医药卫生—麻醉学]