1．5％甲哌卡因与0．5％布比卡因混合液对超声引导下肌间沟神经阻滞起效时间及镇痛时间的作用  

作　　者：Jeff Gadsden, MD Admir Hadzic, MD, PhD, Kishor Gandhi, MD, MPH, Ali Shariat, MD Daquan Xu, MB, MPH, Thomas Maliakal, MD, Vijay Patel, MD 安光惠(译) 李士通(校) 

机构地区：[1]St. Luke's-Roosevelt Hospital Center, New York, New York. Kishor Gandhi is currently affiliated with Thomas Jefferson University Hospital, Philadelphia, Pennsylvania [2]不详

出　　处：《麻醉与镇痛》2012年第3期23-28,共6页Anesthesia & Analgesia

摘　　要：背景一般采用短效与长效局麻药混合使用来达到神经阻滞起效快维持时间长的效果。但是，有关混合使用局麻药优点的数据报道并不多见。我们假设使用甲哌卡因与布比卡因的混合液进行区域阻滞比单纯使用布比卡因起效更快，且比单纯使用甲哌卡因时效更长。方法研究对象为64例行肩关节镜的患者（18-65岁，ASAⅠ-Ⅱ级），采用超声引导下肌间沟臂丛神经阻滞。受试者随机分配接受3种麻醉药物方案中的1种：1．5％甲哌卡因30ml、0．5％布比卡因30ml、1．5％甲哌卡因15ml与0．5％布比卡因15ml混合液。记录运动和感觉被阻滞的起效时间和维持时间。结果3组腋神经分布区（上干）的感觉阻滞的起效时间相同[甲哌卡因组（8．7±4．3）分钟、布比卡因组（10．0±5．1）分钟、混合液组（11．3±5．3）分钟，组间P=0．21]。运动神经阻滞的持续时间混合液组[（11．5±4．7）小时]位于布比卡因组[（16．4±9．4）小时]和甲哌卡因组[（6．0±4．2）小时]之间。镇痛维持时效最短的是甲哌卡因[（4．9±2．4）小时]，最长的是布比卡因组[（14．0±6．2）小时]，中间组是混合液组[（10．3±4．9）小时]（甲哌卡因组与混合液组相比，P〈0．001，布比卡因组与混合液组相比，P=0．01）。结论超声引导下肌间沟臂丛神经阻滞时，使用1．5％甲哌卡因与0．5％布比卡因混合液的起效时间与单独使用其中任何一种药物相近，平均阻滞时间明显比单独使用甲哌卡因长，但比布比卡因短。BACKGROUND： Short- and long-acting local anesthetics are commonly mixed to achieve nerve blocks with short onset and long duration. However, there is a paucity of data on advantages of such mixtures. We hypothesized that a mixture of mepivacaine and bupivacaine results in a faster onset than does bupivacaine and in a longer duration of blockade than does mepivacaine. METHODS： Sixty-four patients undergoing arthroscopic shoulder surgery （ages 18 to 65 years; ASA physical status Ⅰ-Ⅱ ） with ultrasound-guided interscalene brachial plexus block as the sole anesthetic were studied. The subjects were randomized to receive 1 of 3 study solutions： 30 ml of mepivacaine 1.5%, 30 ml of bupivacaine 0. 5%, or a mixture of 15 m/each of bupivacaine 0.5% and mepivacaine 1.5%. The block onset time and duration of motor and sensory block were assessed. RESULTS： Onset of sensory block in the axillary nerve distribution （superior trunk） was similar among the 3 groups （8. 7 ± 4.3 minutes for mepivacaine, 10. 0 ± 5.1 minutes for bupivacaine, and 11. 3 ± 5.3 minutes for the combination group; P = 0.21 between all groups）. The duration of motor block for the combination group （11.5 ± 4.7 hours） was between that of the bupivacaine （16.4 ± 9. 4 hours） and mepivacaine （6.0 ±4.2 hours） groups （P =0.03 between bupivacaine and combination groups; P =0. 01 between mepivacaine and combination groups）. Duration of analgesia was the shortest with mepivacaine （4. 9 ± 2.4 hours）, longest with bupivacaine （14.0 ±6.2 hours）, and intermediate with the combination group （10.3 ± 4.9 hours） （P 〈 0. 001 for mepivacaine vs. combination group; P = 0.01 for bupivacaine vs. combination group）. CONCLUSIONS： For ultrasound-guided interscalene block, a combination of mepivacaine 1.5% and bupivacaine 0. 5% results in a block onset similar to either local anesthetic alone. The mean duration of blockade with a mepivacaine - bupivacaine mixture was significantly longer than block with mepivacaine 1.

关 键 词：肌间沟臂丛神经阻滞 布比卡因混合液 阻滞起效时间 甲哌卡因 超声引导 镇痛时间 运动神经阻滞 长效局麻药 

分 类 号：R614.4[医药卫生—麻醉学]