右旋美托咪啶加入到左旋布比卡因中可延长臂丛神经阻滞的持续时间  

作　　者：Aliye Esmaoglu Fusun Yegenoglu, MD Aynur Akin Cemil Yildirim Turk 潘云超(译) 喻田(校) 

机构地区：[1]Department of Anesthesiology and Intensive Care and tDepartment of Orthopedic Surgery and Traumatology, University of Erciyes, Melikgazi Kayseri, Turkey [2]不详

出　　处：《麻醉与镇痛》2012年第3期29-32,共4页Anesthesia & Analgesia

摘　　要：背景和目的我们针对右旋美托咪啶添加到左旋布比卡因中对腋路臂丛神经阻滞效果的影响加以评估。主要观察指标为起效时间、感觉和运动神经阻滞时间及镇痛时间。方法选择60例择期行前臂和手部手术的患者，采用随机双盲试验方法将患者分成两组。通过神经刺激的方法定位腋下4条主要神经（肌皮神经、桡神经、正中神经、尺神经）。将患者随机分配到两组中的任一组。给予L组（n=30）0．5％左旋布比卡因40ml（200mg）＋生理盐水1ml；给予LD组（n=30）0．5％左旋布比卡因40ml（200mg）＋右旋美托咪啶1ml。记录运动和感觉阻滞起效时间、阻滞持续时间和镇痛持续时间。结果两组中的患者基本资料和手术特点都相似。感觉和运动阻滞起效时间LD组比L组明显缩短（P〈0．05）。感觉和运动阻滞持续时间LD组比L组明显延长（P〈0．01）。镇痛持续时间LD组比L组长（P〈0．05）。分别于10、15、30、45、60、90、120分钟记录收缩压，LD组明显低于L组（P〈O．05）。60、90、120分钟记录舒张压，LD组明显低于L组（P〈0．05）。除基础值外，LD组心率明显低于L组（P〈0．05）。在LD组有7例心动过缓患者，L组无心动过缓者（P〈0．05）。结论右旋美托咪啶加入左旋布比卡因用于腋路臂丛神经阻滞，可缩短起效时间，延长持续时间和镇痛时间。但右旋美托咪啶可能导致心动过缓。BACKGROUND AND OBIECTIVES： We evaluated the effect of adding dexmedetomidine to levobupivacaine for axillary brachial plexus blockade. The primary endpoints were the onset and duration of sensory and motor block and duration of analgesia. METHODS： Sixty patients scheduled for elective forearm and hand surgery were divided into 2 equal groups in a randomized, double-blind fashion. The 4 main nerves in the axilla （musculocutaneus, radial, median, ulnar） were identified using neural stimulation. Patients were assigned randomly to 1 of the 2 groups. In group L （n = 30）, 40 ml （200 mg） of 0. 5% levobupivacaine ＋ 1 ml saline and in group LD （n = 30）, 40 ml （200 mg） of 0. 5% levobupivacaine ＋ 1 ml dexmedetomidine were given. Motor and sensory block onset times, block durations, and duration of analgesia were recorded. RESULTS： Demographic data and surgical characteristics were similar in both groups. Sensory and motor block onset times were shorter in group LD than in group L （P 〈 0.05）. Sensory and motor blockade durations were longer in group LD than in group L （P 〈 0. 01）. Duration of analgesia was longer in group LD than in group L （P 〈 0.05）. Systolic arterial blood pressure levels in group LD at 10, 15, 30, 45, 60, 90, and 120 minutes were significandy lower than those in group L （P 〈 0.05）. Diastolic arterial blood pressure levels in group LD at 60, 90, and 120 minutes were significantly lower than those in group L （P 〈 0.05）. Heart rate levels in group LD, except basal measurements, were significantly lower than those in group L （P 〈 0. 05）. In group LD bradycardia was observed in 7 patients, although there was no bradycardia in group L （P 〈 0.05 ）. CONCLUSIONS： Dexmedetomidine added to levobupivacaine for axillary brachial plexus block shortens the onset time and prolongs the duration of the block and the duration of postoperative analgesia. However, dexmedetomidine also may lead to bradycardia.

关 键 词：腋路臂丛神经阻滞 镇痛持续时间 左旋布比卡因 右旋美托咪啶 阻滞起效时间 运动神经 心动过缓 镇痛时间 

分 类 号：R614.4[医药卫生—麻醉学]