两种浓度罗哌卡因用于自控肌间沟持续臂丛神经镇痛的效果  

Effects of ropivacaine in two different concentration for patient-controlled interscalene analgesia

作　　者：李挺[1] 马剑峰[1] 刘若海[1] 南洋[1] 余微萍[1] 李军[1] 

机构地区：[1]温州医学院附属第二医院麻醉科,浙江温州325027

出　　处：《温州医学院学报》2013年第4期261-264,共4页Journal of Wenzhou Medical College

基　　金：浙江省医学会临床科研基金资助项目(2011ZYC-A25)

摘　　要：目的 :比较两种浓度罗哌卡因用于自控肌间沟臂丛神经镇痛的效果及并发症。方法:选择拟行上臂或肩部手术患者50例,年龄18～70岁,美国麻醉医师协会(ASA)I～II级,在超声引导联合神经刺激技术下行肌间沟臂丛神经阻滞并留置导管,术后患者自控镇痛(PCA)。随机分成两组:0.1%罗哌卡因组(A组)与0.25%罗哌卡因组(B组),每组25例,无背景持续输注,单次PCA量为5 mL,锁定时间15 min,1 h限制剂量为20 mL。术后0.5、3、6、24 h(t1～4),评估患者静息和活动时的疼痛VAS评分及运动阻滞程度,记录相关并发症。结果:与B组比较,A组静息和活动的疼痛VAS平均评分、平均运动阻滞评分较高(P<0.01)。静息状态下,A组t4时的疼痛VAS评分高于B组(P<0.01),活动状态下,A组t2～4时的疼痛VAS评分高于B组(P<0.01);A组患者患肢手部麻木感的病例多于B组(19:8,P<0.05),Horner综合征的病例少于B组(3:13,P<0.05)。结论:0.25%罗哌卡因用于自控肌间沟臂丛神经镇痛的效果优于0.1%罗哌卡因,但对颈交感神经的影响较大。0.1%罗哌卡因可满足静息状态下的镇痛,并保持一定自主活动功能。Objective： To compare the analgesic effects and complications of ropivacaine in two different concentration for patient-controlled interscalene. Methods： Fifty patients with ASA I-II, aged 18-70 years old,scheduled for upper arm or shoulder operation were randomized into 2 groups to receive patient-con- trolled analgesia with either ropivacaine 0.1% （A group, n=25） or ropivacaine 0.25% （B group, n=25） through an interscalene catheter with 5 mL per bolus （15-minute lockout）. The maximum infusion was 20 mL per four hours. At postoperative 0.5, 3, 6 and 24 h （t1-4）, VAS scale of pain at rest or during movement and motor block of both groups were assessed. Complications were recorded. Results： Compared with B group, the aver- age VAS scale at rest or during movement and motor block scale were higher in A group （P〈0.01）. At rest, the pain scale of t1 in A group was higher than that in B group （P〈0.01）. During movement, the pain scale of t2-4 in A group was higher than that in B group （P〈0.01）. The cases with paresthesia of hand in A group were more than that in B group （19 vs. 8, P〈0.05）. Horner syndrome in A group was less than that in B group （3 vs. 13, P〈0.05）. Conclusion： Ropivacaine 0.25% for patient-controlled interscalene analgesia pro- vides more effective pain control with increasing the intensity of cervical sympathetic ganglia block com- pared with Ropivacaine 0.1%. Ropivacaine 0. 1% provides satisfied pain relief with keeping autonomous motion of upper extremity at certain degree.

关 键 词：臂丛神经 神经阻滞 术后镇痛 罗哌卡因 

分 类 号：R614.4[医药卫生—麻醉学]