超声引导下左旋布比卡因复合硫酸镁股神经阻滞对前交叉韧带重建术后镇痛效果的影响  

Effect of levobupivacaine on magnesium sulfate combined with ultrasound-guided femoral nerve block on postoperative analgesia in anterior cruciate ligament reconstruction

作　　者：张隆盛[1] 杨铎 张顺才 张欢楷[1] 黄志良[1] ZHANG Longsheng YANG Duo ZHANG Shuncai ZHANG Huankai HUANG Zhiliang.(Department of Anesthesiology, Jieyang people＇s Hospital, Jieyang 622000, Chin)

机构地区：[1]广东省揭阳市人民医院麻醉科,522000

出　　处：《临床麻醉学杂志》2017年第10期991-994,共4页Journal of Clinical Anesthesiology

摘　　要：目的探讨左旋布比卡因复合硫酸镁用于超声引导下股神经阻滞对前交叉韧带重建术后镇痛效果的影响。方法选择择期行关节镜下前交叉韧带重建术患者107例,男66例,女41例,年龄25~60岁,ASAⅠ或Ⅱ级。将患者随机分为研究组(n=56)和对照组(n=51)。两组均在全麻诱导前实行超声引导患侧股神经阻滞,研究组给予0.25%左布比卡因和2%硫酸镁混合液20ml,对照组给予0.25%左布比卡因20ml。记录股神经感觉和运动阻滞情况,记录术后4、6、12、24和48h的静息和运动时VAS评分,记录术后48h内追加镇痛药情况、曲马多用量、术后48h满意度评分和术后48h内恶心呕吐等不良反应的发生情况。结果术后12h硫酸镁组静息和运动时VAS评分明显低于对照组(P<0.05)。硫酸镁组需追加镇痛药5例(8.9%),明显少于对照组的10例(19.6%)(P<0.05);硫酸镁组曲马多用量明显少于对照组(P<0.05)。硫酸镁组股神经感觉和运动阻滞起效时间明显短于,感觉和运动阻滞持续时间明显长于,满意度评分明显高于对照组(P<0.05)。两组恶心呕吐发生率差异无统计学意义。结论左旋布比卡因复合硫酸镁应用于超声引导股神经阻滞,可以缩短阻滞起效时间,延长阻滞持续时间,提高术后镇痛效果及患者的满意度,减少镇痛药物应用,并且不增加不良反应的发生。Objective To investigate the effect of the compound administration of levobupivacaine and magnesium sulfate in ultrasonography-guided femoral block on postoperative analgesia of anterior cruciate ligament reconstruction.Methods A total of 107 patients,66 males and 41 females,aged 25-60 years,ASA physical status Ⅰ orⅡ,undergoing arthroscopic anterior cruciate ligament（ACL）reconstruction,were randomly divided into magnesium sulfate group（n=56）and control group（n=51）.Both groups were treated with ultrasound-guided ipsilateral femoral nerve block before anesthesia induction.The patients in the magnesium sulfate group were treated with 0.25% levobupivacaine and 2% magnesium sulfate mixture 20 ml,and the control group was treated with 0.25%levobupivacaine 20 ml.The blocking of sensation and movement of femoral nerve was recorded.The VAS scores of resting and exercise were recorded at 4,6,12,24 and 48 hafter operation.The additional analgesics,tramadol dosage,satisfaction score at postoperative 48 h,incidence of nausea and vomiting and other adverse reactions at 48 hafter surgery were recorded.Results At postoperative 12 h,VAS score was significantly lower in the magnesium sulfate group than that in the control group（P〈0.05）.There were 5 cases（8.9%）needing additional analgesics in the magnesium sulfate group,significantly lower than 10 cases（19.6%）in the control group（P〈0.05）.The tramadol dosage of magnesium sulfate group was significantly lower than that in the control group（P〈0.05）.The duration and onset time of sensation and movement block and Likert satisfaction score in the magnesium sulfate group were significantly superior to that of control group（P〈0.05）.The incidence of adverse reactions between the two groups were not statistically different.Conclusion The combined applications of levobupivacaine and magnesium sulfate in ultrasound-guided ipsilateral femoral nerve block could shorten the onset time and prolong the duration of blocking,improve the postoperative an

关 键 词：术后镇痛 股神经阻滞 硫酸镁 前交叉韧带重建术 

分 类 号：R614[医药卫生—麻醉学]