腘窝坐骨神经阻滞术中合用盐酸氢吗啡酮对罗哌卡因镇痛时效的影响  

Observation on the effect of hydromorphone on the action of ropivacaine in popliteal sciatic nerve block for postoperative analgesia

作　　者：杨文婧[1] 徐源[1] 初丽艳[1] 张慧明[2] 张祥晶[1] YANG Wen - jing;XU Yuan;CHU Li -yan;et al(Department of Anesthesiology, Beijing Tong Ren Hospital, Capital Medical University, Beijing 100730, China.)

机构地区：[1]首都医科大学附属北京同仁医院麻醉科,北京100730 [2]首都医科大学附属北京友谊医院普通外科,北京100050

出　　处：《临床和实验医学杂志》2018年第9期976-979,共4页Journal of Clinical and Experimental Medicine

基　　金：北京同仁医院科研骨干基金资助项目(编号:TRYY-KYJJ-2016-019)

摘　　要：目的观察腘窝坐骨神经阻滞术中合用盐酸氢吗啡酮对罗哌卡因镇痛时效的影响。方法前瞻性选取北京同仁医院拟行足踝手术病人68例,随机分为单纯罗哌卡因组(R组)及罗哌卡因联合盐酸氢吗啡酮组(RH)两组,各34例。所有患者全麻前给予超声引导下腘窝坐骨神经阻滞。R组局麻药为0.4%罗哌卡因30 ml神经周围注射;RH组在0.4%罗哌卡因中加入0.01 mg/kg盐酸氢吗啡酮共30 ml神经周围注射。观察阻滞后12 h、24 h及36 h病人VAS评分及镇痛持续时间。结果 RH组在给药后24 h VAS评分(1.2±0.5)明显低于R组(3.5±1.2),RH组镇痛持续时间(27.5±2.1 h)明显长于R组(22.3±1.8 h),差异均有显著性。两组术后镇痛相关的不良反应发生率无显著差异(P>0.05)。结论腘窝坐骨神经阻滞时,与单纯应用0.4%罗哌卡因相比,在0.4%罗哌卡因中加入盐酸氢吗啡酮可以明显延长镇痛持续时间,并减轻阻滞作用消退时病人的反跳性疼痛。Objective To observe the effect on postoperative analgesia of popliteal sciatic nerve block with hydromorphone plus ropivacaine. Methods A total of 68 patients scheduled for foot or ankle operations in this hospital. They were randomly allocated into two groups： ropivacaine group（ group R） and ropivacaine plus hydromorphone group（ group RH）,and 34 cases in each group. Patients in group R were injected with 0. 4% ropivacaine for popliteal sciatic nerve block and patients in group RH were injected with 0. 4% ropivacaine combined with hydromorphone. VAS（ visual anolog scale） scores of these patients were recorded at 12 h,24 h and 36 h after injection,and the analgesia maintaining periods were recorded. The incidence of anesthetic toxicity was also recorded. Results VAS scores in patients of group RH（ 1. 2 ± 0. 5） were significantly lower than those（ 3. 5 ± 1. 2） in group R at 24 hours after the injection（ P〈0. 05）. Analgesia maitaining time in group RH（ 27. 5 ± 2. 1 h） was longer than that（ 22. 3 ± 1. 8 h） of group R（ P〈0. 05）. There was no significant differences between group R and group RH on anesthetic side effects. Conclusion Hydromorphone can significantly prolong analgesia maintaining time and mitigate the rebound of pain at the fade of numb feeling.

关 键 词：腘窝坐骨神经阻滞 罗哌卡因 盐酸氢吗啡酮 

分 类 号：R614[医药卫生—麻醉学]