罗哌卡因复合不同剂量地塞米松行肌间沟臂丛神经阻滞在患儿上肢手术后的镇痛效果  

Postoperative analgesic effect of ropivacaine combined with different dose of dexamethasone for brachial plexus block in children undergoing upper limb surgery

作　　者：陈培章 石翊飒[1] 金平[1] 李雅楠[1] 王亚琴 CHEN Peizhang;SHI Yisa;JIN Ping;LI Yanan;WANG Yaqin(Department of Anesthesiology,Lanzhou University Second Hospital,Lanzhou 730010,China)

机构地区：[1]兰州大学第二医院麻醉科,730010

出　　处：《临床麻醉学杂志》2022年第6期598-602,共5页Journal of Clinical Anesthesiology

摘　　要：目的观察罗哌卡因复合不同剂量地塞米松行肌间沟臂丛神经阻滞(ISBPB)对患儿上肢骨折手术后镇痛效果的影响。方法选择上肢骨折手术患儿73例,男46例,女27例,年龄3~7岁,ASAⅠ或Ⅱ级。随机分为三组:单纯罗哌卡因组(R组,n=24)、罗哌卡因复合地塞米松0.1 mg/kg组(D1组,n=24)和罗哌卡因复合地塞米松0.2 mg/kg组(D2组,n=25),三组药液容量均为0.3 ml/kg。患儿在麻醉后行超声引导下ISBPB,均保留自主呼吸。记录痛觉阻滞时间、运动阻滞时间、阻滞后24 h内镇痛药物(布洛芬混悬液、氢吗啡酮)的使用情况。记录膈神经阻滞、Horner综合征、声带麻痹、阻滞侧感觉异常等术后并发症的发生情况。结果D2组痛觉阻滞时间明显长于R组(P<0.05)。R组和D1组痛觉阻滞时间差异无统计学意义。三组运动阻滞时间差异无统计学意义。D1组和D2组阻滞后24 h内布洛芬混悬液使用次数、氢吗啡酮使用率明显低于R组(P<0.01),D1组和D2组差异无统计学意义。三组膈神经阻滞率差异无统计学意义。三组术后未出现其余并发症。结论与单纯罗哌卡因比较,0.25%罗哌卡因复合地塞米松0.1 mg/kg和0.2 mg/kg可安全应用于患儿肌间沟臂丛神经阻滞,减轻术后疼痛;复合地塞米松0.2 mg/kg时明显延长镇痛时间。Objective To observe the effects of interscalene brachial plexus block(ISBPB) with ropivacaine combined with different doses of dexamethasone on postoperative analgesia in children undergoing upper limb fracture surgery. Methods Seventy-three children for upper limb fracture surgery, 46 males and 27 females, aged 3-7 years, ASA physical status Ⅰ or Ⅱ, were randomly divided into three groups: ropivacaine alone group(group R, n = 24), ropivacaine combined with dexamethasone 0.1 mg/kg group(group D1, n = 24), and ropivacaine combined with dexamethasone 0.2 mg/kg group(group D2, n = 25). The injection doses of the three groups were 0.3 ml/kg. The children underwent ultrasound-guided ISBPB after anesthesia, and all retained spontaneous breath. The pain block time, motor block time, frequency, and type of analgesics(ibuprofen suspension, hydromorphone) used within 24 hours after block. Phrenic nerve block, Horner syndrome, vocal cord paralysis, block side paresthesia, and other postoperative complications were recorded. Results The pain block time in group D2 was significantly longer than that in group R(P < 0.05). There was no significant difference in pain block time between groups R and D1. There was no significant difference in movement block time among the three groups. The number of ibuprofen suspension use and hydromorphone use rate within 24 hours after blockade in groups D1 and D2 were significantly lower than those in group R(P < 0.01). There was no statistical significance between groups D1 and D2. There was no significant difference in phrenic nerve block rate among the three groups. There were no other postoperative complications in the three groups. Conclusion Compared with ropivacaine alone, 0.25% ropivacaine combined with dexamethasone 0.1 mg/kg and 0.2 mg/kg can be safely applied to ISBPB in children, and reduce the occurrence of postoperative pain. The analgesic time is prolonged when dexamethasone 0.2 mg/kg is used.

关 键 词：地塞米松 罗哌卡因 儿童 肌间沟臂丛神经阻滞 术后镇痛 

分 类 号：R726.1[医药卫生—儿科]