与利多卡因单独静脉局部麻醉相比，利多卡因联合氨丁三醇有更好的麻醉镇痛效果
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Analgesic effects of lidocaine-ketorolac compared to lidocaine alone for intravenous regional anesthesia
背景与目的
静脉局部麻醉是上肢手术常用的简单且可靠的麻醉方式。为了增加麻醉效果与减轻疼痛，临床上已出现许多药物与利多卡因联合运用的方案，本研究探讨氨丁三醇与利多卡因联合使用的局部麻醉效果。
方 法
本研究纳入ASA分级I 或II级行择期上肢手术患者40例，随机分为了两组：一组（利多卡因组）：20例患者均接受200mg利多卡因，二组（利多卡因联合氨丁三醇组）：20例患者均接受200mg利多卡因+20mg氨丁三醇，两组患者用药均稀释为40ml；于术后1、6、12、24h进行各指标记录及VAS疼痛评分。
结 果
两组间松止血带时疼痛无统计学意义（P=0.443）；利多卡因联合氨丁三醇组松止血带后疼痛发生时间较利多卡因组晚；利多卡因联合氨丁三醇组术后VAS评分明显低于利多卡因组，且利多卡因联合氨丁三醇组要求额外镇痛药物使用的患者数量较少（P＜0.001）。
结 论
利多卡因联合氨丁三醇用于静脉局部麻醉有较好的镇痛效果。
原始文献摘要
Seyfi S, Banihashem N, Bijani A, et al. Analgesic effects of lidocaine-ketorolac compared to lidocaine alone for intravenous regional anesthesia. Caspian J Intern Med 2018; 9(1):32-37.
Background: Intravenous regional anesthesia is a simple and reliable method for upper extremity surgery. In order to increase the quality of blocks and reduce the amount of pain, many drugs are used with lidocaine. In this study, the effect of ketorolac-lidocaine in intravenous regional anesthesia was investigated.
Methods: 40 patients undergoing elective upper limb with America Society of Anesthesiologists class I and II were selected and randomly divided into two groups. The first group of 20 patients received 200 mg of lidocaine, and the second group, 200 mg of lidocaine with 20 mg of ketorolac. In both groups, the drug was diluted to 40 ml. In both groups, the onset of sensory block, onset of tourniquet pain, the onset of pain after opening the tourniquet, score of postoperative pain and analgesic prescription in the first 24 hours, during 1, 6, 12 and 24 hours were studied. A measure of the quality of analgesia was evaluated by VAS.
Results: The mean onset of tourniquet pain in the two groups was not significantly different (P=0.443). In the ketorolac group, the onset of pain after opening the tourniquet was significantly longer than lidocaine group (p<0.001). The mean postoperative pain score during the first 24 hours after surgery in the ketorolac group was significantly lower than lidocaine group (p<0.001). The average number of analgesia prescription during the 24 hours after operation was significantly lower in ketorolac group than lidocaine group (p<0.001).
Conclusions: Adding ketorolac to lidocaine for regional anesthesia can reduce the postoperative pain for up to 24 hours after opening the tourniquet.
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