罗哌卡因联合右美托咪定⽤于臂丛神经阻滞的镇痛效果
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Analgesic effect of Ropivacaine combined with Dexmedetomidine on brachial plexus block
背景与目的
罗哌卡因联合右美托咪定与罗哌卡因单独应⽤于臂丛神经阻滞镇痛效果的⽐较，为上肢外伤⼿术提供更好的麻醉⽅式。
方 法
试验共收集了我院2013年2⽉⾄2015年7⽉在臂丛神经阻滞麻醉下进⾏上肢⼿术的114例患者，并随机接受罗哌卡因单独麻醉（对照组）或罗哌卡因联合右美托咪定麻醉（联合组）。对照组30s内推注完20mL0.375%罗哌卡因；联合组30s内推注完20mL
0.375% 罗哌卡因+100μg右美托咪定。⽐较两组间感觉和运动神经元的阻滞效果、视觉模拟评分（VAS）、⼼率（HR）、平均动脉压（MAP）、外周⽑细⾎管⾎氧饱和度（SPO2）及不良反应。
结 果
与对照组相⽐，联合组感觉和运动神经阻滞的起效时间明显缩短（感觉阻滞8.9 min vs. 12.4 min,P < 0.05 ；运动阻滞7.5 min vs. 12.8min,P < 0.05 ），阻滞持续时间显著延⻓（590.2 min vs. 532.1 min, P <0.05）。两组间术后即刻及4h的VAS评分⽆显著差异；然⽽，联合组术后8h、12h、24h的VAS评分均显著低于对照组（8h:2.4 vs. 3.0,P < 0.05；12h: 2.2 vs. 4.2,P < 0.05；24h:2.1 vs. 5.4,P < 0.05）。麻醉前两组间的HR、MAP 及SPO2⽆统计学差异；但麻醉后与对照组相⽐，联合组MAP和HR显著下降，SPO2明显升⾼（MAP:78 vs. 84,P < 0.05; HR:72 vs. 79,P <0.05;SPO2:95.1 vs. 88.2, P < 0.05）。联合组不良反应发⽣率明显低于对照组（3.6 vs. 7.2, P < 0.05）。
结 论
罗哌卡因联合右美托咪定⽤于臂丛神经阻滞在术中及术后的镇痛效果优于罗哌卡因单独使⽤。
原始文献摘要
Zhenqing L, Menglu J, Tongsheng X,et al.Analgesic effect ofRopivacaine combined with Dexmedetomidine on brachial plexus block[J]. BMCAnest hesiology,2018,18(1):107.
Background: This randomized controlled study investigated the analgesic eff ect of ropivacaine in combination with dexmedetomidine versus ropivacaine alone on brachial plexus block to provide alternative anesthetic means f or upper limb trauma surgery.
Methods: Totally 114 patients who received upper limb surgeries under brachial plexus block anesthesia in our hospital from February 2013 to July 2015 were enrolled. The patients were randomized to ropivacaine alone (the control group) or ropivacaine combined with dexmedetomidine (the combination group). The blocking eff ect on sensory and motor neurons, visual analog scale (VAS) score, heart rate (HR), mean arterial pressure (MAP), peripheral capillary oxygen saturation (SPO2) and adverse reactions were compared between the two groups.
Results: The time to onset of sensory and motor nerve blockade was significantly shorter in the combination group than in the control group (8.9 min vs. 12.4 min f or sensation blockade; 7.5 min vs. 12.8min f or motor blockade, P < 0.05 f or both comparisons), and the duration of the blockade was significantly longer in the combination group (590.2 min vs. 532.1 min, P < 0.05). There was no significant difference in VAS scores between the two groups immediately and 4h af ter surgery; however, 8, 12 and 24 h after surgery, the VAS scores were all significantly lower in the combination group than the control group (2.4 vs. 3.0 f or 8 h; 2.2 vs. 4.2 for 12 h, and 2.1 vs. 5.4for 24 h, respectively, P < 0.05 f or all comparisons). There was no statistical diff erence in HR, MAP and SPO2 between the two groups bef ore anesthesia, but after anesthesia, the MAP and HR were significantly lower, and the SPO2 was significantly higher in the combination group than the control group (78 vs. 84 f or MAP; 72 vs. 79 f or HR; and 95.1 vs. 88.2 f or SPO2, P < 0.05 f or all comparisons). The rates of adverse reaction was significantly lower in the combination group than the control group (3.6 vs. 7.2, P < 0.05).
Conclusion: The brachial plexus blocking effect of ropivacaine combined with
dexmedetomidine was superior to that of ropivacaine alone, mainly intra-operatively and postoperatively.
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