国际麻醉学与复苏杂志   2018, Issue (9): 0-0
    
右美托咪定复合罗哌卡因对肩关节镜手术中超声引导下臂丛上干和颈浅丛阻滞效果的影响
孙世宇, 陈明慧, 沈伟军, 张玲玲, 牛小引, 傅舒昆, 林福清1()
1.上海市第十人民医院
Effects of dexmedetomidine plus ropivacaine in ultrasound-guided brachial plexus upper trunk and superficial cervical plexus nerve block in shoulder arthroscopic surgery
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摘要:

目的 评价右美托咪定(dexmedetomidine, Dex)复合罗哌卡因在肩关节镜手术中对超声引导臂丛上干和颈浅丛阻滞效果的影响。 方法 选取60例肩袖损伤患者,ASA分级Ⅰ、Ⅱ级,择期行超声引导下单侧臂丛上干和颈浅丛神经阻滞麻醉联合全身麻醉下肩关节镜手术,采用随机数字表法分为单纯罗哌卡因组(D组)和Dex复合罗哌卡因组(E组),每组30例。超声引导下穿刺成功后,D组注入0.35%罗哌卡因12 ml,E组注入含1 μg/kg Dex的0.35%罗哌卡因12 ml。之后给予全身麻醉。记录术前(T0)、手术开始5 min(T1)、手术开始30 min(T2)和拔除喉罩30 min后(T3)患者的HR、MAP和SpO2,记录T1、T2时BIS值,记录手术时间、拔除喉罩时间(停用七氟醚至拔除喉罩时间)、阿片类镇痛药物(舒芬太尼)用量、七氟醚使用量以及患者在术后6、12、18、24 h的VAS评分等指标。 结果 两组患者的年龄、性别、体重、ASA 分级、BMI、手术时间、术中补液量以及T1、T2时的BIS 值差异均无统计学意义(P>0.05)。与D组比较,E组舒芬太尼、七氟醚使用量明显减少(P<0.05),T1~T3时MAP明显降低,T3时HR降低(P<0.05),术后6、12、18 h的VAS评分明显降低(P<0.05)。E 组发生心动过缓2 例,发生率明显高于D 组(P<0.05)。两组患者在复苏后48 h 内均未发生高血压、低血压、心动过速以及术后恶心呕吐等副作用。 结论 与单纯应用罗哌卡因相比,肩关节镜手术中采用Dex复合罗哌卡因行臂丛上干和颈浅丛神经阻滞,能够减少术中阿片类药物及七氟醚的用量,提供更加平稳的麻醉状态,减轻术后疼痛。

关键词: 臂丛上干阻滞; 颈浅丛阻滞; 罗哌卡因; 右美托咪定; 肩关节; 关节镜检查
Abstract:

Objective The addition of dexmedetomidine(Dex) to local anesthetics can prolong peripheral nerve block. However, clinical safety data on the brachial plexus upper trunk and superficial cervical plexus block are limited. We compared the efficiency of ropivacaine combined with Dex to efficiency of ropivacaine alone in the ultrasound-guided brachial plexus upper trunk and superficial cervical plexus block during shoulder arthroscopy. Methods A total of sixty patients with rotator cuff injury, ASAⅠor Ⅱ were enrolled. The patients underwent single shoulder arthroscopy, with ultrasound-guided brachial plexus upper trunk and superficial cervical plexus block combined with general anesthesia. Patients were randomly divided into two groups: group D (ropivacaine alone) and group E (ropivacaine combined with Dex), 30 patients in each group. After successful ultrasound-guided puncture, in the group D, 0.35% ropivacaine (12 ml) was injected in each patient while 0.35% ropivacaine combined with 1 μg/kg of Dex (12 ml) was injected in patients of the group E. Before the operation (T0), 5 min after the operation (T1), 30 min after the operation (T2), and 30 min after removal of the laryngeal mask (T3), HR, MAP and SpO2 were recorded. Operation duration, time of laryngeal mask removal (from stopping sevoflurane to removal of laryngeal mask), dosage of opioid analgesic(sufentanil), the amount of sevoflurane, VAS at 6, 12, 18, 24 h after surgery, and side effects such as hypertension, hypotension, tachycardia, bradycardia, nausea, and vomiting were recorded. Results The differences in age, gender, weight, ASA classification, BMI, operation time, intraoperative fluid intake, BIS value of T1 and T2 between the two groups were not statistically significant (P>0.05). Compared with the group D, the dosage of sufentanil and sevoflurane in the group E was significantly reduced (P<0.05). T1-T3 MAP and T3 HR was significantly lower (P<0.05). And VAS score was significantly lower 6, 12 h and 18 h after surgery (P<0.05). Two cases of bradycardiaoccurred in group E, which was significantly higher than group D(P<0.05). No side effects such as hypertension, hypotension, tachycardia and postoperative nausea and vomiting occurred in the two groups within 48 h after resuscitation.  Conclusions In the treatment of shoulder arthroscopy under ultrasound-guided brachial plexus upper trunk and superficial cervical plexus block combined with general anesthesia, ropivacaine combined with Dex can reduce the dosage of sufentanil and sevoflurane, provide a more stable state of anesthesia at the same time and prolong postoperative analgesia time, when compared with ropivacaine alone.

Key words: Brachial plexus upper trunk nerve block; Superficial cervical plexus nerve block; Ropivacaine; Dexmedetomidine; Shoulder joint; Arthoroscopy