不同浓度罗哌卡因用于上肢淋巴静脉吻合患者臂丛阻滞的效果分析

Effects of brachial plexus block with different doses of Ropivacaine on lymphatic venous anastomosis surgery for patients with upper limb lymphedema

摘要:

目的  探讨不同浓度罗哌卡因在淋巴水肿患者淋巴静脉吻合术中的臂丛阻滞效果。方法  随机选择90例择期行上肢淋巴静脉吻合术患者，随机均分为A、B、C 3组，分别予以0.200%罗哌卡因30ml，0.250%罗哌卡因30 ml及0.375%罗哌卡因30 ml，在超声引导下经肌间沟入路行臂丛神经阻滞。评估3组患者感觉阻滞起效时间（T1）、运动阻滞起效时间（T2）、感觉阻滞完善时间（T3）、镇痛持续时间（T4）、运动阻滞恢复时间（T5）、运动阻滞程度、患者满意度及不良事件。结果  ①A、B、C 3组患者感觉阻滞起效时间分别为（4.06±0.60）、（3.17±0.72）和（2.16±0.63）min，运动阻滞起效时间分别为（6.33±0.93）、（5.52±0.93）和（4.35±1.02）min。各指标组间比较差异有统计学意义（F =65.316和32.502，P =0.000）；②3组患者随着罗哌卡因浓度的升高，感觉阻滞完善时间逐渐缩短，组间差异有统计学意义（F =25.496，P =0.000）。而镇痛持续时间及运动阻滞恢复时间随着罗哌卡因浓度升高逐渐延长，组间差异有统计学意义（F =27.066和25.787，P =0.000）；③在注药后15 min，C组患者运动阻滞程度≥3级比例高于其余两组，差异有统计学意义（P <0.05）；注药后30 min，C组患者运动阻滞达≥3级比例高于A、B两组，差异有统计学意义（P <0.05）。而A组患者存在明显的感觉运动阻滞分离现象。3组患者满意度分别为80%、87%和93%。结论  对于上肢淋巴静脉吻合术患者，选择0.250%罗哌卡因30 ml行肌腱沟臂丛神经阻滞感觉阻滞，能够满足手术要求，是安全可行的。

Abstract:

Objective To discuss the effects of different doses of Ropivacaine on the brachial plexus block for lymphatic venous anastomosis surgery in patients with upper limb lymphedema. Methods Ninty patients with upper limb lymphedema were randomly divided into groups A, B and C, which received brachial plexus block with 0.200% Ropivacaine 30 ml, 0.250% Ropivacaine 30 ml and 0.375% Ropivacaine 30 ml respectively. Sensory block onset time (T1), motion block onset time (T2), ideal sensory block time (T3), analgesia duration (T4), motor block recovery time (T5), degree of motor block, patient satisfaction and adverse events were assessed in all the subjects. Results The sensory block onset time (T1), motion block onset time (T2) and ideal sensory block time (T3) were all the shortest in the group C (0.375% Ropivacaine 30 ml), and the longest in the group A (0.200% Ropivacaine 30 ml), the differences among the three groups were statistically significant (P < 0.01); whereas, compared among the three groups, both analgesia duration (T4) and motor block recovery time (T5) were the shortest in the group A, and the longest in the gorup C with significant differences (P < 0.01). Besides, the degree of motor block and patient satisfaction increased gradually with the increasing dose of Ropivacaine, there were significant differences among the three groups (P < 0.05). There were 3 adverse events in the group A with incomplete blockage. Conclusions The application of 0.250% Ropivacaine is a good choice for brachial plexus block in secondary lymphedema patients with lymphatic venous anastomosis surgery. It can meet the requirements of the operation.