罗哌卡因复合舒芬太尼对神经丛阻滞效果的影响

目的探讨舒芬太尼复合罗哌卡因用于臂丛、颈丛神经阻滞时的安全性及有效性。方法　将40例18岁至75岁择期行臂丛或颈丛神经阻滞麻醉的上肢及颈部手术患者用随机双盲法分为对照组与实验组,每组20人。对照组: 1%罗哌卡因10mL+0. 9%氯化钠注射液20 mL;实验组: 1%罗哌卡因10 mL+舒芬太尼10μg(1 mL)+0. 9%氯化钠注射液19 mL。比较麻醉前、后2组患者生命体征,镇痛、镇静、运动阻滞评分及镇痛作用时间。结果　麻醉前、后2组患者生命体征差异无统计学意义(P>0. 05)。麻醉后5 min, 1、2和4 hVAS评分实验组低于对照组,差异有统计学意义(P<0. 05);麻醉10~30 min,实验组镇静评分高于对照组,差异亦有统计学意义(P<0. 05); 2组之间运动阻滞评分差异无统计学意义。结论　罗哌卡因复合舒芬太尼用于神经丛阻滞麻醉,镇痛起效较快,作用持续时间较长,镇静效果较好,不良反应少,可减少静脉镇痛镇静药的用量,提高镇痛效果。

Evaluation on Efficacy of Sulfentanil Combined with Ropivacaine for Brachial and Jugular Plexus Nerve Block

Objective To evaluate the efficacy and safety of sulfentanil combined with ropivacaine in brachial and jugular plexus nerve block. Methods Forty ASA Ⅰ, Ⅱ patients without contraindications of brachial and jugular plexus nerve block, aged 18~75, and weighing 47~98 kg, underwent elective cervical and upper limbs operations were randomly divided into two groups(n=20). 1% ropivacaine 10 mL+0.9% NS 20 mL(group A) and sufentanil 10.0 μg(1 mL) combined with 1% ropivacaine 10 mL+0.9% NS 19 mL(group B) were given separately. The efficacy of analgesia, sedation and locomotor block were evaluated by: 1Visual analogue scales(VAS)(0=no pain, 10=severe pain); 2 Ramsay sedation scales; 3 Bromage motor scores; 4 side effects such as nausea, vomiting, tickle and respiratory depression were also recorded at the points of before injection, 5 min, 10 min,15min, 20 min, 30 min, 1 h, 2 h and 4 h after injection. Results The demographic data(age, height, bodyweight, MAP and HR before operation) and durations of operations were comparable among two groups(P>0.05). VAS of 5 min, 1 h, 2 h and 4 h after injection in group B were lower than group A(P＜0.05); and Ramsay sedation scales 10 min till 30 min after injection were higher than group A(P＜0.05). Conclusion It has been demonstrated in this study that sulfentanil combined with ropivacaine for brachial and jugular plexus nerve block is safe and more efficient for early analgesia and sedation, and longer for analgesia than to use ropivacaine alone.