罗比卡因与布比卡因用于连续臂丛神经阻滞术后镇痛的比较

目的观察0.125%罗比卡因与0.125%布比卡因应用于上肢连续臂丛阻滞患者术后自控镇痛的可行性和有效性。方法45例拟行上肢择期手术的患者随机分为罗比卡因组(R组)、布比卡因组(B组)和对照组(N组),每组15例。术前均予肌间沟径路或腋路臂丛阻滞以及臂丛神经鞘内置管。术后R组与B组使用便携式患者自控镇痛泵,泵内液体分别为0.125%的罗比卡因和0.125%的布比卡因,N组为对照组,观察24h。记录3组患者的疼痛视觉模拟评分和镇痛药使用情况,记录R组与B组患者的运动阻滞、麻木感、局麻药用量、满意度、镇痛技术问题和并发症。结果R组与B组两组在术后各个时间点的疼痛评分均较低,组间差异无统计学意义(P>0.05)。N组疼痛评分在术后0h、3h时与R组和B组比较差异无统计学意义(P>0.05);在术后6h、12h、18h、24h均较高,与前两组间相比差异有统计学意义(P<0.05)。R组与B组两组镇痛满意度较高,组间差异无统计学意义(P>0.05),运动阻滞、麻木感、补充用药、局麻药用量差异无统计学意义(P>0.05);技术问题与并发症两组发生率均低。结论0.125%罗比卡因与0.125%布比卡因均可有效地用于上肢术后的连续臂丛阻滞患者自控镇痛,并且效果相似。

Comparison of continuous brachial plexus block of ropivacaine vs bupivacaine for patient-controlled analgesia

Objective To observe the feasibility and efficacy of 0.125% ropivacaine versus 0.125% bupivacaine in continuous brachial plexus block for patient-controlled analgesia (PCA) following upper extremity surgery. Methods Forty-five patients scheduled for elective upper-limb surgery were randomly divided into three groups:group R,group B and group N.All patients received an interscalene or axillary brachial plexus block and perineural catheter.Postoperatively,via the catheter,patients in group R and group B received a portable infusion pump delivering studying solution (0.125% ropivacaine or bupivacaine,respectively) for 24h.Group N served as control group.To every patient,pain visual analog scale scores (VAS) and use of analgesic were recorded.In group R and group B,motor block,the sense of numbness,local anesthetic consumption,overall satisfaction scores,technical problems and complications were all recorded. Results At all time points,the VAS scores in group R and group B were low,but there was no significant difference between them(P>0.05).At 0h and 3h after operation,there were no differences between group N and group R or group B(P>0.05).At 6h,12h,18h and 24h after operation,the VAS scores in group N were higher with the difference being significant between group N and group R or group B (P<0.05).The overall satisfaction scores in group R and group B were high,but there was no significant difference between them(P>0.05).No significant differences were found between group R and group B in motor block,the sense of numbness,supplemental analgesia and local anesthetic consumption (P>0.05).Both the technical problem and complication had low incidence. Conclusion 0.125% ropivacaine and 0.125% bupivacaine appeared similarly effective in providing PCA following upper-extremity surgery.