氯普鲁卡因防治罗库溴铵注药痛效果研究

目的观察应用氯普鲁卡因减轻罗库溴铵注药痛的效果。方法拟行择期需行气管内插管全身麻醉患者150例,麻醉诱导时用限时法给予肌松药,按麻醉诱导时给予罗库溴铵前预先静脉注射的药物,将患者随机分为五组,每组30例。Ⅰ组生理盐水3 ml,Ⅱ组利多卡因30 mg/3 ml,Ⅲ组氯普鲁卡因30 mg/3 ml,Ⅳ组氯普鲁卡因60mg/3 ml,Ⅴ组氯普鲁卡因90 mg/3 ml。左手背静脉穿刺,置入20 G静脉套管针。为了药物能较长时保留在静脉中,在患者左前臂包裹气压止血带,加压至70 mmHg,以3 ml/10 s的速度在左手背静脉注入各组预先给予的药物,30 s时松开止血带。随即在10 s内注射插管剂量的罗库溴铵0.6 mg/kg,由一名事先不知用药情况的麻醉医师专职观察且询问患者疼痛情况,选用Ambesh四分疼痛评定法为标准,进行评分、记录。同时观察记录在注射罗库溴铵完毕及术后24 h副作用等情况。结果 I组罗库溴铵注药痛发生率97%,中度、重度疼痛77%,轻度疼痛20%;Ⅱ组患者77%无注药痛与Ⅲ组73%相似。3个氯普鲁卡因处理组疼痛轻,重度疼痛(0～1/30),Ⅳ组疼痛更轻,中度、重度疼痛(0/30);尤其Ⅴ组100%无注药痛。Ⅱ、Ⅲ、Ⅳ、Ⅴ组与Ⅰ组比较发生罗库溴铵注药痛的程度轻,Ⅴ组罗库溴铵注药痛程度最轻。结论预注利多卡因、氯普鲁卡因均能减轻罗库溴铵的注药痛,其中预注氯普鲁卡因90mg效果最好。

Effect of chloroprocaine on pain caused by rocuronium injection

Objective: To explore the effect of chloroprocaine on the pain caused by rocuronium injection.Methods: 150 adult patients scheduled for selected surgeries under general anesthesia with a tracheal intubation were randomly assigned to 5 groups(30 per group).The neuromuscular blocking agent was administrated according to timing principle during anesthetic induction period.The dorsum of left hand was catheterized with 20-gauge catheters.With the aim of keeping the drug within the vein,the forearm was squeezed with a tourniquet up to 70 mm Hg;the patients were administered normal saline(3 ml)(GroupⅠ),lidocaine 30 mg(GroupⅡ),chloroprocaine 30 mg(Group Ⅲ),chloroprocaine 60 mg(Group Ⅳ),or chloroprocaine 90 mg(GroupⅤ),diluted into 3 ml of normal saline.The occlusion was released after 30s and a tracheal intubating dose of 0.6 mg/kg of rocuronium was injected in10s.The patients were observed and asked immediately if they had pain in the arm,and the response was assessed with Ambesh four-point scale system as the standard,and within the first 24 h after the administration of the rocuronium,the injection site was checked for any complications by an anesthesiologist who did not know which drug was administered.Results: The incidence of pain caused by rocuronium injection was 97% in Group I,that of moderate and severe pain was 77%,and that of mild pain was 20% in Group I.The incidence of no pain from rocuronium in GroupⅡ(77%) was similar to that of Group Ⅲ(73%).The degree of pain was lower among three chloroprocaine groups,severe pain(0-1/30),meanwhile that of GroupⅣ was lighter,moderate and severe pain(0/30),especially none of pain in GroupⅤ(100%).The patients in GroupⅡ,Ⅲ,Ⅳand Ⅴfelt less pain than those in GroupⅠrespectively,and the patients in Group Ⅴ felt no pain.Conclusion: Preintravenous injection of lidocaine or chloroprocaine can effectively relieve the rocuronium injection pain,and preintravenous injection of 90 mg chloroprocaine is the most effective in reducing pain.