吗啡和地塞米松对罗哌卡因肋间神经阻滞的影响

目的评价吗啡和地塞米松对罗哌卡因肋间神经阻滞的影响。方法择期行肺叶切除术患者72例，性别不限，年龄45～65岁，体重48～70kg，ASAI或Ⅱ级。麻醉方式采用常规的静吸复合全麻方法。根据肋间神经阻滞药液种类随机分为罗哌卡因组（R组）、罗哌卡因复合吗啡组（RM组）、罗哌卡因复合地塞米松组（RD组）及罗哌卡因复合吗啡和地塞米松组（RMD组），每组18例。术毕关闭胸腔前在切口上、下各两肋骨作胸廓内肋间神经阻滞，每点使用研究药物溶液各5ml，总量为20ml。肋间神经阻滞的药物中分别含有罗哌卡因10mg和／或吗啡2mg和／或地塞米松10mg。记录无痛状态时间、对疼痛治疗的总体评价及嗜睡、恶心等情况，并观察麻醉结束后患者血流动力学及呼吸情况。结果RMD组患者无痛状态的持续时间（21．32±5．03）h较R组（7．68±2．76）h、RM组（11．07±3．48）h、RD组（9．25±4．42）h明显延长（P〈0．05）。RMD组患者对肋间神经阻滞镇痛效果评价的满意度明显高于其他三组患者（P〈0．05）。RMD组患者术后出现嗜睡、恶心发生率与RM组相比差异无统计学意义（P〉0．05），但瘙痒发生率则较低。结论地塞米松和吗啡可延长罗哌卡因的肋间神经阻滞时间，并提高镇痛总体满意度。

Effects of morphine and dexamethasone on ropivacaine for intercostals blockade

Objective To evaluate the effects of dexamethasone,morphine on the efficacy of ropivacaine in intercostals nerve blockade.Methods Seventy two ASAⅠor Ⅱ patients of both sexes aged 45-65 years scheduled for elective lobectomy were enrolled.A standardized general anesthetic was administered to all patients.According to the different anesthetic solution of intercostals block,patients were randomized into four groups as follows:ropivacaine group (group R),ropivacaine added with morphine group (group RS),ropivacaine added with dexamethasone group (group RD),ropivacaine added with morphine and dexamethasone (group RMD).At time of thoracotomy closure,anesthetic solution was injected under separate rib angles with certainty (two for each up and down incision sides,5mL per nerve,20mL total).All blocks were performed by the same surgeon.Haemodynamic and respiratory parameters,the time of analgesic state,patients' gross evaluation of intercostals block and adverse effects were recorded after anesthesia.Results The time of analgesic state in group RMD was significantly longer compared with group R,group RM and group RD(P<0.05).Satisfactory rate of patients' gross evaluation of intercostals block in group RMD in group RMD was 77.7% (14/18),47.1% (8/17) in group R,and 50%(8/16)in group RD(P<0.05).There was no significant difference in haemodynamic and respiratory parameters between groups.The incidence rate of nausea and dizziness in group RMD didn't differ from in group RM.1/18 and 3/18 patients had pruritus in groups RMD,RM respectively.Conclusion Dexamethasone,morphine can prolong ropivacaine block time,improve satisfactory rate of patients' gross evaluation of intercostals block.