不同浓度罗哌卡因用于腋路臂丛神经阻滞的研究

目的探讨0.25%、0.3%、0.375%罗哌卡因用于臂丛神经阻滞的有效性和安全性,并与0.25%布比卡因对照.方法选择ASAⅠ-Ⅱ级准备行上肢手术的病人80例,随机分为4组,每组20例,分别用0.25%、0.3%、0.375%罗哌卡因和0.25%布比卡因40ml行臂丛神经阻滞,观察病人有无不适症状,并分别对感觉和运动进行评价.结果随着浓度增加罗哌卡因麻醉强度依次增加,40m10.25%罗哌卡因麻醉强度明显低于0.25%布比卡因,且满意率低,仅为85%;将罗哌卡因浓度提高到0.375%,显示出与0.25%布比卡因相当的麻醉强度,满意率则提高到100%.结论 0.25%罗哌卡因用于臂丛神经阻滞起效慢、满意率低,不是临床使用的适宜浓度;0.3%、0.375%罗哌卡因起效快,作用完善,副作用少,可推荐用于长时间臂丛神经阻滞,而以0.375%罗哌卡因最为适宜.

A comparison of ropivacaine of different concentration for axillary brachial plexus block.

Objective To investigate the efficacy and safety of 0.25%, 0.3%, 0.375% ropivacaine, and to compare the efficacy of ropivacaine with 0.25% bupivacaine. Methods Eighty ASA physical status I or II patients scheduled for upper extremity surgery were randomly assigned to four groups(n = 20per group). Brachial plexus block was performed separately with 40 ml of 0.25%, 0.3%, 0.375% ropivacaine or 0.25% bupivacaine in four groups, then monitored carefully if any patients felt uncomfortable. Sensory and motor function were evaluated at 5, 10, 15, 20, 30, 45 and 60 mm after local anesthetic injection. Results The anesthesia efficacy of ropivacaine was increased along with the increase of its concentration. The anesthesia efficacy of 0.25% ropivacaine was significantly less than that of 0.25% bupivacaine, and the satisfactory rate of block with 0.25% ropivacaine was low, only 85%. Ropivacaine showed the equal efficacy with 0.25% bupivacaine when its concentration was raised to 0.375%. Conclusion 0.3%, 0.375% ropivacaine had a short onset time, a complete efficacy, and few side reactions. The most appropriate concentration is 0.375%.