运动感觉神经阻滞分离与患者自控镇痛技术用于肌腱修复与重建手术的临床研究

目的　探讨运动感觉神经阻滞分离与患者自控镇痛 (PCA)技术用于肌腱修复与重建手术以及术后主、被动功能锻炼的可行性。方法　 2 10例患者 ,均采用 0 2 5 %布比卡因、0 0 6 2 5mg/ml罂粟碱和 0 2 5mg/ml地塞米松混合液作腋路臂丛运动感觉神经阻滞分离麻醉药物 ,随机分为A、B和C 3组 ,每组 70例患者。A组为空白对照组 ,B、C组为实验组。B组患者自控静脉镇痛 (PCIA)泵药液为曲马多 0 0 1～ 0 0 15mg/kg、恩丹西酮 0 0 5～ 0 10mg/kg ,C组在B组PCIA泵用药基础上加用咪唑安定 0 15～ 0 30mg/kg ,泵液均加生理盐水至 10 0ml,阻滞注药后开启。PCA设置 :背景剂量 2ml/h ,单次剂量 2ml,锁定时间 6 0min ,维持时间 4 8h。比较阻滞注药后 1、2、3、6、12h等 5个时点运动感觉阻滞深度及开泵后即刻、12、2 4、4 8h 4个时点视觉模拟评分法 (VAS)、镇静评分法 (Ramesay)评分相关数值。结果　 3组患者 1、2、3h 3个时点运动阻滞深度逐渐增强 ,6和 12h 2个时点明显减弱 ;感觉阻滞深度均满意 ,VAS、Ramesay评分 ,2 4、4 8h 2个时点镇痛、镇静深度 ,A组

Application of separating brachial plexus block combined with preoperative analgesia by patient controlled intravenous analgesia in tendon repair

OBJECTIVE: To investigate whether the separating brachial plexus block combined with preoperative analgesia by patient controlled analgesia (PCA) can be applied in tendon repair and postoperative active or passive functional exercise. METHODS: Two hundred and ten cases with tendon injury were randomly divided into 3 groups and all of the patients were administered Bupivacaine (0.25%), Papaverine (0.0625 mg/ml), and Dexamethasone (0.25 mg/ml) in separating brachial plexus block through axillary approach. Group A was control group, and preoperative analgesia was not applied. Preoperative analgesia was applied in group B and C. Tramadol and Ondansetron were administered in group B, Midazolam was administered besides Tramadol and Ondansetron in group C. The injection volume in the PCIA pump was increased to 100 ml by mixing physiologic saline. The pump was started after separating brachial plexus block in velocity of 2 ml/h, and its maintenance time was 48 h. The effect of separating brachial plexus block at 1, 2, 3, 6 and 12 h after finishing brachial plexus block was compared. The VAS, Ramesay assessment scoring were recorded at 0, 12, 24 and 48 h after starting pump. RESULTS: In each group, the effect of motor block became greater in the ascending order from 1, 2 to 3 h after finishing brachial plexus block, and less in the descending order from 3, 6 to 12 h after finishing brachial plexus block. Only at 6 and 12 h after finishing brachial plexus block, the effect of motor block of group B and group C was significantly less than that of group A (P < 0.05, < 0.01), the effect of motor block of group C was less than that of group B (P > 0.05). The effect of sensory block in the patients of all 3 groups was satisfactory. The VAS, Ramesay assessment scoring, effect of analgesia and sedation at 24 and 48 h after starting pump became greater in the ascending order from group A to group C, in which group B and group C were significantly greater than group A (P < 0.01). CONCLUSIONS: The separating brachial plexus block combined with preoperative analgesia by 2 kinds of PCIA dispensation can be both applied in tendon repair, but the separating effect of brachial plexus block of group B was superior to the group C.