不同浓度罗哌卡因用于臂丛阻滞的临床研究

目的观察不同低浓度罗哌卡因用于臂丛阻滞下行手、腕部肌腱断裂吻合术时选用多大浓度可达到最佳的感觉与运动阻滞相分离的麻醉效果。方法随机抽取手、腕部肌腱断裂120例，臂丛阻滞成功病例，美国麻醉师协会（ASA）分级Ⅰ-Ⅱ级。随机分成三组，每组40例，分别用0．25％（A组）、0．3％（B组）、0．375％（C组）罗哌卡因麻醉。采用肌间沟臂丛阻滞法。用针刺法测感觉阻滞平面，用现时疼痛强度评分（PPI）评估术中疼痛，用改良Bromage法评估上肢运动神经阻滞程度，比较三组感觉、疼痛、运动阻滞及恢复上的异同。结果三组均能达到感觉阻滞。运动阻滞起效时间、最大运动阻滞时间、运动恢复时间：C组明显优于A组、B组（P〈0．01）。术中PPI评分：A组疼痛不适者多于B、C组（P〈0．01）。Bromage评分：运动神经阻滞C组明显强于A、B组（P〈0．01）。结论0．3％的罗哌卡因可达到手、腕部肌腱吻合手术的麻醉要求。

A comparison between different low concentrations of ropivacaine for lumbar plexus block

Objective To observe the different low concentrations of roplvacaine for brachial plexus block in band and wrist tendon rupture anastomosis. Methods One hundred and twenty ASA I - II patients scheduled for hand and wrist tendon rupture anastomosis were randomly divided into 3 groups with 40 patients in each group. Brachial plexus block was performed aud 0.25% （ group A）, 0.3% （ group B） and 0. 375% ropivacaine （group C） were administered in each group respectively. Measurement of the feeling of acupuncture block plane, PPI assessment of intraoperative pain and modified Bromage method were used to assess the degree of upper limb motor block. The similarities and differences of feeling, pain, motor block and recovery were compared among groups. Results There was,no significant difference in blockade effect among groups. However, longer onset time of motor block, shorter largest block exercise time and exercise time to restore were observed in group C compared with group A and group B （ P 〈0.01）. PPI score was higher in group A than that in group B and group C （ P 〈0.01）. Bromage score indicated that the effect of motor nerve block was significantly stronger in group C than that in group A and group B （ P 〈0.01 ）. Conclusion 0.3% ropivacaine can be used in hand and wrist tendon surgery.