国产罗哌卡因在肌间沟臂丛阻滞麻醉中的效果观察

目的 比较0．5％、0．75％国产罗哌卡因和0．5％布比卡因用于肌间沟臂丛神经阻滞的效果和安全性，评价国产罗哌卡因进行臂丛阻滞麻醉的有效性和安全性。方法 随机选择ASA（美国麻醉学家学会）Ⅰ-Ⅱ级需行肌间沟臂丛阻滞的手指再造手术病人60例，随机双盲分为3组，每组20人，分别采用0．5％罗哌卡因30ml，0．75％罗哌卡因加ml和0．5％布比卡因各30ml，以针尖触及神经出现并传至拇指的触电样异感为注药标准。注药后测定起效时间、阻滞平面，判断上肢活动程度，详细记录术后创口疼痛时间、上肢运动恢复时间及可能发生的不良反应和并发症。结果 3组病人c，～T，阻滞起效时间，均〈5min（P〉0．05），注药20min后3组病人上肢均不能水平举动，3组病例的感觉阻滞时间无差异，0．75％罗哌卡因和0．5％布比卡因组运动阻滞程度差异无统计学意义（P〉0．05），0．5％罗派卡因组运动阻滞时间明显短于另外2组（P〈0．05），3组病例麻醉优艮率均为100％（P〉0．05）。无局麻药毒性反应和严重并发症发生。结论 0．5％和0．75％国产罗哌卡因用于肌间沟臂丛神经阻滞效果和术后持续镇痛作用与0．5％布比卡因相似，0．5％罗哌卡因可用于肌肉松弛程度要求低的上肢手术麻醉，0．75％罗哌卡因适合任何上肢手术的麻醉。

Efficacy of Homemade Ropivacaine in Interscalene Brachial Plexus Block Anesthesia

Objective] To compare the efficacy and safety of 0. 5% and 0. 75% homemade ropivacaine and 0. 5% bupivacaine in interscalene brachial plexus block anesthesia and evaluate the efficacy and safety of homemade ropivacaine in brachial plexus block anesthesia. Methods] 60 ASA Ⅰ and Ⅱpatients scheduled for finger reconstructions were double-blindly divided into 3 groups randomly and received interscalene brachial plexus block with 0. 5% homemade ropivacaine （30ml） , 0. 75% homemade ropivacaine （20ml） and 0. 5% bupivocaine （30ml） respectively; the nervous abnormal sense conducted to thumb was used to lead the location of local anesthetics injection; the analgesic area, onset timing of motor and sensory block, timing of incision, timing of hand and shoulder movement, and the complications and adverse reactions were recorded carefully. Results] The onset timing and the anal- gesia area on C5 to T1 of brachial plexus dermatomes were less than 5 minutes in all groups （ P 〉0. 05 ） ; after 20 minutes, all the patient in the three groups could not lift their upper limbs （ P 〉 0. 05 ） ; no significant difference was found in the duration of sensory block between the 3 groups （ P 〉0. 05 ） ; the duration of motor block of group A was significantly different with other two groups （ P 〈 0. 05 ） , while it was similar between group B and group C （P 〉0.05 ）. anesthesia in all the three groups were 100% effective; no toxic reaction or serious complication was found. Conclusion] The anesthetic effect of 0. 5% and 0. 75% ropivacaine in interscalene brachial plexus block anesthesia is similar with that of the 0. 5% bupivacaine; 0. 5% ropivacaine seems more suitable for lower muscle relaxant while 0. 75% ropivacaine is suitable for brachial block on all upper extremitty surgeries.