超声引导下氢吗啡酮复合罗哌卡因对喙突旁臂丛神经阻滞的效果及安全性研究

目 的　探究超声引导下氢吗啡酮复合罗哌卡因对喙突旁臂丛神经阻滞的效果及安全性。方法　选择择期行单侧桡骨远端骨折切开复位内固定术的患者 60 例作为研究对象。采用随机数字表法，将患者分为罗哌卡因组（R组）、舒芬太尼复合罗哌卡因组（SR组）和氢吗啡酮复合罗哌卡因组（HR组）。超声引导下行喙突旁入路臂丛神经阻滞，R组注射 0.33％罗哌卡因 30 mL，SR组注射舒芬太尼 5 μg+0.33％罗哌卡因 30 mL，HR组注射氢吗啡酮 1 mg+0.33％罗哌卡因 30 mL。记录感觉和运动阻滞的起效时间和维持程度，记录术后补救镇痛情况、患者镇痛满意情况。结果　与R组比较，SR组和HR组感觉阻滞持续时间和运动阻滞持续时间延长，HR组术后曲马多补救镇痛率降低（P<0.05）；与SR组比较，HR组感觉和运动完全阻滞持续时间延长（P<0.05），3 组感觉及运动阻滞的起效时间差异无统计学意义（P>0.05）；与R组及SR组比较，HR组感觉持续阻滞在<12 h时段的患者构成比降低（P<0.05），在≥20 h时段增高（P<0.05）；与R组及SR组比较，HR组运动持续阻滞在<12 h时段的患者构成比降低（P<0.05），在 12～24 h时段增高（P<0.05）。结论　氢吗啡酮可延长罗哌卡因喙突旁臂丛神经阻滞的持续时间，且延长效果优于舒芬太尼，可减少术后镇痛药物的使用，但也增大了运动神经阻滞程度，可能不利于患者术后康复。

Efficacy and Safety of Hydromorphone Combined with Ropivacaine in Ultrasound-Guided Subclavian Brachial Plexus Block Treatment

Objective To investigate the efficacy and safety of hydromorphone combined with ropivacaine in ultrasound-guided subclavian brachial plexus block. Methods Sixty patients scheduled for unilateral open reduction and internal fixation of radial shaft fractures were enrolled. Using a random number table，the patients were divided into three groups：the ropivacaine group（R group），the sufentanil combined with ropivacaine group（SR group），and the hydromorphone combined with ropivacaine group（HR group）. Ultrasound-guided subclavian brachial plexus block was performed with the R group receiving 30 mL of 0.33％ ropivacaine，the SR group receiving 5 μg of sufentanil and 30 mL of 0.33％ ropivacaine，and the HR group receiving 1 mg of hydromorphone and 30 mL of 0.33％ ropivacaine. The onset and duration of sensory and motor blocks were recorded，as was the duration of postoperative rescue analgesia and patient satisfaction with the analgesia. Results Compared to those in the R group，both the SR and HR groups exhibited prolonged duration of sensory and motor blocks，and the HR group had a decreased postoperative tramadol rescue analgesia rate（P<0.05）. Compared to those in the SR group，the duration of complete sensory and motor blocks in the HR group were significantly longer（P<0.05）. There was no significant difference in the onset time of sensory and motor blocks among the three groups（P>0.05）. Compared to the R group and SR group， the proportion of patients with sense of obstruction in the HR group decreased during the <12 h period（P<0.05），but increased during the ≥ 20 h period（P<0.05）. Compared to the R and SR groups，the HR group had a lower proportion of patients with movement obstruction during the <12 h period（P<0.05） but an increased proportion during the 12-24 h period（P<0.05）. ConclusionHydromorphone could prolong the ropivacaine subclavian brachial plexus block，which is superior to sufentanil. It reduces the need for postoperative analgesics but increases the degree of motor block，which may not be favorable for patients''postoperative recovery.