罗哌卡因复合右美托咪定对超声引导下低位肌间沟入路臂丛神经阻滞效果的影响
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摘要
目的观察罗哌卡因复合右美托咪定对低位肌间沟入路臂丛神经阻滞的起效和持续时间以及术后镇痛效果的影响。方法选取桡骨远端切开复位内固定的患者42例,随机分为罗哌卡因组(R组)和罗哌卡因复合右美托咪定组(RD组),每组21例。在超声引导下行低位肌间沟臂丛神经阻滞,分别比较两组患者感觉阻滞起效时间、运动阻滞起效时间、感觉恢复的时间、运动恢复的时间、伤口开始疼痛的时间、术后视觉模拟疼痛评分(visual analogue scale,VAS)等指标。结果两组感觉和运动阻滞的起效时间差异无统计学意义(P>0.05),RD组的感觉和运动阻滞持续时间明显长于R组(P<0.01),RD组的镇痛时间明显长于R组(P<0.01)。在神经阻滞后30 min和60 min,RD组的HR低于R组(P<0.05),在阻滞后的15、30和60 min,RD组的MAP低于R组(P<0.05),RD组的术后6 h和12 h的VAS评分低于R组(P<0.05)。结论罗哌卡因复合右美托咪定对桡骨远端骨折切开复位内固定的患者行低位肌间沟神经阻滞能延长神经的感觉和运动阻滞持续时间,延长术后镇痛的时间,降低患者术后6 h和12 h的VAS评分。
引文
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[19] Abdallah FW,Brull R.Facilitatory effects of perineural dexmedetomidine on neuraxial and peripheral nerve block:a systematic review and meta-analysis[J].Br J Anaesth,2013,110(6):915-925.
[2] 杨鲍勃,康熙赞,马大青,等.右美托咪定的实验研究和临床应用[J].临床麻醉学杂志,2011,27(10):1034-1040.
[3] Abdallah FW,Brull R.Facilitatory effects of perineural dexmedetomidine on neuraxial and peripheral nerve block:a systematic review and meta-analysis[J].Br J Anaesth,2013,110(6):915-925.
[4] Weerink MAS,Struys MMRF,Hannivoort LN,et al.Clinical Pharmacokinetics and Pharmacodynamics of Dexmedetomidine[J].Clin Pharmacokinet,2017,56 (8):893-913.
[5] Andersen JH,Grevstad U,Siegel H,et al.Does dexmedetomidine have a perineural mechanism of action when used as an adjuvant to ropivacaine?:a paired,blinded,randomized trial in healthy volunteers[J].Anesthesiology,2017,126(1):66-73.
[6] Ma D,Rajakumaraswamy N,Maze M.a2-Adrenoceptor agonists:shedding light on neuroprotection?[J].Br Med Bull,2005,71:77-92.
[7] Dahmani S,Paris A,Jannier V,et al.Dexmedetomidine increases hippocampal phosphorylated extracellular signal—regulated protein kinase 1 and 2 content by an a2-adrenoceptor-independent mechanism:evidence for the involvement of imidazoline I1 receptors[J].Anesthesiology,2008,108(3):457-466.
[8] Engelhard K,Werner C,Eberspacher E,et al.The effect of the alpha 2-agonist dexmedetomidine and the N-methyl-D-aspartate antagonist S(+)-ketamine on the expression of apoptosis-regulating proteins after incomplete cerebral ischemia and reperfusion in rats[J].Anesth Analg,2003,96(2):524-531.
[9] Talke P,Bickler PE.Effects of dexmedetomidine on hypoxia-evoked glutamate release and glutamate receptor activity in hippocampal slices[J].Anesthesiology,1996,85(3):551-557.
[10] Brummett CM,Norat MA,Palmisano JM,et al.Perineural administration of dexmedetomidine in combination with bupivacaine enhances sensory and motor blockade in sciatic nerve block without inducing neurotoxicity in rat[J].Anesthesiology,2008,109(3):502-511.
[11] Konakci S,Adanir T,Yilmaz G,et al.The efficacy and neurotoxicity of dexmedetomidine administered via the epidural route[J].Eur J Anaesthesiol,2008,25(5):403-409.
[12] Lavand′homme PM,Eisenach JC.Perioperative administration of the alpha2-adrenoceptor agonist clonidine at the site of nerve injury reduces the development of mechanical hypersensitivity and modulates local cytokine expression[J].Pain,2003,105(1/2):247-254.
[13] Lavand′homme PM,Ma W,De Kock M,et al.Perineural alpha (2A)-adrenoceptor activation inhibits spinal cord neuroplasticity and tactile allodynia after nerve injury[J].Anesthesiology,2002,97(4):972-980.
[14] Romero-Sandoval A,Eisenach JC.Perineural clonidine reduces mechanical hypersensitivity and cytokine production in established nerve injury[J].Anesthesiology,2006,104 (2):351-355.
[15] Park SK,Sung MH,Suh HJ,et al.Ultrasound Guided Low Approach Interscalene Brachial Plexus Block for Upper Limb Surgery[J].Korean J Pain,2016,29(1):18-22.
[16] 吴健华,陈志远,李琛,等.改良法肌间沟臂丛神经阻滞的临床观察[J].临床麻醉学杂志,2000,16(1):44.
[17] Renes SH,Rettig HC,Gielen MJ,et al.Ultrasound-guided low-dose interscalene brachial plexus block reduces the incidence of hemidiaphragmatic paresis[J].Reg Anesth Pain Med,2009,34(5):498-502.
[18] 胡光俊,宋晓阳,陶军.罗哌卡因复合右美托咪定对臂丛神经阻滞的影响[J].临床麻醉学杂志,2014,30(6):546-549.
[19] Abdallah FW,Brull R.Facilitatory effects of perineural dexmedetomidine on neuraxial and peripheral nerve block:a systematic review and meta-analysis[J].Br J Anaesth,2013,110(6):915-925.
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