摘要
目的 比较外周神经刺激器 (PNS)定位技术与异感定位技术用于腋路臂丛神经阻滞(BPB)的成功率 ,以及罗比卡因与布比卡因的临床效果。方法 4 5例拟行前臂、腕、手掌及手指部位手术的患者 ,随机分为三组 ,每组 15例。Ⅰ组采用PNS定位 ,当刺激到桡神经、尺神经或正中神经中的任意一支神经时予以阻滞 ;Ⅱ组采用PNS分别定位到两支神经时予以阻滞。局麻药均为 0 5 %罗比卡因。Ⅲ组采用异感定位 ,局麻药为 0 5 %布比卡因。结果 三组患者神经阻滞起效时间分别是( 2 0 4± 3 3 )、( 14 5± 3 2 )和 ( 2 9 1± 4 0 )分钟 (P <0 0 1)。与Ⅰ组、Ⅱ组相比 ,Ⅲ组对桡神经阻滞的有效例数最少 (P <0 0 5 )。布比卡因比罗比卡因运动阻滞完善 ,运动阻滞持续时间长 (P <0 0 1)。PNS定位组神经阻滞成功率显著高于异感定位 (P <0 0 1)。三组镇痛持续时间无区别。结论 PNS定位较异感定位更精确 ,阻滞成功率高 ;两点定位给药较一点定位给药阻滞起效快 ;罗比卡因比布比卡因起效快 ,运动阻滞轻 。
Objective To compare the success rate of axillary brachial plexus block (BPB) using the peripheral nerve stimulator (PNS) with that using paresthesia technique and clinical effects of ropivacaine with bipivacaine.Methods 45 patients underwent surgery of the forearm,wrist,hand and fingers were randomly assigned to three groups with 15 cases each.In group Ⅰ (single injection),the whole vomule of local anesthetic was injected after locating only one of the median,ulnal or radial nerves.In group Ⅱ (double injections),half of the volume was injected after locating one nerve and the other half was injected after locating the another nerve.0 5% ropivacaine was used as local anesthetic.A PNS was used to identify the nerves.In group Ⅲ (paresthesia),when elicited a paresthesia,the whole volume of 0 5% bupivacaine was injected.Results Onset times of nerve block in group Ⅰ,Ⅱ and Ⅲ were (20 4±3 3) min,(14 5±3 2)min,and (29 1±4 0)min respectively ( P< 0 01).The group Ⅲ had poorer analgesia of the radial nerve than the group Ⅰ and group Ⅱ ( P< 0 05).Degree of motor block and the duration of motor block were significantly higher and longer with bupivacaine than with ropivacaine ( P< 0 01).The success rate of block was greater with PNS than with paresthesia technique ( P< 0 01).There was no difference in the duration of median analgesia among three groups.Conclusions For axillary BPB,PNS location provided a greater success rate of block than the paresthesia technique.Double injections resulted in a faster onset of block than single injection.Compared with bupivacaine,ropivacaine has the further advantages of quicker onset time,less motor block and shorter duration of motor block.
出处
《临床麻醉学杂志》
CAS
CSCD
2002年第3期127-129,共3页
Journal of Clinical Anesthesiology
