不同温度罗哌卡因用于臂丛神经阻滞后对阻滞区域皮温及阻滞特性影响的研究
Effect of ropivacaine at different temperatures on skin temperature in the blocked area after brachial plexus block
段磊 1王泽鹏 1黄荔刚 1杨景康 1马欢1
作者信息
- 1. 西安航天总医院麻醉科,西安 710100
- 折叠
摘要
目的 探讨经红外热像仪观测下不同温度罗哌卡因行锁骨上臂丛神经阻滞后对皮温变化及阻滞特性的影响.方法 选取择期行掌骨骨折切开复位内固定患者63例,性别不限,年龄≥18岁,美国麻醉医师协会(ASA)分级Ⅰ～Ⅲ级,按随机数字表法分为加温组(注射37 ℃ 0.5％罗哌卡因15ml,W组)、常温组(注射23℃0.5％罗哌卡因15ml,N组)和低温组(注射4 ℃ 0.5％罗哌卡因15ml,L组),每组21例,均在超声引导下实施锁骨上臂丛神经阻滞.主要观察指标:通过红外热像仪观测患肢阻滞后5～30 min(每5 min记录1次)大拇指甲床下0.81 cm2区域(桡神经支配区域)皮温变化、小拇指甲床下0.81 cm2区域(尺神经支配区域)皮温变化.次要观察指标:术区感觉阻滞起效时间、术区镇痛维持时间、术后24 h羟考酮消耗量和神经阻滞后不良事件发生率.结果 神经阻滞后5～30min,W组患者患肢桡、尺神经支配区域皮温高于N组和L组(均P＜0.05),N组患者患肢桡、尺神经支配区域皮温高于L组(均P＜0.05).阻滞后30 min,W组患者患肢桡神经支配区域皮温高于同组尺神经(P＜0.05);N组患者患肢两神经支配区域皮温差异无统计学意义(P＞0.05);L组患者患肢桡神经支配区域皮温低于同组尺神经(P＜0.05).W组患者术区感觉阻滞起效时间短于N组和L组(均P＜0.05),L组患者术区感觉阻滞起效时间长于N组(P＜0.05);W组患者术区镇痛维持时间长于N组和L组(均P＜0.05),L组患者术区镇痛维持时间与N组比较差异无统计学意义(P＞0.05);W组患者术后24h羟考酮消耗量低于N组和L组(均P＜0.05),L组患者术后24h羟考酮消耗量高于N组(P＜0.05).L组患者注药时有1例发生注射痛,其余2组未见不良事件发生.结论 经红外热像仪观测下,37 ℃罗哌卡因行锁骨上臂丛神经阻滞后,桡、尺侧支配区域皮温高于23 ℃、4 ℃罗哌卡因.与23 ℃、4 ℃罗哌卡因比较,37 ℃罗哌卡因可缩短术区感觉阻滞起效时间、延长术区镇痛维持时间,并减少术后24 h羟考酮消耗量.
Abstract
Objective To explore the effect of ropivacaine at different temperatures on skin temperature and blockage charac-teristics after supraclavicular brachial plexus block using infrared thermography.Methods A total of 63 patients who were sched-uled for open reduction internal fixation due to metacarpal fractures,men or women,age≥18 years old,and American Society of Anes-thesiologists(ASA)grades Ⅰ-Ⅲ,were selected.According to the random number table method,they were divided into three groups(n=21):a warmed group(injection with 15 ml of 0.5％ropivacaine at 37℃,group W),a normothermic group(injection with 15 ml of 0.5％ropivacaine at 23 ° C,group N)and a hypothermic group(injection with 15 ml of 0.5％ropivacaine at 4 ℃,group L).All the patients performed supraclavicular brachial plexus nerve block under ultrasound guidance.Primary outcomes:skin temperature changes in the area beneath the thumb nail bed(0.81 cm2)and the area beneath the little finger nail bed(0.81 cm2)5-30 min after block observed us-ing infrared thermography.Secondary outcomes:the onset of sensory blockade in the surgical area,the duration of postoperative analge-sia maintenance in the surgical area,the consumption of hydromorphone within postoperative 24 h and the incidence of adverse events after blockade.Results After nerve blockade for 5-30 min,group W showed higher skin temperature innervated by the radial and ulnar nerves than group N and group L(all P＜0.05),while group N had higher skin temperature innervated by the radial and ulnar nerves than group L(all P＜0.05).After nerve blockade for 30 min,the skin temperature innervated by the radial nerve in group W was higher than that by the ulnar nerve(P＜0.05).There was no statistical difference between skin temperature innervated by the radial and ulnar nerves in group N(P＞0.05).The skin temperature innervated by the radial nerve in group L was lower than that by the ulnar nerve(P＜0.05).The onset time of sensory blockade in group W were shorter than that in group N and group L(all P＜0.05),while the group L required longer onset time than group N(P＜0.05).The duration of analgesia maintenance in group W were longer than that in group N and group L(all P＜0.05),and there was no statistical difference as to the duration of analgesia maintenance between group L and group N(P＞0.05).The consumption of hydromorphone within postoperative 24 h in group W were lower than that in group N and group L(all P＜0.05),while the group L consumed higher amounts of hydromorphone within postoperative 24 h than group N(P＜0.05).There was 1 case of injection pain during local anesthetic injection in group L,while no adverse events were observed in the other two groups.Conclusions After brachial plexus nerve block by ropivacaine at 37 ℃,the skin temperature innervated by the radial and ulnar nerves increase by 23 ℃ and 4 ℃,respectively,through infrared thermography.Compared with ropivacaine at 23 ℃ and 4 ℃,rop-ivacaine at 37℃ can shorten the onset time of sensory blockade,prolong the duration of postoperative analgesia maintenance,and re-duce oxycodone consumption within 24 h after surgery.
关键词
温度/罗哌卡因/臂丛神经阻滞/阻滞效果Key words
Temperature/Ropivacaine/Brachial plexus nerve block/Blocking effect引用本文复制引用
基金项目
西安市卫生健康委员会2022年卫生科研人才项目(2022yb40)
出版年
2024
NETL
NSTL
万方数据