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不同局部麻醉药屈指肌腱鞘管内麻醉有效性和安全性的比较
Efficacy and safety of various local anesthetic in transthecal digital block
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DOI:
作者:
游玉媛
YOU Yuyuan
作者单位:
广州中医药大学附属佛山市中医院麻醉科
Department of Anesthesiology,Foshan Hospital, Guangzhou University of Traditional Chinese Medicine
关键词:
屈指肌腱鞘管内阻滞;局部麻醉药;指-肱动脉收缩压指数;血管效应;手指皮肤温度
Transthecal digital block; Local anesthetic;Digital-
摘要:
目的 探讨利多卡因、布比卡因和罗哌卡因溶液在手指屈肌腱鞘管内阻滞中的有效性和安全性。方法 选择手指末节创伤需紧急施行手术的患者90例,随机分为3组,每组30例,分别应用1%利多卡因(L组)、0.5%布比卡因(B组)和0.5%罗哌卡因(R组)溶液进行屈指肌腱鞘管内阻滞,记录各组麻醉起效时间、持续时间和术后24小时内要求止痛药治疗的次数,记录麻醉前(T0)和麻醉后10 min(T10)、90 min(T90)、360 min(T360)的患指指动脉收缩压、患肢肱动脉收缩压、患指皮肤温度和局部血管效应。结果 L组麻醉起效时间和持续时间明显短于B组和R组,R组持续时间明显长于B组(P值均<0.01);L组术后24小时内要求止痛药治疗的次数明显高于B组和R组(P值均<0.01);T10时R组局部皮肤供血不充分的频率高于L组和B组(P值均<0.05);R组T10时指-肱动脉收缩压指数(=指动脉收缩压÷肱动脉收缩压×100)明显低于T0时并且明显低于同一时间点的L组和B组(P值均<0.01);R组T10时的手指皮肤温度比T0时下降(P<0.05),T90和T360时的手指皮肤温度与T0比较无差异,R组T10时的手指皮肤温度与同一时间点的L组和B组比较无差异(P值均>0.05);术后随访所有患者患指功能恢复良好。结论 1%利多卡因、0.5%布比卡因和0.5%罗哌卡因溶液用于手指屈肌腱鞘管内阻滞均能提供有效的麻醉,其中1%利多卡因麻醉起效最快,对手指血流灌注无明显影响,但麻醉持续时间最短,难以胜任较长时间的手术,0.5%布比卡因和0.5%罗哌卡因均能提供较长时间的麻醉和术后镇痛,但0.5%的罗哌卡因在屈指肌腱鞘管内阻滞注药早期可能对手指血流灌注产生一定影响但术后未出现任何并发症,其安全性有待进一步的研究。
Objective To investigate the efficacy and safety of various local anesthetic in transthecal digital block. Methods Ninety adult patients who underwent instant reconstruction because of traumas of fingertip were enrolled in the study.There were 41 women and 49 men, ASAⅠ~Ⅱ. They were randommized into three groups and there were thirty patients in each group.They received transthecal digital blocks with Lidocaine 1%(group L), Bupivacaine 0.5% (group B)and ropivacaine 0.5% (group R) respectively.Onset time of anesthesia effect, duration of anesthesia and requirement for pain medication during the first 24 hours after surgery were recorded in all groups. The digital artery systolic blood pressure, brachial artery systolic blood pressure,finger temperature and local vessel reaction were recorded before block(T0), ten minutes after block(T10),ninety minutes after block(T90), three hundred and sixty minutes after block(T360). Results Onset time and duration of anesthesia of group L were significant shorter than group B and group R,and duration of anesthesia of group R prolonged significantly than group B . Requirement of pain medication in group L was significant higher than in group B and group R during the first 24 hours after surgery(both P<0.01). Blanching of the skin in group R was more frequent than in group L and group B at T10. The digital-brachial artery systolic blood pressure index (the ratio of the digital to the brachial arterial systolic pressures) of group R at T10 decreased significantly than at T0,and was significant lower than group L and group B at the same time(both P<0.05).No deference was found between T0, T90 and T360 of group R in this index(both P>0.05).Finger temperature of group R at T10 decreased significantly than at T0(P<0.05),but there was no deference among three groups at T10. All the local vessel reaction were normal after releasing the tourniquet at the end of operation. Conclusion Lidocaine 1%, Bupivacaine 0.5% and ropivacaine 0.5% all can provide effective anesthesia in transthecal digital block. Onset time of lidocaine 1% is the fastest among three groups in transthecal digital block and no influence on digital perfusion is found.But it’s duration of anesthesia is so short that it is not suitable for long-playing operations. Both bupivacaine 0.5% and ropivacaine 0.5% can provide long lasting anesthesia and postoperative analgesia.It is our opinion that ropivacaine 0.5% maybe affect digital perfusion in the initial stage of transthecal digital block.So further study should be done on the safety of ropivacaine 0.5% in transthecal digital block.
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