Yadav R K, Sah B P, Kumar P, Singh S N
Department of Anaesthesiology and Critical care, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
Kathmandu Univ Med J (KUMJ). 2008 Jul-Sep;6(23):302-9. doi: 10.3126/kumj.v6i3.1704.
Various local anaesthetic agents are used for brachial plexus block.We compared effectiveness of addition of Dexamethasone versus Neostigmine to Lignocaine, adrenaline admixtures for Brachial plexus block in providing perioperative analgesia.
Ninety patients were randomized in three groups and were received 24 ml of study drugs. The group A [Lignocaine with adrenaline (1.5%)], group B [Lignocaine with adrenaline (1.5%)] +500 microg Neostigmine, and group C (Lignocaine with adrenaline (1.5%) +4 mg Dexamethasone) for brachial plexus block through supraclavicular approach. The observed parameters were onset of analgesia, completion of sensory and motor blockade, Duration of analgesia, Surgeon's score, side effects, number of supplemental analgesics doses and Visual analogue scale (VAS) score for pain in 12 hour of post-operative period.
Mean onset of analgesia 4.6+/-1.1 , 4.4 +/-0.8 , 3.8+/-1.8 mins in group A,B and C respectively and the Mean onset of motor blockade were 7.7+/- 2.0, 7.0+/-1.8, 6.0 +/- 2.1 mins in group A,B and C respectively. Similarly Mean Complete sensory block in 10.6 +/-3, 10.4+/-2.5, and 8.9+/-2.2 mins and Mean complete motor block in 17.3+/-4.3, 17.2 +/-4.0 and 14.7+/-3.5 mins in group A, B and C respectively were achieved. Duration of analgesia was 176.5+/-53.5, 225.7+/-53.3 and 454.2+/-110.7 mins in group A, B and C respectively. Duration of analgesia in group C was statistically significant in comparison with other groups. The number of mean analgesic requirement by group C (0.9+/-0.4) was significantly (p-0.005) lower. The mean VAS was significantly lower in group C in 12 hours post-operatively.
The onsets of action, duration of analgesia were better in dexamethasone group and also need less number of rescue analgesics requirement.
多种局部麻醉剂用于臂丛神经阻滞。我们比较了在利多卡因、肾上腺素合剂中添加地塞米松与新斯的明用于臂丛神经阻滞以提供围手术期镇痛的效果。
90例患者随机分为三组，每组接受24毫升研究药物。A组[含肾上腺素（1.5%）的利多卡因]，B组[含肾上腺素（1.5%）的利多卡因]+500微克新斯的明，C组[含肾上腺素（1.5%）的利多卡因]+4毫克地塞米松，通过锁骨上途径进行臂丛神经阻滞。观察参数包括镇痛起效时间、感觉和运动阻滞完成时间、镇痛持续时间、外科医生评分、副作用、补充镇痛剂剂量以及术后12小时疼痛的视觉模拟评分（VAS）。
A、B、C组的平均镇痛起效时间分别为4.6±1.1、4.4±0.8、3.8±1.8分钟，平均运动阻滞起效时间分别为7.7±2.0、7.0±1.8、6.0±2.1分钟。同样，A、B、C组的平均完全感觉阻滞时间分别为10.6±3、10.4±2.5、8.9±2.2分钟，平均完全运动阻滞时间分别为17.3±4.3、17.2±4.0、14.7±3.5分钟。A、B、C组的镇痛持续时间分别为176.5±53.5、225.7±53.3、454.2±110.7分钟。C组的镇痛持续时间与其他组相比具有统计学意义。C组的平均镇痛需求数量（0.9±0.4）显著更低（p = 0.005）。术后12小时C组的平均VAS显著更低。
地塞米松组的起效时间、镇痛持续时间更佳，且所需的补救性镇痛剂数量更少。
