Haasio J, Tuominen M, Rosenberg P H
Department of Anaesthesia, Surgical Hospital, University Central Hospital, Helsinki, Finland.
Ann Chir Gynaecol. 1990;79(2):103-7.
Continuous interscalene brachial plexus block with a single dose of 0.75% bupivacaine (150-210 mg) with adrenaline, continued with an infusion of plain 0.25% bupivacaine 0.25 mg/kg/h, was performed on 20 patients to provide analgesia during shoulder surgery and in the postoperative period. The control group included 20 patients who were given general anaesthesia for surgery after starting a continuous interscalene brachial plexus block; test dose of 0.75% bupivacaine (22.5 mg) with adrenaline, continued with an infusion of 0.25% bupivacaine 0.25 mg/kg/h. Surgery was performed successfully under regional anaesthesia in 16/20 patients; 4/16 were given one dose of fentanyl during the surgery, and diazepam or midazolam as supplementary sedation were given in 13/16 cases. For postoperative analgesia 35/40 patients had a fully functioning catheter for 20-26 hours and the need for oxycodone i.m. during that time was 1.5 +/- 0.4 doses after regional anaesthesia (n = 14) and 1.8 +/- 0.4 doses after general anaesthesia (n = 18). There was a statistically significant difference in the mean plasma bupivacaine concentrations between the groups, concentrations in the regional anaesthesia group being higher at 5, 30, 60 min and 3 h (maximum 2.3 micrograms/ml at 60 min), but there was no difference between the values at 24 h. One infusion of local anaesthetic was discontinued because of probable treatment-related side-effects (breathing difficulties, nausea). Mild local anaesthetic toxicity (dizziness, tinnitus) was noticed in four patients.
对20例患者实施连续肌间沟臂丛神经阻滞，单次给予含肾上腺素的0.75%布比卡因（150 - 210 mg），随后持续输注0.25%的单纯布比卡因，速率为0.25 mg/kg/h，以在肩部手术期间及术后提供镇痛。对照组包括20例患者，在开始连续肌间沟臂丛神经阻滞后接受全身麻醉进行手术；给予含肾上腺素的0.75%布比卡因试验剂量（22.5 mg），随后持续输注0.25%布比卡因，速率为0.25 mg/kg/h。16/20例患者在区域麻醉下手术成功；4/16例患者在手术期间给予一剂芬太尼，13/16例患者给予地西泮或咪达唑仑作为辅助镇静。术后镇痛方面，35/40例患者的导管在20 - 26小时内功能良好，区域麻醉后这段时间内曲马多肌内注射的需求量为1.5±0.4剂（n = 14），全身麻醉后为1.8±0.4剂（n = 18）。两组间平均血浆布比卡因浓度存在统计学显著差异，区域麻醉组在5、30、60分钟和3小时时浓度较高（60分钟时最高达2.3微克/毫升），但24小时时两组值无差异。1例因可能与治疗相关的副作用（呼吸困难、恶心）停止输注局部麻醉药。4例患者出现轻度局部麻醉药毒性（头晕、耳鸣）。
