在锁骨上臂丛神经阻滞中，将地塞米松、咪达唑仑或肾上腺素添加到0.5%布比卡因中的效果。
The efficacy of adding dexamethasone, midazolam, or epinephrine to 0.5% bupivacaine in supraclavicular brachial plexus block.
作者信息
El-Baradey Ghada F, Elshmaa Nagat S
机构信息
Department of Anesthesia and ICU, Faculty of Medicine, Tanta University, Tanta, Egypt.
出版信息
Saudi J Anaesth. 2014 Nov;8(Suppl 1):S78-83. doi: 10.4103/1658-354X.144083.
AIMS
The aim was to assess the effectiveness of adding either dexamethasone or midazolam in comparison with epinephrine addition to 0.5% bupivacaine in supraclavicular brachial plexus block.
SETTINGS AND DESIGN
This is a prospective randomized controlled observer-blinded study.
SUBJECTS AND METHODS
This study was carried out in Tanta University Hospital on 60 patients of both sexes; American Society of Anesthesiologists physical Status I and II, age range from 18 to 45 years undergo elective surgery to upper limb. All patients were anesthetized with ultrasound guided supraclavicular brachial plexus block and randomly divided into three groups (each group 20 patients) Group E (epinephrine): 30 mL bupivacaine 0.5%with 1:200,000 epinephrine (5 μg/mL). Group D (dexamethasone): 30 mL bupivacaine 0.5% and dexamethasone 8 mg. Group M (midazolam): 30 ml bupivacaine 0.5% and midazolam 50 μg/kg. The primary outcome measures were onset and duration of sensory and motor block and time to first analgesic request.
STATISTICAL ANALYSIS USED
The windows version of SPSS 11.0.1 (SPSS Inc., Chicago, IL, USA) was used for statistical analysis. Data were presented in form of mean ± standard deviation multiple analysis of variance (ANOVA) was used to compare the three groups and Scheffe test was used after ANOVA. Power of significance P < 0.05 was considered to be statistically significant.
RESULTS
Onset of sensory and motor block was significantly rapid (P < 0.05) in Groups D and M in comparison with Group E. Time of administration of rescue analgesic, duration of sensory and motor block showed significant increase (P < 0.05) in Group D in comparison with Group M which showed significant increase (P < 0.05) in comparison with Group E.
CONCLUSIONS
In comparison with epinephrine and midazolam addition of dexamethasone to bupivacaine had rapid onset of block and longer time to first analgesic request with fewer side-effects.
目的
本研究旨在评估在0.5%布比卡因用于锁骨上臂丛神经阻滞时，添加地塞米松或咪达唑仑与添加肾上腺素相比的有效性。
设置与设计
这是一项前瞻性随机对照、观察者盲法研究。
研究对象与方法
本研究在坦塔大学医院对60例患者进行，包括男性和女性；美国麻醉医师协会身体状况分级为I级和II级，年龄范围在18至45岁，接受上肢择期手术。所有患者均采用超声引导下锁骨上臂丛神经阻滞麻醉，并随机分为三组（每组20例患者）。E组（肾上腺素组）：30毫升0.5%布比卡因加1:200,000肾上腺素（5微克/毫升）。D组（地塞米松组）：30毫升0.5%布比卡因加8毫克地塞米松。M组（咪达唑仑组）：30毫升0.5%布比卡因加50微克/千克咪达唑仑。主要观察指标为感觉和运动阻滞的起效时间和持续时间以及首次要求镇痛的时间。
统计分析方法
使用SPSS 11.0.1的Windows版本（SPSS公司，美国伊利诺伊州芝加哥）进行统计分析。数据以均值±标准差的形式呈现，采用方差分析（ANOVA）对三组进行比较，方差分析后采用谢费检验。显著性水平P < 0.05被认为具有统计学意义。
结果
与E组相比，D组和M组的感觉和运动阻滞起效明显更快（P < 0.05）。与M组相比，D组的补救镇痛给药时间、感觉和运动阻滞持续时间显著延长（P < 0.05），而M组与E组相比也有显著延长（P < 0.05）。
结论
与肾上腺素和咪达唑仑相比，在布比卡因中添加地塞米松具有更快的阻滞起效时间和更长的首次要求镇痛时间，且副作用更少。
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