在臂丛神经阻滞中，局部麻醉药添加芬太尼对镇痛持续时间的影响。
Effect of addition of fentanyl to local anesthetic in brachial plexus block on duration of analgesia.
作者信息
Chavan Shirish G, Koshire Alka R, Panbude Prasad
机构信息
Department of Anaesthesia, NDMVPS Medical College, Nashik, Maharashtra, India.
出版信息
Anesth Essays Res. 2011 Jan-Jun;5(1):39-42. doi: 10.4103/0259-1162.84183.
INTRODUCTION/CONTEXT: A comparative study was carried out to evaluate the analgesic efficacy and side effects of addition of fentanyl to local anesthetic undergoing surgeries on forearm and elbow. All patients were hemodynamically stable, and there were no serious side effects in any of the patients in both the groups. The difference in the mean duration of analgesia between the groups was statistically significant (P<0.01). So we can conclude- Addition of Fentanyl to local anaesthetic in brachial plexus block increases duration of analgesia.
MATERIALS AND METHODS
Patients were randomly divided into two groups: group I (control) and group II (study). All the patients were subjected to brachial plexus block with supraclavicular approach. After obtaining paraesthesia, drugs were administered as follows: Group I (control): bupivacaine 0.5% 20 mL + lignocaine 2% 10 mL + NS 1 mL Group II (study): bupivacaine 0.5% 20 mL + lignocaine 2% 10 mL + fentanyl 1 mL (50 microgm). Observations were noted. All the relevant information was recorded on a pretested, predefined, semi-open pro forma sheet. Regular monitoring of PR, BP and RR, side effects,degree of sedation were recorded. Evaluation of pain and pain relief was done according to McGill pain questionnaire (0- no pain to 5- excruciating pain). When patients complained of discomforting pain (McGill grade II), parenteral analgesic was prescribed, and the total number of doses in the 24-hour period was noted.
RESULTS
The duration of analgesia in group II (study) was significantly longer (695±85 min) than those in group I (415±78 min). However, onset time of analgesia was prolonged in group 2. We conclude that the addition of fentanyl to local anesthetics causes an improved success rate of sensory blockade but a delayed onset of analgesia, although this may be accounted for by the decreased pH caused by fentanyl. There was no statistically significant difference in the incidence of side effects between the two groups.
CONCLUSIONS
This study has shown that the mean duration of analgesia is extended if fentanyl is added to local anesthetics, without increasing the side effects.
引言/背景：进行了一项比较研究，以评估在前臂和肘部手术中，在局部麻醉剂中添加芬太尼的镇痛效果和副作用。所有患者血流动力学稳定，两组患者均未出现严重副作用。两组之间平均镇痛持续时间的差异具有统计学意义（P<0.01）。因此我们可以得出结论——在臂丛神经阻滞的局部麻醉剂中添加芬太尼可延长镇痛持续时间。
材料与方法
患者被随机分为两组：第一组（对照组）和第二组（研究组）。所有患者均采用锁骨上入路进行臂丛神经阻滞。获得感觉异常后，按以下方式给药：第一组（对照组）：0.5%布比卡因20 mL + 2%利多卡因10 mL + 生理盐水1 mL；第二组（研究组）：0.5%布比卡因20 mL + 2%利多卡因10 mL + 芬太尼1 mL（50微克）。进行观察。所有相关信息都记录在预先测试、预先定义的半开放式表格上。定期监测心率、血压和呼吸频率、副作用、镇静程度并记录。根据麦吉尔疼痛问卷（0-无痛至5-剧痛）对疼痛和疼痛缓解情况进行评估。当患者主诉疼痛不适（麦吉尔分级II级）时，开具非肠道镇痛药，并记录24小时内的总剂量。
结果
第二组（研究组）的镇痛持续时间（695±85分钟）明显长于第一组（415±78分钟）。然而，第二组的镇痛起效时间延长。我们得出结论，在局部麻醉剂中添加芬太尼可提高感觉阻滞的成功率，但会延迟镇痛起效时间，尽管这可能是由于芬太尼导致pH值降低所致。两组之间副作用发生率无统计学显著差异。
结论
本研究表明，在局部麻醉剂中添加芬太尼可延长平均镇痛持续时间，且不增加副作用。
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