Saryazdi Hamid, Yazdani Alireza, Sajedi Parvin, Aghadavoudi Omid
Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Adv Biomed Res. 2015 Oct 22;4:232. doi: 10.4103/2277-9175.167901. eCollection 2015.
There is no agreement about the effect of adding opioids to local anesthetics in peripheral nerve blocks. The aim of this study was to investigate the effect of adding different opioids with equipotent doses of lidocaine in axillary brachial plexus block using ultrasonography and nerve locator guidance.
In a prospective, randomized, double-blind clinical trial study, 72 adult patients aged 18-65 years old scheduled for orthopedic surgery of the forearm and hand with axillary brachial plexus block were selected and randomly allocated to four groups. Meperidine (pethidine), buprenorphine, morphine, and fentanyl with equipotent doses were added in 40cc of 1% lidocaine in P, B, M, and F groups, respectively. The onset and duration of sensory and motor blocks, severity of patients' pain, duration of analgesia, hemodynamic and respiratory parameters, and adverse events (such as nausea and pruritus) during perioperative period were recorded.
The onset time for the sensory block was similar in the four groups. The onset time for the motor block was significantly faster in morphine and pethidine groups (P = 0.006). The duration of sensory and motor blocks was not statistically different among the four groups. The quality of motor blockade was complete in 100% of patients receiving pethidine or morphine and 77.8% of patients receiving buprenorphine or fentanyl (P = 0.021).
In the upper extremity surgeries performed under axillary brachial plexus block addition of morphine or pethidine to lidocaine may be superior to other opioids (i.e. fentanyl and buprenorphine) due to better quality and quantity of motor blockade and faster onset of the block.
关于在周围神经阻滞中向局部麻醉药中添加阿片类药物的效果尚无定论。本研究的目的是使用超声和神经定位仪引导，研究在腋路臂丛神经阻滞中添加不同阿片类药物与等效剂量利多卡因的效果。
在一项前瞻性、随机、双盲临床试验研究中，选择72例计划进行前臂和手部骨科手术且需行腋路臂丛神经阻滞的18 - 65岁成年患者，并随机分为四组。P组、B组、M组和F组分别在40cc 1%利多卡因中添加等效剂量的哌替啶、丁丙诺啡、吗啡和芬太尼。记录围手术期感觉和运动阻滞的起效时间和持续时间、患者疼痛程度、镇痛持续时间、血流动力学和呼吸参数以及不良事件（如恶心和瘙痒）。
四组感觉阻滞的起效时间相似。吗啡组和哌替啶组运动阻滞的起效时间明显更快（P = 0.006）。四组之间感觉和运动阻滞的持续时间无统计学差异。接受哌替啶或吗啡的患者中100%运动阻滞质量完全，接受丁丙诺啡或芬太尼的患者中77.8%运动阻滞质量完全（P = 0.021）。
在腋路臂丛神经阻滞下进行的上肢手术中，向利多卡因中添加吗啡或哌替啶可能优于其他阿片类药物（即芬太尼和丁丙诺啡），因为运动阻滞的质量和数量更好且阻滞起效更快。
