Khairnar Prakash, Agarwal Munisha, Verma Uttam Chandra, Kumar Rakesh
Department of Critical Care, Asian Institute of Medical Sciences, Faridabad, Haryana, India.
Department of Anesthesia and Critical Care, Maulana Azad Medical College, New Delhi, India.
Indian J Anaesth. 2016 Aug;60(8):584-9. doi: 10.4103/0019-5049.187794.
Patients with burns may require multiple surgeries, but poor general condition and underlying protein energy malnutrition make them unsuitable candidates for general or spinal anaesthesia. This study evaluated the role of magnesium sulphate as an adjuvant with levobupivacaine and ropivacaine used in combined femoral and lateral femoral cutaneous nerve (LFCN) blocks in burn patients with relative sparing of thigh portion.
This prospective, randomised, double-blind study included 54 adult patients of 18-65 years age, undergoing split-thickness skin graft harvest from the thigh, allotted to three equal groups of 18 each. Group L patients received femoral nerve (FN) block with 15 mL of 0.5% levobupivacaine and 8 mL for LFCN block; Group LM patients received 14 mL of 0.5% levobupivacaine along with 1.0 mL of 15% magnesium sulphate for FN block, 7.5 mL of 0.5% levobupivacaine with 0.5 mL of 15% of magnesium sulphate to LFCN block and Group R patients received 15 mL of 0.5% ropivacaine for FN block and 8 mL of 0.5% ropivacaine for LFCN block. Time to block onset and complete surgical block, duration of analgesia, total analgesic dose and the overall analgesia satisfaction score were measured in the first 24 h post-operatively. Quantitative data were analysed with ANOVA and qualitative data subjected to Chi-square tests. Intergroup comparison was performed with independent t-test.
The duration of post-operative analgesia did not differ with the addition of magnesium (P = 0.610). Time to onset of the block was significantly decreased with the addition of magnesium (P = 0.0341), but time to complete surgical block onset was similar across the groups.
Both ropivacaine and levobupivacaine have good perioperative analgesic efficacy. Magnesium as an analgesia adjuvant with levobupivacaine does not prolong the duration of post-operative analgesia.
烧伤患者可能需要多次手术，但一般状况较差及潜在的蛋白质能量营养不良使他们不适合全身麻醉或脊髓麻醉。本研究评估了硫酸镁作为佐剂与左旋布比卡因和罗哌卡因联合用于大腿部分相对未受影响的烧伤患者的股神经和股外侧皮神经（LFCN）阻滞中的作用。
本前瞻性、随机、双盲研究纳入了54例年龄在18至65岁之间、接受大腿中厚皮片取皮术的成年患者，将其平均分为三组，每组18例。L组患者接受15毫升0.5%左旋布比卡因的股神经（FN）阻滞和8毫升用于LFCN阻滞；LM组患者接受14毫升0.5%左旋布比卡因加1.0毫升15%硫酸镁用于FN阻滞，7.5毫升0.5%左旋布比卡因加0.5毫升15%硫酸镁用于LFCN阻滞，R组患者接受15毫升0.5%罗哌卡因用于FN阻滞和8毫升0.5%罗哌卡因用于LFCN阻滞。在术后24小时内测量阻滞起效时间和完全手术阻滞时间、镇痛持续时间、总镇痛剂量和总体镇痛满意度评分。定量数据采用方差分析，定性数据采用卡方检验。组间比较采用独立t检验。
添加硫酸镁后术后镇痛持续时间无差异（P = 0.610）。添加硫酸镁后阻滞起效时间显著缩短（P = 0.0341），但各组手术阻滞完全起效时间相似。
罗哌卡因和左旋布比卡因均具有良好的围手术期镇痛效果。硫酸镁作为左旋布比卡因的镇痛佐剂不会延长术后镇痛时间。
