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超声引导锁骨上阻滞用于上肢矫形手术时,与布比卡因相比,布比卡因中加入右美托咪定用于神经周围给药的效果。

Effect Of Perineural Administration Of Dexmedetomidine With Bupivacaine Versus Bupivacaine Alone In Ultrasound Guided Supraclavicular Block For Upper Extremity Orthopaedic Operations.

机构信息

PAF Hospital Mushaf Sargodha.

CMH Malir Karachi.

出版信息

J Ayub Med Coll Abbottabad. 2023 Jul-Sep;35(3):384-389. doi: 10.55519/JAMC-03-12044.

Abstract

BACKGROUND

During procedures on the upper limbs, the brachial plexus block is usually advised. To increase the length of the block, many medicines have been utilized as adjuvants. The purpose of this study was to compare the effects of dexmedetomidine plus bupivacaine against bupivacaine alone on the onset and duration of the sensory and motor block and the duration of analgesia in the supraclavicular block during upper extremity orthopaedic surgery.

METHODS

Sixty individuals qualified for orthopaedic operations on the upper extremities, ranging in age from 20 to 60 years, participated in this prospective, randomized investigation. The modified Bromage scale and the pinprick method were used to assess the sensory and motor block. Using a visual analogue pain scale, the postoperative pain was evaluated at 0, 6, 12 and 24 hours after surgery.

RESULTS

In patients receiving only bupivacaine, the mean onset time of sensory and motor block was 32.84 minutes and 26.67 minutes respectively; while in those receiving bupivacaine along with dexmedetomidine, it was 23.38 minutes and 14.81 minutes (p<0.005). In the intervention group (bupivacaine and dexmedetomidine), the period between the first request for analgesia and the duration period of sensory and motor block were both longer (p<0.005). The intervention group experienced less postoperative discomfort for 24 hours (p<0.05).

CONCLUSIONS

Dexmedetomidine added to bupivacaine perineurally prolonged both numbness and immobility while shortening the time it took for sensory and motor blocks to begin. Moreover, dexmedetomidine considerably decreased postoperative pain when combined with bupivacaine for supraclavicular blocks.

摘要

背景

在上肢手术过程中,通常建议进行臂丛神经阻滞。为了延长阻滞的长度,许多药物已被用作佐剂。本研究旨在比较右美托咪定加布比卡因与单纯布比卡因对上肢骨科手术锁骨上阻滞感觉和运动阻滞的起始和持续时间以及镇痛持续时间的影响。

方法

60 名符合上肢骨科手术条件的患者,年龄在 20 岁至 60 岁之间,参与了这项前瞻性、随机研究。改良 Bromage 量表和针刺法用于评估感觉和运动阻滞。术后 0、6、12 和 24 小时使用视觉模拟疼痛量表评估术后疼痛。

结果

仅接受布比卡因的患者感觉和运动阻滞的平均起始时间分别为 32.84 分钟和 26.67 分钟;而接受布比卡因加右美托咪定的患者分别为 23.38 分钟和 14.81 分钟(p<0.005)。在干预组(布比卡因和右美托咪定)中,首次要求镇痛与感觉和运动阻滞持续时间之间的间隔均较长(p<0.005)。干预组在 24 小时内术后不适感较少(p<0.05)。

结论

神经周围给予右美托咪定加布比卡因可延长感觉和运动阻滞的麻木和运动障碍持续时间,同时缩短感觉和运动阻滞开始的时间。此外,与布比卡因联合使用时,右美托咪定可显著减少锁骨上阻滞的术后疼痛。

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