Ghoniem Basma M, Shams Gamal Hendawy, Abdelsalam Wafaa, Elsharkawy Mahmoud Fawzy
Department of Anesthesiology, Surgical Intensive Care and Pain Medicine Department, Faculty of Medicine, Kafr-El Sheikh University, Kafr-El Sheikh, Egypt.
Curr Drug Saf. 2025;20(4):490-497. doi: 10.2174/0115748863332349241108094956.
For surgical procedures of the upper limbs, ultrasound-guided supraclavicular brachial plexus block (SCBPB) represents a safe substitute for general anesthesia. The present study evaluated the effectiveness and safety of incorporating 1μg/kg dexmedetomidine (DEX) into 20 ml bupivacaine, as opposed to using 20 ml and 30 ml bupivacaine without additives, in SCBPB.
This randomized, controlled, double-blind study included 75 patients assigned to elective upper-limb surgery under the mid-humerus level. Patients were randomized into three equal groups to receive US-guided SCBPB with 20 ml bupivacaine 0.5% + 1 μg/kg DEX in group BD, 20 ml bupivacaine 0.5% without additives in group B20, and 30 ml bupivacaine 0.5% in group B30 (control).
Compared to group B20, groups BD and B30 had significantly quicker onset times for sensory and motor blocks. Groups BD and B30 had a more significant block duration than group B20. Group BD experienced considerably lower intraoperative hemodynamics than groups B20 and B30. Groups BD and B30 had a significantly delayed time to first rescue analgesia and consumed less pethidine than group B20. Compared to group B20, the pain score was significantly reduced in groups BD and B30. Comparable levels of pain score, rescue analgesia time, total pethidine consumption, and motor and sensory block onset and duration were seen in the BD and B30 groups.
DEX with a lower volume (20 ml) of bupivacaine reaches the same result as a higher volume of bupivacaine (30 ml) in managing perioperative pain and hemodynamic stability without the risk of the high volume of bupivacaine. Further, adding DEX to small dose of bupivacaine (20 ml) is more effective than small dose of bupivacaine (20 ml) alone without additives in prolonging the duration of sensory and motor block, reducing pain intensity, and delaying the need for rescue analgesia.
对于上肢外科手术，超声引导下锁骨上臂丛神经阻滞（SCBPB）是全身麻醉的一种安全替代方法。本研究评估了在SCBPB中，将1μg/kg右美托咪定（DEX）加入20ml布比卡因中的有效性和安全性，对比使用不含添加剂的20ml和30ml布比卡因的情况。
这项随机、对照、双盲研究纳入了75例计划在肱骨中段水平进行择期上肢手术的患者。患者被随机分为三组，每组人数相等：BD组接受超声引导下的SCBPB，使用20ml 0.5%布比卡因+1μg/kg DEX；B20组接受20ml不含添加剂的0.5%布比卡因；B30组（对照组）接受30ml 0.5%布比卡因。
与B20组相比，BD组和B30组的感觉和运动阻滞起效时间明显更快。BD组和B30组的阻滞持续时间比B20组更长。BD组术中血流动力学变化比B20组和B30组小得多。BD组和B30组首次补救镇痛时间明显延迟，哌替啶用量比B20组少。与B20组相比，BD组和B30组的疼痛评分显著降低。BD组和B30组在疼痛评分、补救镇痛时间、哌替啶总用量以及运动和感觉阻滞的起效和持续时间方面相当。
较低容量（20ml）的布比卡因加DEX在围手术期疼痛管理和血流动力学稳定性方面与较高容量（30ml）的布比卡因效果相同，且无大容量布比卡因的风险。此外，在小剂量布比卡因（20ml）中添加DEX在延长感觉和运动阻滞持续时间、降低疼痛强度以及延迟补救镇痛需求方面比单独使用小剂量布比卡因（20ml）不含添加剂更有效。
