Gormley W P, Murray J M, Fee J P, Bower S
Department of Anaesthesia, Ulster Hospital, Dundonald, Belfast.
Br J Anaesth. 1996 Jun;76(6):802-5. doi: 10.1093/bja/76.6.802.
Peripheral administration of opioids has been suggested as a means of improving regional block. We studied 60 patients receiving axillary brachial plexus anaesthesia, allocated randomly to receive either normal saline 10 ml or normal saline 10 ml with alfentanil 10 micrograms/kg body weight through an axillary cannula. All patients received 1.5% lignocaine at a dose of 7 mg/kg body weight with adrenaline 1 in 200,000. The incidence of satisfactory block was similar in both groups. Although the percentage of patients with complete anaesthesia in the median nerve distribution was greater in the alfentanil group, there was no significant difference in any other distribution. The time to return of sensation and motor function was prolonged significantly in the alfentanil group (P < 0.05). After return of normal sensation, there was no significant difference between groups in postoperative analgesia. In a second part of the study, there was no significant increase in plasma concentrations of alfentanil in 10 patients given lignocaine and alfentanil, as outlined above. These observations suggest that alfentanil may have a peripheral local anaesthetic action.
有人提出外周给予阿片类药物是改善区域阻滞的一种方法。我们研究了60例接受腋路臂丛神经麻醉的患者，随机分配通过腋静脉套管接受10 ml生理盐水或10 ml生理盐水加10微克/千克体重阿芬太尼。所有患者均接受1.5%利多卡因，剂量为7毫克/千克体重加1:200,000肾上腺素。两组的满意阻滞发生率相似。虽然阿芬太尼组正中神经分布区完全麻醉的患者百分比更高，但在其他任何分布区均无显著差异。阿芬太尼组感觉和运动功能恢复时间显著延长（P<0.05）。感觉恢复正常后，两组术后镇痛无显著差异。在研究的第二部分，如上述，10例接受利多卡因和阿芬太尼的患者血浆阿芬太尼浓度无显著升高。这些观察结果表明阿芬太尼可能具有外周局部麻醉作用。
