Mezzatesta J P, Scott D A, Schweitzer S A, Selander D E
St. Vincent's Hospital, Melbourne, Victoria, Australia.
Reg Anesth. 1997 Jul-Aug;22(4):357-62. doi: 10.1016/s1098-7339(97)80012-0.
The aim of this study was to compare the efficacy and safety of continuous axillary brachial plexus block by infusion and by intermittent injection of bupivacaine 0.25% in the management of postoperative pain.
Two methods of continuous axillary brachial plexus block for pain management were compared in a prospective randomized trial. Twenty 16- to 62-year-old male patients (ASA I and II), undergoing microsurgery, received 0.25% bupivacaine following surgery, by either continuous infusion (group C, n = 10), or intermittent hourly bolus (group B, n = 10), via an axillary brachial plexus catheter inserted prior to operation. Efficacy assessments and analysis of plasma bupivacaine levels were performed for up to 38 hours postsurgery.
There was no difference between groups with respect to pain scores, degree of motor block, or supplemental narcotic requirements. Plasma bupivacaine levels were higher in group C, with the difference reaching significance after 26 hours (means +/- SEM: C = 1.03 +/- 0.10 micrograms/mL, B = 0.73 +/- 0.08 microgram/mL, P < .05). There were no significant differences in cumulative bupivacaine doses or infusion rates between the groups. Complications included one case of axillary artery puncture at insertion, two unplanned premature catheter removals, and a self-limited grand mal convulsion in a known epileptic.
Overall, both techniques provided safe and effective postoperative analgesia. As compared with continuous infusion, intermittent bolus administration resulted in lower plasma bupivacaine levels despite similar infusion rates.
本研究旨在比较在术后疼痛管理中，通过输注和间歇性注射0.25%布比卡因进行连续腋路臂丛神经阻滞的疗效和安全性。
在一项前瞻性随机试验中比较了两种用于疼痛管理的连续腋路臂丛神经阻滞方法。20例年龄在16至62岁的男性患者（ASA I和II级）接受显微手术，术后通过术前插入的腋路臂丛神经导管，以连续输注（C组，n = 10）或每小时间歇性推注（B组，n = 10）的方式给予0.25%布比卡因。术后长达38小时进行疗效评估和血浆布比卡因水平分析。
两组在疼痛评分、运动阻滞程度或补充麻醉剂需求方面无差异。C组血浆布比卡因水平较高，26小时后差异具有统计学意义（均值±SEM：C组 = 1.03±0.10微克/毫升，B组 = 0.73±0.08微克/毫升，P <.05）。两组间布比卡因累积剂量或输注速率无显著差异。并发症包括1例置管时腋动脉穿刺、2例计划外提前拔除导管以及1例已知癫痫患者发生的自限性大发作惊厥。
总体而言，两种技术均提供了安全有效的术后镇痛。与连续输注相比，尽管输注速率相似，但间歇性推注给药导致血浆布比卡因水平较低。
