超声引导上肢手术锁骨上臂丛阻滞中单独使用布比卡因与联合使用纳布啡的比较研究

Said M. El-Medany, Hisham Shaaban, Kareem Ateba, A. Abdel Razek
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引用次数: 0

摘要

臂丛神经阻滞是一种被充分研究的上肢可靠麻醉或镇痛方法。臂丛神经阻滞有多种入路。这些入路根据局部麻醉注射到斜角肌间、锁骨上、锁骨下和腋窝阻滞的程度来分类。锁骨上阻滞术通过单次注射为手臂提供快速的密集麻醉,非常适合从肱骨远端到手部的手臂和前臂手术。超声引导导致锁骨上入路进入臂丛的更好做法,降低了并发症的风险。在局部神经阻滞中,人们一直在寻找局部麻醉剂的辅助剂,以延长镇痛持续时间,但副作用较小。目的比较纳布啡联用布比卡因与单用布比卡因在超声引导下上肢手术锁骨上臂丛阻滞中感觉和运动阻滞的发生、持续时间、镇痛持续时间、术后镇痛需求、对血流动力学的影响及可能的并发症。患者与方法本研究在亚历山大美因大学医院对50例成年患者进行研究,患者均为美国麻醉学学会I和II分会会员,计划在超声引导下在锁骨上臂丛阻滞下行手部和前臂手术。采用密封信封技术将患者随机分为两组(每组25例)。I组患者仅接受布比卡因阻滞治疗,II组患者接受布比卡因和纳布啡作为阻滞的辅助治疗。结果我们的研究结果显示,与仅接受布比卡因阻滞的I组患者相比,纳布啡组(II组)患者的感觉和运动阻滞持续时间明显更长,术后镇痛持续时间也更长。结论纳布啡与布比卡因联合应用于锁骨上臂丛神经阻滞可显著增加感觉和运动阻滞的持续时间,延长术后镇痛时间,且无血流动力学不稳定。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparative study between the use of bupivacaine alone or with nalbuphine in ultrasound-guided supraclavicular brachial plexus block for upper limb surgeries
Background Brachial plexus block is a well-studied method of providing reliable anesthesia or analgesia for the upper extremity. Many approaches for brachial plexus block are present. These approaches are classified according to the level of local anesthetic injection into interscalene, supraclavicular, infraclavicular, and axillary blocks. By providing a rapid onset of dense anesthesia of the arm with a single injection, the supraclavicular block is perfect for operations involving the arm and forearm, from the distal humerus down to the hand. Ultrasound guidance has resulted in a better practice of supraclavicular approach to the brachial plexus, with decreasing the risk of complications. There has always been a search for adjuvants to local anesthetics used in regional nerve block with drugs that prolong the duration of analgesia but with lesser adverse effects. Objective To compare the effect of nalbuphine as an additive to bupivacaine versus bupivacaine alone in supraclavicular brachial plexus block with ultrasound guidance in upper limb surgeries regarding onset and duration of sensory and motor blocks, duration of analgesia, and postoperative analgesic requirements, as well as the effects on hemodynamics and possible complications with each technique. Patients and methods This study was carried out in Alexandria Main University Hospital on 50 adult patients of both sexes, American Society of Anesthesiology I and II, scheduled for surgeries of the hand and forearm under supraclavicular brachial plexus block with ultrasound guidance. Patients were randomly categorized into two equal groups (25 patients each) using the sealed envelope technique. Group I patients received bupivacaine only for the block, and group II patients received bupivacaine and nalbuphine as an adjuvant for the block. Results The results of our study showed that patients in nalbuphine group (group II) had significantly longer sensory and motor blocks duration, with longer duration of postoperative analgesia, when compared with patients in group I, who were received bupivacaine only for the block. Conclusion Coadministration of nalbuphine with bupivacaine in supraclavicular brachial plexus block leads to a significant increase in the duration of sensory and motor blocks and provides prolonged postoperative analgesia without causing adverse hemodynamic instability.
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