【罂粟摘要】布比卡因的温度对锁骨上丛阻滞特性的影响：一项随机对照试验

局麻药温度的变化可能会影响周围神经阻滞的效果。加热的布比卡因对锁骨上臂丛神经阻滞的影响尚未得到评估。

本研究旨在评估加温的0.5%布比卡因对接受上肢中段以下骨科手术的成年患者行锁骨上入路臂丛神经阻滞效果的影响。主要观察指标是感觉阻滞的起效时间。次要观察指标是运动阻滞的起效时间、感觉和运动阻滞的持续时间以及到首次要求镇痛的时间。

随机、双盲、对照试验。

范围设置

大学教学医院。

方法

本研究纳入90例接受择期或急诊上肢中段以下骨科手术的患者。患者被随机分为两组并接受超声引导下锁骨上入路臂丛神经阻滞。第一组接受23°C 30ml 0.5%布比卡因。第二组接受37°C 30ml 0.5%布比卡因。在所有患者中评估感觉和运动阻滞的起效时间、术后疼痛的严重程度、感觉和运动阻滞的持续时间以及首次需要镇痛的时间。

结果

加热的布比卡因组感觉和运动阻滞的起效时间明显加快。感觉和运动阻滞的持续时间以及首次需要镇痛的时间在加热的布比卡因组显著延长。此外，加热的布比卡因可显著降低术后镇痛药物的消耗量。

局限性

结论

0.5%布比卡因加温至37°C可改善锁骨上入路臂丛神经的阻滞特性，可促进感觉-运动阻滞的快速起效并提供更好的术后镇痛质量。

原始文献来源

Makharita Mohamed Younis,Shalaby Shimaa Abd El-Satar,Saber Hosam I El Said, et al. The Influence of Bupivacaine Temperature on Supraclavicular Plexus Block Characteristics: A Randomized, Controlled Trial.[J].Pain Physician,2020,23(6):589-597.

Abstract

Background: Changes in local anesthetics temperature may influence the characters of the peripheral nerve block. The effect of warmed bupivacaine on supraclavicular brachial plexus block has not yet been evaluated.

Objectives: This study was designed to evaluate the influence of warming bupivacaine 0.5% on the characteristics of supraclavicular plexus block in adult patients undergoing orthopedic surgery below the mid-arm. The primary objective was the time to onset of sensory block. The secondary objectives were the time to onset of motor block, the duration of sensory and motor blocks, and the time to the first analgesic requirement.

Study Design: Randomized, double-blind, controlled trial.

Setting: University hospital setting.

Methods: Ninety patients who underwent elective or emergency orthopedic surgery below the mid-arm were included in this study. Patients were randomly allocated into 2 groups and received ultrasound-guided supraclavicular brachial plexus block. Group I received 30 mL 0.5% bupivacaine at 23°C. Group II received 30 mL bupivacaine 0.5% warmed to 37°C. The onset of sensory and motor blocks, postoperative pain severity, the duration of sensory and motor blocks, and the time to the first analgesic requirement were evaluated in all patients.

Results: The warm bupivacaine group had a significantly accelerated onset time of sensory and motor block. The duration of sensory and motor block and the time to first requirement for analgesia were significantly longer in the warm bupivacaine group. Moreover, it significantly reduced the postoperative analgesics consumption.

Limitations: Postoperative assessment of the offset of the sensory and motor blocks of the individualized nerves was inaccessible, in addition to a small sample size.

Conclusions: Warming bupivacaine 0.5% to 37°C improves the characteristics of supraclavicular plexus block. It promotes rapid onset of sensory-motor block and provided better quality of postoperative analgesia.