局麻药佐剂对神经阻滞效果的影响

神经阻滞中，不仅仅局麻药的种类、浓度及剂量影响神经阻滞的效果，其添加剂也会对阻滞效果产生很大影响。

摘要译文

氯胺酮与硫酸镁在后段手术球周阻滞中作为局麻药佐剂：一项随机对照研究

背 景

在球周阻滞中使用局麻药佐剂可能会改善阻滞特征。这项双盲、平行组、随机、对照试验的目的是评估氯胺酮与硫酸镁作为局麻药佐剂对玻璃体视网膜手术患者球周阻滞的安全性和有效性。

方 法

将126例计划行玻璃体视网膜手术的患者随机分为氯胺酮组（GK，n=42）、硫酸镁组（GM，n=42）或对照组（GC，n=42）。

主要结果是眼球运动障碍的发生和持续时间、眼睑运动障碍的持续时间和感觉阻滞的发生。

次要结果包括开始手术的时间、镇痛持续时间、眼压以及患者和外科医生的满意度。

结 果

氯胺酮或镁的使用显著缩短了眼球运动障碍的发生时间，增强了感觉阻滞的发生，延长了眼球和眼睑运动障碍的持续时间，减少了开始手术所需的时间，并增加了总镇痛时间。

镁对眼球和眼睑运动迟滞的持续时间以及镇痛的影响显著更为显著，而氯胺酮显著缩短了开始手术所需的时间。

两种药物的使用均显著提高了患者和外科医生的满意度。

结 论

在玻璃体视网膜手术中，使用氯胺酮或硫酸镁作为局麻药佐剂用于球周阻滞，可改善阻滞的起效时间、持续时间和质量，使患者和外科医生更满意，且与药物不良反应或手术并发症无关。

原文摘要

Ketamine versus magnesium sulphate as anadjuvant to local anesthetics in the peribulbar block for posterior segmentsurgeries: a randomized controlled study

Background: The use of an adjuvant to localanesthetics in the peribulbar block may improve block characteristics. The aimof this double-blinded, parallel-group, randomized, controlled trial was toevaluate the safety and efficacy of ketamine versus magnesium sulphate asadjuvants to the local anesthetic mixture of peribulbar block in patientsscheduled for vitreoretinal surgeries.

Methods: A total of 126 patients scheduledfor vitreoretinal surgery were randomly allocated as either ketamine (GK,n=42), magnesium sulphate (GM, n=42), or control (GC, n=42) groups. The primaryoutcomes were the onset and duration of globe akinesia, duration of lidakinesia, and onset of sensory block. Secondary outcomes included time to startsurgery, duration of analgesia, intraocular pressure, and patient and surgeonsatisfaction.

Results: The use of either ketamine ormagnesium significantly shortened the onset of globe akinesia, enhanced theonset of sensory block, prolonged the duration of globe and lid akinesia,minimized the time required to start surgery, and increased the total analgesictime. The effect of magnesium was significantly more pronounced on durations ofglobe and lid akinesia as well as analgesia, whereas ketamine significantlyshortened the time required to start surgery. Both patient and surgeonsatisfaction were significantly improved with the use of either drug.

Conclusions: In vitreoretinal surgeries theuse of either ketamine or magnesium sulphate as adjuvants to the localanesthetic mixture of peribulbar block improved the onset, duration, andquality of the block, offered better patient and surgeon satisfaction, and wasnot associated with drug adverse effects or surgical complications.

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