A Comparative Study On The Anesthetic Effect Of Ultrasound-guided Axillary Branchial Plexus Block With Levobupivacaine And Ropivacaine

Objective: Patients received ultrasound guidance for axillary brachial plexus block with 0.375% levobupivacaine or 0.375% ropivacaine 20 mL.To compare the anesthesia onset time,duration of anesthesia,anesthetic analgesic effect and complicat-ions of the two drugs.Methods:Sixty patients aging 18~65 years old,weighing 40~90 kg,ASA I-II undergoing Upper limb fracture surgery in our hospital with brachial plexus block were randomly divided into two groups according to the random number table,group L(n=30)and group R(n=30).Patients received ultrasound guidance for axillary brachial plexus block with 0.375% levobupivacaine or0.375% ropivacaine 20 mL.Exclusion criteria: non-cooperation,puncture site injury,upper limb injury with neurological dysfunction,local anesthetic allergy,liver and kidney dysfunction and coagulation abnormalities.Mean arterial pressure(MAP),heart rate(HR),pulse oximetry(SpO2),respiratory rate(RR)and electrocardiogram(ECG)were monitored by multifunctional monitor,and the patients were treated with face mask with low concentration of oxygen.They lay on the operating bed,with the injured hand placing in a salute posture,shoulder and elbow benting 90 degrees.Sterilized the axillary skin with iodophor.Applied an ultrasonic coupling agent to the portable color Doppler ultrasound probe.And then put it on a sterile protective cover which coated with iodine outside.In order to observe every branch of axillary brachial plexus road,we probed axillary pectoralis major focuses on the border between sliding detect axillary artery.Using short axis needle technology,puncture needle was monitoried to the direction timely,until reaching around the nerve.the musculocutaneous nerve,median nerve,ulnar nerve and radial nerve were injected with a quarter of the local anesthetic,while the syringe had no blood.The ultrasound-guided brachial plexus block time,operationtime and tourniquet time were monitored and recorded.MAP,HR,SpO2,RR and Ramsay sedation score during operation were recorded every 5 minutes within 30 minutes.The onset time,the recovery time of sensory and motor nerves function and the efficacy of anesthetic analgesic were observed.The intraoperative and postoperative complications were observed such as local anesthetic infusion into the blood vessels,hematoma of puncture site,nerve injury,nausea and vomiting.All operations and observations were performed by one anesthesiologists who were proficient in the technique and didn’t know the grouping or medication.Results: There was no significant difference in gender,age,height,weight and ASA grade between the two groups(P>0.05).There were no significant difference in nerve block time,operation time and tourniquet time(P>0.05).There was no significant difference in MAP,HR,Sp02,RR and Ramsay sedation score respectively for the six time which before nerve blocking(T1),after nerve blocking(T2),5min(T3),10min(T4),20min(T5),30min(T6)between group L and group R(P> 0.05).The onset time of motor nerve block in group L was(10.5±1.1)min,and that was(10.2±1.1)min in group R,there was no significant difference between the two groups(P>0.05).The onset time of sensory nerve block in group L was(2.7±0.3)min,which was shorter than that in group R(5.0±0.5)min,and the difference between the two groups was statistically significant(P<0.05).The recovery time of sensory nerve block in group L was(450±24)min,which was longer than that in group R(330±24)min,the difference between the two groups was statistically significant(P<0.05).The recovery time of motor nerve block in group L was(432±23)min,which was longer than that in group R(324±18)min,the difference between the two groups was statistically significant(P<0.05).The analgesic effect of anesthesia in the two groups was similar,the difference was not statistically significant(P>0.05).There were no anesthesia-related complications in both groups,such as local anesthetic infusion into the blood vessels,hematoma of puncture site,nerve injury,nausea and vomiting.Conclusion: Compared with ropivacaine,the effect of levobupivacaine on sensory nerve block was faster,and the duration of sensory and motor block was longer.According to the operation needs,different local anesthetics should be selected.if the motor function needs early recovery after operation,the ropivacaine can be selected.If the operation is longer,or require the absolute braking of the limb during microsurgery,or need a long time to postoperative analgesia,we can choose levobupivacaine.