Effects Of Different Doses Of Glucocorticoids On The Common Effect Of Ropivacaine In Brachial Plexus Block

Objective:This research adopts the method of double blind randomized controlled comparison of two different doses of commonly used clinical Glucocorticoid(dexamethasone, Jia Qianglong) effects on anesthesia effect of 0.4% ropivacaine for axillary brachial plexus block, providing reference for clinical use. Methods:Part one: Effects of different dose of dexamethasone on the effect of ropivacaine on brachial plexus block1、The object of study:Elective upper limb fracture operation 100 patients as experimental group, aged 22 to 67 years old, ASA grade I ~ II, body weight 48 ~ 89 kg, body mass index(BMI) of 22 ~ 26 kg/m2. Randomly divided into 5 groups, 20 cases in each group. A group of 0.4% ropivacaine 40 ml plus dexamethasone 0.2mg/kg, intravenous injection of normal saline(NS); B group of 0.4% ropivacaine 40 ml plus dexamethasone 0.15mg/kg, intravenous injection of normal saline(NS); C group of 0.4% ropivacaine 40 ml plus dexamethasone 0.1mg/kg, intravenous injection of normal saline(NS); group D, 40 ml ropivacaine 0.4% with NS 1ml, intravenous injection of dexamethasone 0.15mg/kg; group E, 40 ml ropivacaine 0.4% with NS 1ml, intravenous injection of normal saline(NS) 1ml.2、Anesthesia methods: all the patients were using a nerve stimulator, 2mm or so for the puncture point, in axillary artery pulsatility most obvious, to have the corresponding nerve stimulation symptoms, suck back without blood, slow injection of narcotic drugs, a total of 40 ml. The movement is gentle, avoid the damage of vessels and nerves, and observe the patient was reaction. Block operations to complete 40 min after the start of operation. To assess the degree of pain with homemade blunt needle, observed and recorded with different doses of dexamethasone in 0.4% ropivacaine in brachial plexus axillary nerve block in the sensory block onset time, completely painless time, motor block time, sensory recovery time and total recovery time, record the anesthesia effect evaluation, satisfaction and operation doctor patient satisfaction, record group 5 after 24 hours of adverse reactions(such as drowsiness, nausea, vomiting, skin itching, respiratory inhibition).Part two: Effects of different doses of methylprednisolone on ropivacaine for brachial plexus block anesthesia:1、The object of study: elective upper limb fracture operation 100 patients as experimental group, aged 22 to 67 years old, ASA grade I ~ II, body weight 48 ~ 89 kg, body mass index(BMI) of 22 ~ 26 kg/m2. Randomly divided into 5 groups, 20 cases in each group. Group A plus methylprednisolone 1mg/kg of 0.4% ropivacaine 40 ml, intravenous injection of normal saline(NS); group B plus methylprednisolone 0.75mg/kg of 0.4% ropivacaine 40 ml, intravenous injection of normal saline(NS); group C plus methylprednisolone 0.5mg/kg of 0.4% ropivacaine 40 ml, intravenous injection of normal saline(NS); D group 0.4% ropivacaine 40 ml plus NS 1ml, intravenous methylprednisolone 0.75mg/kg; group E, 40 ml ropivacaine 0.4% with NS 1ml, intravenous injection of normal saline(NS) 1ml.2、Anesthesia methods: all the patients were using a nerve stimulator, 2mm or so for the puncture point, in axillary artery pulsatility most obvious, to have the corresponding nerve stimulation symptoms, suck back without blood, slow injection of narcotic drugs, a total of 40 ml. The movement is gentle, avoid the damage of vessels and nerves, and observe the patient was reaction. Block operations to complete 40 min after the start of operation. To assess the degree of pain with homemade blunt needle, observed and recorded the presence of different dose of methylprednisolone in 0.4% ropivacaine in brachial plexus of axillary nerve block in the sensory block onset time, completely painless time, motor block time, feel the recovery time and recovery time, record the anesthesia effect evaluation, satisfaction and operation doctor patient satisfaction, the 5 groups were recorded after 24 hours of adverse reactions(such as drowsiness, nausea, vomiting, skin itching, respiratory inhibition). Results:1、The five group of dexamethasone in A group than in C group, the onset time is short, long maintenance time, good effect of anesthesia. B group than in C group, the onset time is short, long maintenance time, good effect of anesthesia. A group than in B group had no significant difference. Three groups of dose of dexamethasone added 0.4% ropivacaine group compared with the intravenous group anesthesia onset time is shortened, the maintenance time is lengthened, anesthesia effect in improving the. Dexamethasone added to the local group the nerve block monitoring index was significantly stronger in intravenous injection group, the D group than in E group, the onset time is short, long maintenance time, good effect of anesthesia.2、Five groups of methylprednisolone, three groups of dose methylprednisolone were added 0.4% ropivacaine for axillary brachial plexus anesthesia with intravenous injection of sensory motor block onset time speeds up, maintain time prolonged, anesthesia effect in improving the. A group, B group and C group between sensory motor block onset time, duration, anesthesia effect with no statistical difference(P > 0.05). D group than in E group, the onset time is short, long maintenance time, good effect of anesthesia. Conclusion:1、Add 0.4% ropivacaine for axillary brachial plexus block in a certain dose of dexamethasone with intravenous injection of dexamethasone can make the onset time of anesthesia shortens maintenance time prolonged, the anesthetic effect, improve. And brachial plexus block monitoring index does not increase with dexamethasone dose and linear increase. This study shows that the 0.15mg/kg effect of dexamethasone in 0.4% ropivacaine for axillary brachial plexus block optimal, recommended for use in clinical work.2、Add a strong dragon is in intravenous injection of methylprednisolone in 0.4% ropivacaine for axillary brachial plexus block, axillary brachial plexus block onset time is short, long maintenance time, improve the effect of block. High dose of methylprednisolone and lower doses of methylprednisolone had no significant differences on 0.4% ropivacaine for axillary brachial plexus block anesthesia effect.