Effects And Its Reasonable Dose Combining Ropivacaine With Dezocine On Axillary Brachial Plexus Block

Objective: compare the clinical efficacy and safety of different doses dezocine combined with 0.375% ropivacaine on axillary brachial plexus block. To investigate the reasonable dose combining 0.375% ropivacaine with dezocine on axillary brachial plexus block.Method: This test is a randomized double-blind experiment design. Select 80 cases of plans for forearm or hand surgery patients, ASA grade ? ~ ?. According to the random number method is divided into four groups on average. All the patients with axillary brachial plexus block anesthesia. Group A for the control group, was given blocking drug 0.375% ropivacaine 32ml; group B?group C and group D were given blocking drug 0.375% ropivacaine mixed different doses dezocine for 0.05mg/kg?0.1mg/kg and 0.2mg/kg, a total of 32 ml. All patients were intramuscular injection diazepam 10 mg and atropine 0.5mg in 30 minutes before operation. Patients were intravenous lactated Ringer's solution after entering the operating room. Monitoring blood pressure(BP)?heart rate(HR)?pulse oxygen saturation(Sp O2)?respiratory rate(RR)?electrocardiogram(ECG). Blocking drugs were pre-configured by assistant. Mask oxygen inhalation(5L/min). Patients were undertoken for two points method of brachial plexus block anesthesia with axillary approach assisted by nerve stimulator. Routine disinfect skin,use a local anesthetic with 1% lidocaine 0.5ml at the puncture site,connected to the nerve stimulator with the help of the assistant and adjusted the stimulus output current to 0.5m A?1Hz?0.1ms as the guide stimulus. Find the musculocutaneous nerve, median nerve, radial nerve and ulnar nerve used 5cm, 22 G peripheral nerve plexus puncture needle and injected into the pre-configured local anesthetics 8ml respectively. If anesthesia block incompleted during the operation, local additional injected 1% lidocaine 5-10 ml, or intravenous fentanyl 0.1mg; if anesthesia block does not effective, shifted to general anesthesia. All patients were recorded HR, MAP, Sp O2, RR and the Ramsay score at after entering operating room before the anesthesia(T0), after anesthesia(T1), beginning of the operation(T2), the end of surgery(T3). Assessed the effect of sensory and motor block in sensory area and motor area in 30 minutes after the block?every 2 minutes intervals repeat after the injection. Record the onset time of sensory and motor nerve block?time of completely sensory nerve block?motor recovery time. Record the number of anesthesia block incomplete and shift to general anesthesia in operation, and evaluation of clinical anesthesia satisfaction. Records the VAS score at 30 min, 1H, 2h, 4h, 8h, 12 h, 24 h after operation respectively; observes the complication of axillary nerve block and adverse reactions of opioids.Result:(1) Vital signs during anesthesia: 1) Compared with group A: the HR was significant decrease on the time point T2 and T3 in group D; the HR was no significant different in other groups on all time points. 2) During anesthesia, the MAP, Sp O2 and RR were no significant different among four groups on all time points.(2) The Ramsay scores: Compared with group A: the scores was significant increase among other three groups on the time point T2 and T3. Compared with group B, the scores were significant increase on the time point T2 and T3 in group C and D. Compared with group C, the score on time point T2 was significant increase in group D, the scores in other time point was no significant different.(3) The effect of sensory and motor block: 1) Compared with group A: the onset time of sensory block group B was slightly reduced, the onset and complete time were significant reduced in group C and D. Compared with group B: the onset and complete time of sensory block was significant reduced in group C and D. There was no significant different between group C and D. 2) The onset and recovery time of motor block was no significant different among four groups.(4) Compared with group A, the incidence of incomplete block were significant lower in group B, group C and group D; the degree of clinical satisfaction was higher in group B, C and D. Compared with group B, the incidence of incomplete block were significant lower in group C and D; the degree of clinical satisfaction was higher in group C and D. There was no significant different between group C and D.(5) The VAS scores: 1) Compared with group A: The VAS score in other three groups at 2, 4,8and 12 h post-operatively were significant lower. Compared with group B, the score in group C and D was significant lower at 2,4,8,12 h post-operatively. There was no significant different between group C and D.(6) Adverse reaction: Compared with group C, the cases of nausea vomiting and dizziness were significant more in group D(P<0.05).Conclusion:(1) Dezocine combined with ropivacaine for axillary brachial plexus bloce can enhance the anesthetic effects; the clinical application is safe and effective.(2) 0.1mg/kg dezocine combined with 0.375% ropivacaine 32 ml on axillary brachial plexus block has the shorten onset time of the sensory block, the longer-lasting time of the postoperative analgesia, less adverse reactions, and higher clinical anesthesia satisfaction. It is a reasonable dose of clinical.