| Objective To investigate the influence of heart rate variability(HRV)of ultrasound with nerve stimulator-guided interscalene brachial plexus block(ISBPB).Methods 1、①45 patients scheduled for upper extremity surgery were randomized into group A,group B and group C,all patients were given ropivacaine,the concentrations were 0.375%40ml.0.5%30ml and 0.75%20ml.There were 25 patients in each group;②To compare the difference of HRV after left-block and right-block,80 patients scheduled for upper limb extremity surgery were randomized into 4 groups,20 patients in each group:group L1(0.5%ropivacaine 30ml,left-sided block),group R1(0.5%ropivacaine 30ml,right-sided block)and group L2(0.5%ropivacaine 20ml,left-sided block),group R2(0.5%ropivacaine 20ml,right-sided block),.2、All patients fasted for 6h,1mg midazolam were given after enter the anesthesia room and routine monitor Electrocardiogram(ECG),pulse oxygen saturation(SPO2)without oxygen,noninvasive blood pressure(BP).3、The parameter of HRV(LF、HF、LF/HF、SDNN、RMSSD、PNN50%)were monitored by 24hAmbulatory electrocardiogram(AECG)after the vital signs stable,and keep the anesthesia preparation room silence.4、The degree of sensory and motor block were evaluated and record 30min after ultrasound with nerve stimulator-guided ISBPB,all patients enter the operation room if anesthesia effect was perfect,fentanyl 0.05mg was given if anesthesia effect was not perfect 30min after ISBPB,if anesthesia effect was still not satisfied,change the way of anesthesia and the patient was knocked out from experiment.5、The degree and duration of sensory and motor block,the anesthetic effect and maintain time,the recovery time of motor block were evaluated and recorded 30min after drug injection,at the same time complications were observed especially Sinus Bradycardia(SB)and(or)Hypotension(HP).6、Statistical processing All data were analyzed using SPSS software version 17.0.patients’ general data,The parameter of HRV using single factor analysis of variance,compared the two of SNK-q test.Sensory blockade,motion blockade using Student’s t-test,complications after drug injection were count data,qualitative data were presented as numbers with percent,and were analyzed using row*column χ2 test.P<0.05 was considered had statistical significance.Results1、General data Comparison of gender,age,height,weight and HRV of seven groups(P>0.05).2、Nerve segments of nerve root blockade decreased of A、B and C groups 30min after drug injection(P<0.05).3、Compare group A with group B and C,the anesthetic effect and maintaining time had no significant difference 30min after drug injection(P>0.05),but the maintaining time of sensory and motion block decreased of A、B and C groups.4、There was a case in L2 and a case in R2 who was too nervous for operation,Parameter error was too high,so the HRV study was failed.LF in group B and group C were significantly decreased 30min after drug injection(P<0.05);SDNN in group B and PNN50 in group C were significantly decreased 30min after drug injection(P<0.05).Compare group L1 and group R1,the parameter of HRV had no significantly difference 30min after drug injection;Compare group L2 and R2,the parameter of HRV had no significantly difference 30min after drug injection.5、All patients among 7 groups had accorded to the original plan anesthesia,2,2,1 of patients with 0.05mg fentanyl in group A、B and C respectively;1,2,3,1 of patients with 0.05mg fentanyl in group L1、R1、L2and R2 respectively.There were no significant difference in complications of seven groups(P>0.05).Conclusion 0.75%ropivacaine 20ml,0.5%ropivacaine 30ml or 20ml and 0.375%ropivacaine 40ml all can obtain satisfactor anesthetic effect 30 min after ultrasound with nerve stimulated-guided interscalene brachial plexus block,the influence of HRV had difference in different concentrations of ropivacaine,along with the concentrations,the influence on HRV is greater.Whatever left-sided ISBPB or right-sided ISBPB,the influence on HRV had no significantly difference. |
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