The Influence Of Different Adjuvant Drug Efficacy Of The Brachial Plexus Block

Objective To compare the influence of normal saline,50 ug fentanyl,0.75 ug/kg dexmedetomidine,5 mg dexamethasone respectively mixed with 0.4%ropivacaine on patients' hemodynamics,Ramsay score,sensory and motor block working time,sensory and motor block of time when ultrasound-guided combined nerve stimulator in interscalene brachial plexus block.Methods Selected 120 patients with elective forearm surgery with the operation time is less than 3 hours,ASA ???,aged 18?70 years and body mass index of 18.5?28 kg/m2,excluded with experimental contraindications.According to random number table method,it can be divided into group A,group B,group C and groupD.each group 30 cases.Group A was given 0.4%ropivacaine 30 ml.group B was given 0.4%ropivacaine with 50 ug fentanyl 30ml,group C was given 0.4%ropivacaine with 0.75 ug/kg dexmedetomidine 30ml,group D was given 0.4%ropivacaine with 5 mg dexamethasone 30ml.In ultrasound-guided combined nerve stimulator in interscalene brachial plexus block.under the ultrasonic visual setted the frequency of the stimulation of nerve stimulator to 1-2 hz.current 0.8 MA.using 22 G?50 mm long needle nerve block for brachial plexus block.Using the short axis plane piercing technology.in the ultrasonic probe side 1?2 mm as entry point respectively to block the roots of brachial plexus from deep to shallow.When there is a typical target muscle contraction change current of the nerve stimulator down to below 0.4 MA,slightly back needle to the target muscle contraction just disappear,then a little a little to the needles are inserted just target muscle contraction.injected of local anesthetics ahead of nerve trunk proximal under the ultrasound to look straightly,again injected local anesthetics in neural imagery of distal side of neural imagery.Every nerve root injected medicine in the same way,completed in turn three nerve roots of brachial plexus block.To achieve a satisfactory brachial plexus block is that brachial plexus three roots completely surrounding by local anesthetics form the so-called "donut" under ultrasonic visual observation.Recorded respectively in group A,group B,group C,group D before nerve block(T0),nerve block after the completion of the 5 min(T1),nerve block after the completion of the 15 min(T2),nerve block after the completion of 30 min(T3),mean arterial pressure(MAP),heart rate(HR),pulse oxygen saturation(SpO2),Ramsay score;sensory nerve block working time,motor nerve block work time,time of sensory nerve block,time of motor nerve block.Record the age,gender,height,weight of patients in four groups.Result(1)Group A,Group B,Group C and Group D patients with gender,age,height,weight and other general situation is no statistical difference(P>0.05).T0,T1,T2,T3 four time point of the MAP,HR,SpO2 compare is no statistical difference(P>0.05).(2)Group C in T2,T3 time points compared with T0,the difference of heart rate,Ramsay score was statistically significant(P<0.05).(3)B,C,D three groups compared with group A,the difference of sensory and motor nerve block working time,sensory and motor nerve block time was statistically significant(P<0.05),in group C the time of sensory and motor nerve block working time is obviously shorter than group B?groupD,the difference was statistically significant(P<0.05);in group C and group D the time of sensory and motor nerve block is obviously longer than group B,the difference was statistically significant(P<0.05).Conclusion(1)50 ug fentanyl,0.75 ug/kg dexmedetomidine,5 mg dexamethasone respectively mixed with 0.4%ropivacaine can prolong the time of sensory and motor block of brachial plexus,dexmedetomidine and dexamethasone are more apparent when ultrasound-guided combined nerve stimulator in interscalene brachial plexus block.(2)50 ug fentanyl,0.75 ug/kg dexmedetomidine,5 mg dexamethasone respectively mixed with 0.4%ropivacaine can obviously shorten the time of start effect of sensory and motor nerve block when ultrasound-guided combined nerve stimulator in interscalene brachial plexus block.Dexmedetomidine has a central sedation,can alleviate the tension,anxiety of patients,reduce the patients fear of surgery and stress reaction.