| Objectives The aim of this study is to evaluate the effects of intravenously using a certain amount of butorphanol and dexamethasone before ropivacaine axillary brachial plexus block on postoperative analgesia,motor block,and other anesthesia relative aspects.Methods In this study,120 patients who underwent hand surgery,and ASA grade I-II were randomly divided into three groups: group B,group C and group D,40 patients in every group.Record the amount of patients with uncomplete block,which could not have surgery,as fail block,and this part of people were only used in the analysis of successful nerve block rate.Exclude the patients who were lost or have special situation,such as more than one surgery within 24 h,from this study.Finally,102 patients were included in this study: group B had 33 patients,group C had 35 patients and group D had 34 patients.10 minutes before brachial plexus block,all patients began to receive intravenous medicine: Group B: slowly injected 5 ml butorphanol-normal saline diluent（butorphanol 0.8 mg）in 1 minute,then started butorphanol-normal saline diluent infusion at the speed of 4 ml/h（0.2 mg/h）;Group C: slowly injected 5 ml normal saline in 1 minute,then started normal saline infusion at the speed of 4 ml/h;Group D: slowly injected 5 ml dexamethasone-normal saline diluent（dexamethasone 8 mg）in 1 minute,then started dexamethasone-normal saline diluent infusion at the speed of 4 ml/h（1mg/h）.10 minutes later,three groups all received ultrasound-guided axillary brachial plexus nerve block,to completely block median nerve,radial nerve,ulnar nerve,by the same anesthesia doctor with 0.5 % ropivacaine 40 ml.The sign of stop medicine infusion: uncomfortable feelings of patient,the finish of surgery,more than 5 hours of surgery time,and the score of Ramsay surpassed 4.Record the amount of fail nerve block,the onset time of sensory block（T1）,the time of duration of sensory block（T2）,the time of duration of hand motor block（T3）,and the rate of intraoperative ideal sedation（the Ramsay score reach 3-4）.The score of rest disturbance degree within 24 hours after nerve block,the MBS and the VAS score at 4 h、6 h、8 h 、10 h 、12 h、24 h after sensory block,and the occurrence of adverse reactions within 24 h after nerve block were all recorded.Results1.The onset time（T1）:group B 15.00（12.50,17.50）min,group C 14.50（10.00,18.75）min,and group D 12.00（9.00,17.00）min,there was no significant difference among three groups（P>0.05）.The success rate of nerve block: group B87.88 %,group C 80.00 %,and group D 97.06 %,there are no significant difference among three groups（P>0.05）.2.The duration of sensory block（T2）: group B 652.88 ± 336.51 min,group C646.86±187.91 min,and group D 1021.30±291.62 min.T2 in group D was the longest among three groups,and the difference was statistically significant（P<0.05）,but there was no difference between group B and group C（P>0.05）;3.The rate of intraoperative ideal sedation: group B 72.41 %、group C 42.86 %、and group D 48.48 %.The rate in group B was the highest among three groups,and the difference was statistically significant（P<0.05）,but there was no difference between group C and group D（P>0.05）;4.During 4-24 h after nerve block,there was no significant difference of the VAS score between group B and group C（P>0.05）.During 8-12 h after nerve block,the VAS score of group D was significantly lower than group C（P<0.05）.There was no statistically difference in the VAS score between group D and group C at 24 h after nerve block（P>0.05）.During 4-24 h after nerve block,there was no significant difference of the MBS score between group B and group C（P>0.05）.The MBS score of group D was significantly lower than group C at 8 h and 12 h after nerve block（P<0.05）.During 10-24 h after nerve block,the MBS score of group D was significantly lower than group B（P<0.05）.Conclusion Under the condition of this study,intravenously using a certain amount of dexamethasone,10 minutes before nerve block,could prolong the duration of sensory block（the degree could approximately get 158 %）,strengthen the effect of postoperative analgesia,and lower the incidence of adverse reaction and the score of rest disturbance degree within 24 hours after anesthesia.However,it also prolong the duration of motor block（the degree could approximately get 147 %）;butorphanol has little assistant effect on block maintenance,but it could significantly raise the rate of intraoperative ideal sedation（the degree could approximately get 169 %）. |
