| ObjectiveNerve blocks are currently widely used for perioperative analgesia in orthopedic surgery,and ropivacaine is the most commonly used long-acting local anesthetic.However,the duration of analgesia with a single injection of ropivacaine is mostly in 24 hours,and patients may experience pain at night that affects sleep quality.Studies have found that sufentanil has a better synergistic analgesic effect when applied as an adjuvant to brachial plexus nerve blocks.Erythrocyte-encapsulated drug could slow down the drug release with the advantages of prolonged drug half-life and good biocompatibility.Sufentanil,because of its high lipid solubility and small molecular weight,can act continuously with red blood cells as drug carriers.The aim of this study was to observe whether ropivacaine combineded with erythrocyte-coated sufentanil could improve the postoperative analgesic of brachial plexus nerve block.MethodsNinety patients,aged 18-65 years,with a body mass index(BMI)of 18.5-28kg/m2 and ASA class Ⅰ-Ⅱ,were selected for humeral and clavicular osteotomy and internal fixation under general anesthesia.The patients were randomly divided into control group(group C),ropivacaine compounded with sufentanil group(group S)and ropivacaine compounded with erythrocyte-coated sufentanil group(group R).Group C was prepared with 20ml of 0.375%ropivacaine,group S was prepared with 20ml of a mixture of 0.375%ropivacaine compounded with sufentanil 0.5ug/ml,group R was prepared with 0.375%ropivacaine.After the patients were admitted to the room,peripheral veins were catheterization,and ECG monitoring,finger pulse oxygen saturation and non-invasive blood pressure were monitored dynamically.After the patient’s baseline of vital signs were recorded,an ultrasound-guided interosseous plexus nerve block was performed by the same anesthesiologist,and the appropriate medication was administered.After the nerve block was completed the onset of sensory and motor block was recorded by another anesthesiologist.Thirty minutes after the block was completed,propofol 12mg/kg,fentanyl 3μg/kg,and cisatracurium 0.15mg/kg were given.After induction was completed,endotracheal intubation was performed,and anesthesia was maintained with propofol,remifentanil,cisatracurium phenylsulfonate,dexmedetomidine hydrochloride,and sevoflurane.Postoperatively,all patients were connected to intravenous self-administered analgesia(Patient controlled intravenous analgesia,PCIA).Mean arterial pressure(MAP)and heart rate(HR)were recorded before block,30min after block,and at the end of surgery in the three groups of subjects.The amount of intraoperative anesthetic drugs and the number of vasoactive drugs used were recorded.The onset time of sensory block(T1),onset time of motor block(T2),duration of sensory block(T3)and duration of motor block(T4)of the nerve block were recorded.Static VAS and dynamic VAS scores were recorded atlh,4h,12h,24h and 48h postoperatively using visual analogue scale(VAS).The time of the first postoperative analgesic pump press and the times of PCIA presses were recorded.Postoperative adverse reactions were recorded:dizziness,nausea,vomiting,skin pruritus and respiratory depression(RR<8beats/min).Results(1)Comparison of general information of patients in the three groups:There was no statistically significant difference between the three groups in terms of general information such as gender,age,BMI,ASA classification,type of surgery and duration of surgery between the groups(P>0.05).(2)Comparison of intraoperative drug use in the three groups:The intraoperative use of remifentanil was significantly reduced in groups S and R compared with group C(P<0.05),and there was no statistical difference between groups S and R(P>0.05).There was no statistical difference in the intraoperative propofol dosage,sevoflurane dosage and number of vasoactive drugs used in the three groups(P>0.05).(3)Comparison of mean arterial pressure and heart rate in three groups of patients at different intraoperative time points:For comparison between groups,there was no statistically significant difference in MAP and HR between the three groups of patients at the time of admission,at30min of block and at the end of surgery(P>0.05).Comparing within groups,MAP decreased at 30min of block and at the end of surgery in all three patients compared with that at the time of room admission,and the difference was statistically significant(P<0.05).The HR of the three groups of patients showed a decreasing trend at all time points,and the difference was statistically significant(P<0.05).The HR decreased after 30min of block in group S and group R compared with that at the time of admission,and the difference was statistically significant(P<0.05).(4)Comparison of the onset and duration of operative sensory and motor block in the three groups of patients:The differences in the onset time and duration of sensory and motor block in the three groups were not statistically significant(P>0.05).Compared with group C,the duration of sensory block was significantly longer in groups S and R,and the difference was statistically significant(P<0.05).Compared with group S,the duration of sensory block was significantly prolonged in group R,and the difference was statistically significant(P<0.05).(5)Comparison of static and dynamic VAS scores at different time points in the three groups of patients:There was no statistical difference between the static and dynamic VAS scores of patients in the three groups at 1h and 4h postoperatively(P>0.05).Compared with group C,static and dynamic VAS scores were significantly lower in groups S and R at 12h postoperatively(P<0.05);static and dynamic VAS scores were significantly lower in group R at 24h and 48h postoperatively(P<0.05).Compared with group S,dynamic VAS scores were significantly lower in group R at 12h postoperatively(P<0.05);static and dynamic VAS scores were significantly lower in group R at 24h postoperatively(P<0.05);static and dynamic VAS scores were not statistically different in group R at 48h postoperatively(P>0.0 5).(6)Comparison of postoperative analgesic pump use in the three groups:Compared with group C,the first press of the analgesic pump was later(P<0.05)and the number of presses was less(P<0.05)in groups S and R.Compared with group S,the first press of the analgesic pump in group R was later(P<0.05)and the number of presses was less(P<0.05).(7)Comparison of the incidence of adverse reactions among the three groups of patients:There was no significant difference in the incidence of adverse reactions such as postoperative dizziness,nausea,vomiting,skin pruritus,respiratory depression,and neurotoxicity among the three groups(P>0.05).Conclusion1.Erythrocyte-coated sufentanil as a local anesthetic adjuvant prolongs the duration of sensory blockade and duration of analgesia in interosseous groove brachial plexus nerve blocks,reduces intraoperative and postoperative opioid use,and decreases postoperative pain levels in patients.2.Erythrocyte-coated sufentanil as a local anesthetic adjuvant applied to interosseous groove brachial plexus nerve block has less effect on intraoperative hemodynamics,does not increase the incidence of postoperative adverse reactions,and has a high clinical safety. |
