纳布啡作为布比卡因佐剂用于经超声引导下锁骨上神经阻滞的镇痛效果评价
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Randomized Controlled Trial for Evaluating the Analgesic Effect of Nalbuphine as an Adjuvant to Bupivacaine in Supraclavicular Block under Ultrasound Guidance
背景与目的：通过向局麻药中添加佐剂可以延长局部麻醉的疗效。本试验旨在研究经超声引导下将纳布啡加入布比卡因用于锁骨上臂丛神经阻滞的疗效。
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方法：这是一项前瞻性，随机，双盲研究，纳入60名需行上肢选择性骨科手术的性别无差别患者。对照组和研究组均为经超声引导下行锁骨上神经阻滞，对照组C（n = 30）中，使用30mL 0.375％布比卡因+ 1mL生理盐水，研究组N（n = 30），使用30mL 0.375％布比卡因+ 1mL（10mg）纳布啡。观察指标为感觉和运动阻滞的起效时间、持续时间，镇痛持续时间（DOA）和任何不良反应。对各组之间的数据采用SPSS 16.0软件进行独立t检验分析。
结果：在研究组中，有统计学意义的感觉阻滞起效时间缩短（4.89±1.5对14.62±1.73分钟，P = 0.000），感觉阻滞持续时间延长（373.17±15.56分钟对比157.82±11.02分钟，P = 0.000），实现运动阻滞的起效时间缩短（8.83±1.9 min vs. 18.76±1.75 min，P = 0.000），运动阻滞持续时间和长期镇痛时间延长（313.92±16.22 min vs. 121.87±16.62 min，P = 0.000），（389.33±14.52分钟对比171.65±19.79分钟，P = 0.000）。
结论：当纳布啡作为布比卡因的佐剂用于锁骨上神经阻滞术中时，明显缩短了感觉和运动阻滞的起效时间，并延长了感觉和运动阻滞以及DOA的持续时间。
BACKGROUND:Benefits of regional anesthesia can be prolonged by adding adjuvants to local anesthetics. This study was designed to test the efficacy of adding nalbuphine to bupivacaine in supraclavicular brachial plexus blockade using ultrasound (US) guidance.
METHODS:This was a prospective, randomized, double.blin d study involving sixty patients of either sex undergoing elective orthopedic procedures of upper limb. In control Group C (n = 30), 30 mL of 0.375% bupivacaine + 1 mL normal saline and in study Group N (n = 30), 30 mL of 0.375% bupivacaine + 1 mL (10 mg) nalbuphine were used for giving supraclavicular block under US guidance. Parameters assessed were onset and duration of sensory and motor block, duration of analgesia (DOA), and any adverse events. Data between the groups were analyzed using independent t.test with SPSS 16.0 software.
RESULTS:In Group N, there was a statistically significant shorter time to onset of sensory blockade (4.89 ± 1.5 vs. 14.62 ± 1.73 min, P = 0.000), longer duration of sensory block (373.17 ± 15.56 min vs. 157.82 ± 11.02 min, P = 0.000),shorter onset time to achieve motor block (8.83 ± 1.9 min vs. 18.76 ± 1.75 min, P = 0.000), longer duration of motor block (313.92 ± 16.22 min vs. 121.87 ± 16.62 min, P = 0.000), and prolonged analgesia (389.33 ± 14.52 min vs. 171.65 ± 19.79 min, P = 0.000).
CONCLUSIONS:Nalbuphine when added to bupivacaine as an adjuvant in supraclavicular block significantly shortened the onset of sensory and motor block and enhanced the duration of sensory and motor block and DOA.
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