文章摘要
利多卡因复合氢吗啡酮神经阻滞在全关节镜下踝关节手术中的应用
Application of peripheral nerve block using lidocaine and hydromorphone in ankle arthroscopic surgery
  
DOI：10.12089/jca.2022.12.005
中文关键词: 神经阻滞  利多卡因  氢吗啡酮  踝关节镜手术  术后加速康复
英文关键词: Nerve block  Lidocaine  Hydromorphone  Ankle arthroscopic surgery  Enhanced recovery after surgery
基金项目:徐州市科技项目（KC21055）；徐州医科大学附属医院发展基金（ZYFM2020005）
作者单位E-mail
王凯 221009,徐州医科大学徐州临床学院,徐州市中心医院麻醉科  
吴滢 221009,徐州医科大学徐州临床学院,徐州市中心医院麻醉科  
冯仕明 221009,徐州医科大学徐州临床学院,徐州市中心医院骨科  
王明玲 221009,徐州医科大学徐州临床学院,徐州市中心医院手术室  
张哲 221009,徐州医科大学徐州临床学院,徐州市中心医院麻醉科  
张旭 221009,徐州医科大学徐州临床学院,徐州市中心医院麻醉科  
王立伟 221009,徐州医科大学徐州临床学院,徐州市中心医院麻醉科 doctorlww@sina.com 
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中文摘要:
      
目的 探讨利多卡因复合氢吗啡酮神经阻滞在全关节镜下踝关节手术中的应用效果。
方法 选择行全关节镜下踝关节手术患者100例，男61例，女39例，年龄18～64岁，BMI 18.5~25.0 kg/m2，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为两组：2%利多卡因+氢吗啡酮组（LH组）和0.5%罗哌卡因组（R组），每组50例。两组均采用隐神经联合腘窝坐骨神经阻滞，LH组药物配方为氢吗啡酮2 ml（2 mg）+2%利多卡因20 ml共计22 ml，R组为0.5%罗哌卡因22 ml。记录神经感觉阻滞起效时间、持续时间、术后神经运动阻滞恢复情况、术后不良反应发生情况及患者满意情况。
结果 与R组比较，LH组神经感觉阻滞起效时间明显缩短，持续时间明显缩短（P<0.05）。与R组比较，LH组术后2、4、6 h胫神经、腓总神经运动恢复速度明显，患者术后满意度明显升高（P<0.05）。两组镇痛不全、局部血肿、恶心呕吐不良反应的发生率差异无统计学意义。
结论 与0.5%罗哌卡因比较，2%利多卡因复合氢吗啡酮用于隐神经联合坐骨神经阻滞用于全关节镜下踝关节手术，镇痛起效时间缩短，对术后肌力影响更小。
英文摘要:
      
Objective To evaluate the application of peripheral nerve block using lidocaine and hydromorphone in ankle arthroscopic surgery.
Methods A total of 100 patients who received ankle arthroscopy surgery, 61 males and 39 females, aged 18-64 years, BMI 18.5-25.0 kg/m2, ASA physical status Ⅰ or Ⅱ, were involved. All the patients were divided into two groups using randorn number table method: 2% lidocaine + hydromorphone group (group LH) and 0.5% ropivacaine group (group R), 50 patients in each group. Patients in both groups were treated with saphenous nerve and popliteal sciatic nerve block. The drug formulation in group LH was hydromorphone 2 ml (2 mg) + 2% lidocaine 20 ml totaling 22 ml, and 0.5% ropivacaine 22 ml in group R. The onset time, duration of sensory nerve block, postoperative motor nerve recovery rate, incidence of postoperative adverse events and patient's satisfaction were recorded.
Results Compared with group R, the onset time was faster and the duration was shorter in group LH (P < 0.05). The postoperative motor recovery of the tibial and common peroneal nerve were faster in group LH 2, 4, 6 hours after surgery (P < 0.05). Compared with group R, the satisfaction of patients was higher in group LH (P < 0.05). There were no significant differences in the incidence of adverse events, such as incomplete analgesia, local hematoma, nausea and vomiting.
Conclusion Compared with 0.5% ropivacaine, 2% lidocaine combined with hydromorphone can well used for saphenous and sciatic nerve block in ankle arthroscopic daytime surgery. It could be shortening the onset time of sensory block and reducing the motor block after surgery.
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