The Optimal Dose of Butorphanol Combined with Ropivacaine for Supraclavicular Brachial Plexus Block in Patients Undergoing Upper Limb Fracture Surgery: A Randomized, Double-Blind, Controlled Clinical Trial.

内容摘要

The aim of this study was to determine the optimal dose of butorphanol combined with ropivacaine for supraclavicular brachial plexus block in patients undergoing upper limb fracture surgery. A total of 100 patients were randomly divided into five groups at a ratio of 1:1:1:1:1 to receive normal saline combined with 0.375% ropivacaine (NS group), 10&#xa0;&#x3bc;g/kg (B10 group), 20&#xa0;&#x3bc;g/kg (B20 group), 30&#xa0;&#x3bc;g/kg (B30 group), and 40&#xa0;&#x3bc;g/kg (B40 group) butorphanol combined with 0.375% ropivacaine for supraclavicular brachial plexus block with a volume of 20 mL under ultrasound guided, and intraoperative moderate sedation with target-controlled infusion (TCI) of propofol. The primary outcome was the onset time of sensory block, and the secondary outcomes were the onset time of motor block, duration of sensory and motor block, VAS scores at 30&#xa0;minutes before surgery, 3&#xa0;h, 8&#xa0;h, 24&#xa0;h, 48&#xa0;h, and 72&#xa0;h after surgery, QoR-15 scores at 1st, 2nd, and 3rd day after surgery, the time of first use of analgesic drugs after surgery, the intraoperative sedative dose of propofol, analgesic dose of dezocine within 72&#xa0;hours after surgery, patient satisfaction, and adverse events. Compared to the NS group, the duration of sensory (352.7 &#xb1; 33.1 min vs 512.8 &#xb1; 36.2 min, and 538.7 &#xb1; 42.3 min) and motor blockade (307.6 &#xb1; 24.7 min vs 388.5 &#xb1; 37.8 min and 429.8 &#xb1; 36.9 min), time of first postoperative rescue analgesia (6.9 &#xb1; 0.6&#xa0;h vs 9.2 &#xb1; 0.5&#xa0;h, and 9.9 &#xb1; 0.7&#xa0;h), and patient satisfaction score (1.1 &#xb1; 1.0 vs 2.4 &#xb1; 1.0 and 2.6 &#xb1; 0.9) were increased more significantly, and the onset time of sensory (16.4 &#xb1; 2.4 min vs 9.8 &#xb1; 2.6 min and 9.1 &#xb1; 2.9 min) and motor blockade (22.1 &#xb1; 3.5 min vs 16.8 &#xb1; 2.9 min and 16.2 &#xb1; 3.7 min), postoperative rescue analgesic dose of dezocine (38.2 &#xb1; 7.1 mg vs 24.0 &#xb1; 6.4 mg and 22.0 &#xb1; 6.2 mg), and dose of propofol (386.8 &#xb1; 55.8 mg vs 283.2 &#xb1; 42.1 mg, and 266.6 &#xb1; 43.0 mg) for intraoperative moderate sedation were lower in the B30 group and B40 group (all P < 0.005). The nerve block characteristics in B30group and B40 group were comparable (all P > 0.05). The QoR-15 scores at postoperative 24&#xa0;h and 48&#xa0;h in the B40 group (141.0 &#xb1; 6.6 and 141.9 &#xb1; 6.1) were higher than that in the NS group (122.6 &#xb1; 7.6 and 123.9 &#xb1; 6.9), B10 group (125.0 &#xb1; 8.0 and 127.1 &#xb1; 6.1), and B20 group (132.0 &#xb1; 7.2 and 133.9 &#xb1; 7.4, all P < 0.005), and comparable to those in the B30 group (139.4 &#xb1; 6.3 and 141.2 &#xb1; 6.6, P = 0.469 and 0.759). There was no difference in the incidence of adverse events between groups. The optimal synergistic dose of butorphanol combined with ropivacaine for supraclavicular brachial plexus block under intraoperative moderate sedation with propofol was 30&#xa0;&#x3bc;g/kg, without increasing the incidence of adverse events.