The application of combining low dose naloxone with ropivacaine in supraclavicular brachial plexus block

Abstract

Objective: To observe the effect of low dose naloxone combinewith ropivacaine for supraclavicular brachial plexus block. Methods: Seventy patients undergoing elective upper limb surgery were randomly divided into two groups, ropivacaine group (Group R, n=35) and naloxone group (Group N, n=35). An ultrasound guided technique was used in both two groups.The onset and duration time of sensory and motor blockade, visual analog score(VAS)of 3, 6, 12, 18, 24 h postoperatively, time of first request fordezocine, total amount of dezocine needed, incidence of nausea and vomiting postoperatively(PONV) and patients' satisfaction score for analgesia in 24 h after surgery were measured.At the same time, blood samples were taken before anesthesia, 6 h, 24 h after operation for inspecting the concentration of β-endorphin(β-EP)in plasma. Results: The duration of sensory and motor blockade, time of first request for dezocine in Group N were 736.0(713.5, 836.5), 514.5(491.3, 572.8), 708.5(683.2, 877.0)min, which were all prolonged compared to Group R(522.0(469.5, 606.5), 401.0(370.0, 458.5), 570.0(435.0, 618.5)min)(Z=-6.844, -6.758, -6.700, all P<0.01). The 6, 12, 18 h postoperatively VAS of Group N were 0, 5.0(3.0, 5.8), 5.0(5.0, 6.0)point. Among which the 6, 12 h postoperatively VAS of Group N were lower than that of Group R(1.0(1.0, 3.5), 6.0(6.0, 7.0)point)(Z=-6.596, -4.864, all P<0.01), while the 18 h postoperatively VAS was higher than that of Group R (5.0(4.0, 5.0)point)(Z=-2.603, P<0.01). Total amount of dezocine needed in Group N in 24 h after surgery was 7.5(5.0, 10.0)mg, which was lower than that of Group R(10.0(10.0, 15.0)mg)(Z=-3.449, P<0.01). The incidence of PONV after surgery in Group N was 21.9%, which was lower than that of Group R(45.5%)(χ(2)=4.034, P<0.05). Ptients' satisfaction score for analgesia in 24 h after surgery in Group N was 8.0(7.0, 8.0)point, which was higher than that of Group R(7.0(6.0, 7.0)point)(Z=-3.509, P<0.01). At 6 h postoperatively , the concentration of plasma β-EP in Group N was(113.34±12.36)μg/L, lower than that of Group R((147.14±11.65)μg/L)(t=-7.694, P<0.01). Conclusion: Low dose naloxone combine with ropivacaine for supraclavicular brachial plexus block, prolong the duration of sensory and motor blockade without affecting the onset time.