目的 探究右美托咪定对腋路臂丛神经阻滞联合肩胛上神经阻滞患者术后反弹性疼痛的影响。方法 收录2024年9月—2025年10月期间我院接受肩关节镜手术治疗的患者，合计收录样本量为150例，将患者随机分为两组（n=150）：常规腋路臂丛神经阻滞联合肩胛上神经阻滞组（N组，n=75）、复合右美托咪定的腋路臂丛神经阻滞联合肩胛上神经阻滞组（D组，n=75）；评价组间反弹性疼痛、术后恢复情况及应急指标差异。结果 术后2 h、6 h、12 h、24 h疼痛视觉模拟量表（VAS）评分D组较N组更低（P＜0.05）。反弹性疼痛发生率D组（5.33%）较N组（20.00%）更低，首次发作时间D组较N组更迟，持续时间D组较N组更短（P＜0.05）。术后补救镇痛次数、阿片类药物用量、非甾体药物使用率D组较N组更低（P＜0.05）。术后首次下床时间和住院时长D组较N组更短，满意度评分D组较N组更高（P＜0.05）。不良反应发生率D组与N组比较，差异无统计学意义（P＞0.05）。术前组间应激反应指标未见明显差异，术后24 h两组均有不同程度的指标变化，但相较N组而言，D组心率、平均动脉压、收缩压、舒张压变化幅度更小（P＜0.05）。结论 右美托咪定用于腋路臂丛神经阻滞联合肩胛上神经阻滞患者，在降低术后疼痛程度及反弹性疼痛发生率、促进术后康复进程有显著价值，对术后不良反应发生率及应激反应的影响较小。

       Objective To explore the effect of dexmedetomidine on postoperative rebound pain in patients with axillary brachial plexus block combined with suprascapular nerve block．Methods From September 2024 to October 2025，150 patients who underwent arthroscopic surgery in our hospital were randomly divided into two groups（n=150）：conventional axillary brachial plexus block combined with suprascapular nerve block group（N group，n=75） and axillary brachial plexus block combined with dexmedetomidine group（D group，n=75）．The differences of rebound pain，postoperative recovery and emergency indicators between groups were evaluated．Results The pain scores at 2 hours，6 hours，12 hours and 24 hours after operation in group D were lower than those in group N（P＜0.05）．The incidence of rebound pain in group D（5.33%） was lower than that in group N（20.00%），the first attack time in group D was later and the duration in group D was shorter than those in group N（P＜0.05）．The times of postoperative salvage analgesia，the dosage of opioids and the utilization rate of non-steroidal drugs in group D were lower than those in group N（P＜0.05）．The time of getting out of bed for the first time and the length of hospitalization in group D were shorter than those in group N，and the satisfaction score in group D was higher than that in group N（P＜0.05）．There was no significant difference in the incidence of adverse reactions between group D and group N（P＞0.05）．There was no significant difference in stress response indexes between groups before operation，and the indexes of both groups changed in different degrees 24 hours after operation，but compared with group N，the changes of heart rate，mean arterial pressure，systolic pressure and diastolic pressure in group D were smaller（P＜0.05）．Conclusions Dexmedetomidine used in axillary brachial plexus block combined with suprascapular nerve block has significant value in reducing postoperative pain and incidence of rebound pain，promoting postoperative rehabilitation process，and has little effect on postoperative adverse reactions and stress response．

目的 探讨臂丛神经阻滞和关节腔内注射局麻药联合应用在肩关节镜手术中的应用价值。方法 对肩关节镜手术患者100例进行研究,2018年8月—2020年8月入组,根据随机数字表法分组处理,对照组和观察组各为50例,前者用臂丛神经阻滞,后者与关节腔内注射局麻药联合,比较2组麻醉效果、不同阶段疼痛程度、肩关节功能。另对比2组不良反应。结果 观察组麻醉起效时间、苏醒时间和拔管时间分别为(10.72±2.45)min、(8.21±1.32)min和(9.52±1.12)min,与对照组对应指标有差异(P<0.05);2组术前疼痛程度和肩关节功能对比无差异(P>0.05),观察组术后6 h、术后24 h和术后48 h疼痛评分依次为(1.31±0.27)分、(2.87±0.52)分和(3.44±0.42)分,术后6 h、术后12 h、术后24 h和术后48 h镇静评分分别为(2.92±0.32)分、(2.54±0.24)分、(2.38±0.12)分和(2.27±0.15)分,术后1周、1个月和3个月的肩关节功能评分分别为(50.12±4.54)分、(56.18±4.12)分和(73.16±4.78)分,较之于对照组有差异(P<0.05);对照组和观察组出现不良反应的概率分别为18.00%和4.00%(P<0.05)。 结论 在肩关节镜手术中联合应用臂丛神经阻滞联合关节腔内注射局麻药麻醉方式,可提高麻醉效果,术后镇痛和镇静效果明显,也可减少不良反应,对患者肩关节功能改善作用明显,存在广泛应用价值。

目的 观察右美托咪定作为佐剂对罗哌卡因在锁骨上入路臂丛神经阻滞效果的影响。方法 将55例上肢择期手术的受试者随机分为右美组和对照组。右美组:30 μg右美托咪定(0.3 mL)＋0.5%罗哌卡因,对照组:生理盐水(0.3 mL)＋0.5%罗哌卡因。在臂丛神经阻滞操作后,按步骤评估和记录臂丛感觉、运动阻滞程度和起效时间。在术中定期监测和记录生命体征、不良事件的发生。手术后评估和记录术毕24小时生命体征、术后镇痛时间、臂丛神经感觉、运动阻滞的持续时间、术后恶心呕吐评分、补救镇痛药物用量和不良事件等数据。结果 在臂丛神经的感觉和运动起效时间、感觉和运动阻滞持续时间、术后镇痛时间方面,右美组长于对照组,存在统计学差异(P<0.05)。两组间在术后生命体征变化、补救镇痛药物用量、术后恶心呕吐评分、不良事件等数据的比较,未见明显统计学差异(P>0.05)。结论 右美托咪定(30 μg)作为佐剂能加快罗哌卡因在锁骨上入路对臂丛神经阻滞的起效时间,增加其术后镇痛时间和对臂丛神经的感觉、运动阻滞时间,同时较少影响患者生命体征,具备一定的有效性和临床安全性。

Objective To observed the effect of dexmedetomidine as an adjunction with ropivacaine in supraclavicularbrachial plexus block. Methods 55 subjects with elective upper extremity operation were randomly divided into two groups: DEX group and control group. The drugs in DEX group was 30 μg dexmedetomidine (0.3 mL) + 0.5% ropivacaine, 20 mL in total. And the one in control group was normal saline (0.3 mL) +0.5% ropivacaine, 20 mL in total. After the operation of brachial plexus block, the value of sensory and motor block of brachial plexus and the onset time were evaluated and recorded according to the protocol. Vital signs and adverse events were monitored and recorded regularly during the operation.Postoperative vital signs, postoperative analgesia time, duration of brachial plexus sensationsensory and motion block, postoperative nausea and vomiting score, dosage of remedial analgesics and adverse events were assessed and recorded in 24 hours after surgery. Results In terms of sensory and motor onset time of brachial plexus, duration of sensory and motor block and postoperative analgesia, DEX group was longer than the control group, with statistical differences (P<0.05).There were no significant statistical differences between the two groups in postoperative vital signs, the amount of remedial analgesic drugs, postoperative nausea and vomiting scores, adverse events etc(P>0.05). Conclusion As an adjuvant, dexmedetomidine (30 μg) can accelerate the onset time of ropivacaine in the supraclavicular approach of brachial plexus block.It can also increase the postoperative analgesia time and sensory and motor block time of brachial plexus.With less impact on the vital signs of patients, the efficacy and clinical safety of dexmedetomidinecan be found in our study.