Nghiên cứu hiệu quả của gây tê đám rối thần kinh cánh tay đường trên đòn bằng Levobupivacain 0,5% so với 0,375% dưới hướng dẫn siêu âm trong phẫu thuật chi trên
Authors: Trần Thịnh 
Published: May 2023

Đặt vấn đề: Các phẫu thuật vùng chi trên là loại phẫu thuật rất hay gặp trong chấn thương. Có rất nhiều phương pháp phong bế đối với phẫu thuật này như gây mê toàn thân có đặt nội khí quản hoặc mask thanh quản, gây tê đám rối thần kinh cánh tay (ĐRTKCT). Gây tê ĐRTKCT có nhiều ưu điểm là vừa đảm bảo phong bế, vừa tránh các bất lợi của gây mê toàn thân, vừa giảm đau sau phẫu thuật. Trên thế giới, có nhiều nghiên cứu bệnh nhân gây tê ĐRTKCT bằng levobupivacain ở các nồng độ khác nhau như 0,375%, 0,5%, 0,75% với các thể tích thuốc tê khác nhau. Với mục đích là so sánh tác dụng của cùng một liều lượng nhưng khác nhau về nồng độ và thể tích của levobupivacain nhằm tìm một nồng độ thuốc tê levobupivacain thích hợp nhất trong gây tê ĐRTKCT.

Đối tượng, phương pháp: Nghiên cứu tiến cứu, ngẫu nhiên, có so sánh 100 bệnh nhân phẫu thuật chi trên từ 1/3 giữa xương cánh tay trở xuống, bằng phương pháp gây tê ĐRTKCT dưới hướng dẫn siêu âm kết hợp máy kích thích thần kinh cơ chia ngẫu nhiên thành hai nhóm. Nhóm I: gây tê với levobupivacain 0,5% liều lượng 2mg/kg. Nhóm II: gây tê với levobupivacain 0,375% liều lượng 2mg/kg. Theo dõi thời gian đạt ức chế cảm giác, đạt ức chế vận động, thời gian kéo dài cảm giác, vận động và giảm đau sau phẫu thuật. Theo dõi tần số tim, huyết áp, tần số thở, SpO2 và thang điểm VAS vào các thời điểm 0, 4, 8, 12, 16, 20, 24 giờ sau phẫu thuật, sự hài lòng của bệnh nhân và các tác dụng không mong muốn ở cả hai nhóm.

Kết quả: Tỷ lệ thành công gây tê ĐRTKCT ở hai nhóm là 100%. Thời gian đạt được ức chế cảm giác và ức chế vận động trung bình nhóm I (9,34 ± 1,61 và 12,94 ± 1,68) phút ngắn hơn so với nhóm II (14,48 ± 2,03 và 17,70 ± 1,73) phút. Thời gian ức chế vận động, ức chế cảm giác và giảm đau sau phẫu thuật của nhóm I (8,50 ± 0,87; 10,04 ± 1,09 và 11,64 ± 1,50) giờ ngắn hơn so với nhóm II (10,46 ± 1,16; 12,37 ± 1,24 và 14,22 ± 1,90) giờ. Tần số tim, huyết áp, tần số thở, SpO2 ở bệnh nhân thường ít biến đổi trong và sau phẫu thuật. Trong nghiên cứu của chúng tôi không có trường hợp nào xảy ra biến chứng ở cả hai nhóm.

Kết luận: Gây tê ĐRTKCT đường trên đòn dưới hướng dẫn siêu âm kết hợp máy kích thích thần kinh cơ, nhóm gây tê levobupivacain 0,5% hiệu quả tốt hơn nhóm gây tê levobupivacain 0,375% trong phẫu thuật.

ABSTRACT RESEARCH THE EFFECTS OF SUPRACLAVICULAR BRACHIAL PLEXUS ANESTHESIA BY LEVOBUPIVACAIN 0.5% VERSUS 0.375% GUIDED BY ULTRASOUND FOR UPPER LIMB SURGERY

Background: Upper extremity surgeries are very common in trauma. There are many methods of blocking for this surgery such as general anesthesia with intubation or laryngeal mask, intravenous anesthesia, brachial plexus anesthesia, intravenous anesthesia. Anesthesia of the brachial plexus has many advantages of both ensuring blockade, avoiding the disadvantages of general anesthesia, and reducing pain after surgery. In the world, there are many studies of patients anesthetizing brachial plexus with levobupivacaine in different concentrations such as 0.375%, 0.5%, 0.75% with different anesthetic volumes. The aim is to compare the effects of the same dosage but different in concentrations and volume of levobupivacaine in order to find the most appropriate concentration of levobupivacaine for brachial plexus anesthesia.

Methods: The prospective study, randomized, compared 100 patients who had upper limb surgery of 1/3 of the middle of the arm bone or less, using brachial plexus anesthesia under ultrasound guidance combined with stimulator neuromuscular were randomly divided into two groups. Group 1: anesthesia with levobupivacaine 0.5% dose 2mg/kg. Group 2: anesthesia with levobupivacaine 0.375% dose 2mg/kg. Monitor the time of achievement of sensory suppression, achievement of motor inhibition, duration of sensory prolongation, motor and pain relief after surgery. Monitor heart rate, blood pressure, respiratory rate, SpO2 and VAS score at 0, 4, 8, 12, 16, 20, 24 hours after surgery, patient satisfaction and effects undesirable in both groups.

Results: The brachial plexus anesthesia success rate in the two groups was 100%. Mean time to achieve sensory and motor inhibition in the group I (9.34 ± 1.61) and 12.94 ± 1.68) minutes shorter than the group II (14.48 ± 2.03 and 17.70 ± 1.73) minutes. Time of motor block, sensory block and postoperative analgesia of group I (8.50 ± 0.87; 10.04 ± 1.09 and 11.64 ± 1.50) hours shorter than the group II (10.46 ± 1.16; 12.37 ± 1.24 and 14.22 ± 1.90) hours. Heart rate, blood pressure, respiratory rate, SpO2 in patients usually vary little during and after surgery. In our study, there were no cases of complications in both groups.

Conclusion: Anesthesia of the brachial plexus upper clavicle line under ultrasound guidance combined with neuromuscular stimulator, the levobupivacaine anesthetic group 0.5% was better effective than the levobupivacaine anesthesia group 0.375% in surgery.