Application Of Ropivacaine With Nalbuphine Or Dexmedetomidine In Supraclavicular Brachial Plexus Nerve Block

Objective（s）:To investigate the clinical efficacy and safety of Nalbuphine and Dexmedetomidine as adjuvants of ropivacaine hydrochloride in supraclavicular brachial plexus block.Methods:This study was reviewed and approved by the Medical Ethics Committee and Medical Quality Management Committee of Yuxi Traditional Chinese Medicine Hospital with ethical review approval number:2021kysc020.Based on the pretest results,the minimum sample size for each group was n=32,and the missing data rate was set at 20%,resulting in a final sample size of n=40 per group,for a total of 120 individuals.A randomized double-blind controlled clinical trial was used,with the subjects and the visiting group blinded and the test group unblinded.Collect a total of 120 patients from orthopedic department who plan to undergo surgery on the middle and lower segments of the humerus,elbow,and forearm.Using SPSS20.0statistical software to generate a list of random numbers,they were randomly divided into three groups in a double-blind manner:（1）0.4%ropivacaine hydrochloride,30ml（LR group）;（2）0.4%ropivacaine hydrochloride+20 mg nalbuphine hydrochloride,30 ml in total（LN group）;（3）0.4%ropivacaine hydrochloride+1μg.kg^-1（standard body weight）dexmedetomidine,30 ml in total（LD group）,40patients in each group.All patients were placed in the healthy-side position,and underwent water split double point injection under ultrasound guidance from the lateral side of the probe to administer the drugs corresponding to the randomization to complete the supraclavicular brachial plexus block,following the results of randomization.The onset time of warm sensation,pain sensation and motor block of each patient were recorded,as well as the duration of postoperative pain and motor block,the postoperative visual analogue scale（VAS）,the Observer’s assessment alert/Sedation（OAA/S）score after block.The time of the first request for additional intramuscular analgesic was recorded.The hemodynamic changes during the operation and the number of adverse reactions during the perioperative period were recorded in real time,and the differences among different groups were statistically processed.Results:All 120 study subjects successfully completed the supraclavicular brachial plexus block,and no patient was discharged from this study due to unsuccessful block or reaction to local anesthetic toxicity.The statistical results are as follows.1.There were no significant differences in gender,age,American Society of Anesthesiologists（ASA）classification,body mass index（BMI）,length of surgery,and surgical procedure among the three study groups（P>0.05）.2.The time to onset of warm block and time to onset of nociceptive block in all three groups were LD group<LN group<LR group,However,the difference between the three groups was not statistically significant（P>0.05）.The onset of motor block was significantly longer in the LN group than in the LD group,with statistically significant differences（P<0.05）;the time to onset of motor block in LN group was slightly longer in the LN group than in the LR group,but there was no statistically significant difference（P>0.05）;the onset of motor block was slightly longer in the LR group than in the LD group,with no statistically significant differences（P>0.05）.3.The duration of pain and motor block in the LD group was significantly greater than that in the LN and LR groups,and the difference was statistically significant（P<0.05）;the duration of pain and motor block in the LN group was longer than that in the LR group,but the difference was not statistically significant（P>0.05）.4.In the LD group,the VAS scores were significantly lower than those in the LR group at the 8th,10th,12th,14th and 16th hours postoperatively,with statistically significant differences（P<0.05）;in the LD group,the VAS scores were significantly lower than those in the LN group at the 10th,12th,14th and 20th hours postoperatively,with statistically significant differences（P<0.05）;in the LN group,the VAS scores were significantly lower than those in the LR group at the 8th,10th,20th and 24th hours postoperatively,with statistically significant differences（P<0.05）.At 8,10,20,and 24 hours after operation,the VAS score of the LN group was significantly lower than that of the LR group,and the difference was statistically significant（P<0.05）.5.The difference in the number of additional postoperative inotropic analgesics between the LN,LR and LD groups was not statistically significant（P>0.05）;The duration of additional intramuscular injection of analgesics in the LD group was significantly longer than that in the LN group and LR group,and the statistical differences were significant（P<0.05）;the time of additional inotropic analgesics in the LN group was greater than that in the LR group,but there was no statistical difference（P>0.05）.6.At OAA/S score 3,the LD group had more cases than the LN and LR groups,and the difference was statistically significant（P<0.05）;There was no statistically significant difference in the number of cases in the LN group compared with the LR group（P>0.05）.At OAA/S score 4,the LD group had more cases than the LR group,and the difference was statistically significant（P<0.05）;The number of cases in the LN group was more than that in the LR group,and the statistical difference was significant（P<0.05）;the number of cases in the LN group was slightly more than that in the LD group,but there was no statistical difference（P>0.05）.At an OAA/S score of 5,the number of cases was LR group>LN group>LD group,and the difference was statistically significant（P<0.05）when compared between two of the three groups.7.The number of nausea and vomiting cases in the LN group was significantly higher than that in the LR and LD groups,and the difference was statistically significant（P<0.05）.Compared with the LD group,the cases of nausea and vomiting in the LR group were similar in number,and the difference was not statistically significant（P>0.05）.The number of cases with bradycardia was significantly higher in the LD group than in the LN and LR groups,and the statistical difference was significant（P<0.05）.Compared with the LN group,the cases of bradycardia in the LR group were similar in number,and the difference was not statistically significant（P>0.05）.8.Inter-group comparison:When comparing between groups at T1,there was no statistically significant difference in basal MAP and HR among the three study groups（P>0.05）.Comparison between groups at T2 and T3:Compared with LR group,MAP and HR in LN group had no statistical difference（P>0.05）.LD group MAP and HR were significantly lower than LN group,the difference was statistically significant（P<0.05）;);LD group MAP was lower than LR Group,with statistically significant differences（P<0.05）.The HR in the LD group was slightly lower than that in the LR group at T2,However,the difference was not statistically significant（P>0.05）.At T3,HR in LD group was lower than that in LR group,and the statistical difference was significant（P<0.05）.Intra-group comparison:MAP and HR in the LN group did not fluctuate significantly at T1,T2,and T3 time points,and the differences were not statistically significant（P>0.05）.MAP in the LR group showed a significant gradual decrease at T1,T2,and T3,and the differences were statistically significant when compared between two different time points（P<0.05）;HR in the LR group was compared with each other at T1 and T2 time points,and the differences were not statistically significant（P>0.05）.There was no statistical difference when comparing the two time points T1 and T2 with each other（P>0.05）;HR in the LR group at T3 was significantly decreased compared with both T1 and T2（P<0.05）;MAP and HR in the LD group at T1,T2 and T3 showed a significant gradual decrease,Moreover,the statistical difference was significant in pairwise comparison at different time points（P<0.05）.Conclusion（s）:Nalbuphine or dexmedetomidine combined with ropivacaine is safe and effective in ultrasound-guided supraclavicular brachial plexus block,both of which enhance the quality of postoperative analgesia and produce a depth of sedation appropriate for the procedure.Dexmedetomidine is superior to nalbuphine in terms of block onset and duration of block,but the heart rate slowing effect of dexmedetomidine should be noted.