氢吗啡酮与舒芬太尼静脉注射超前镇痛在臂丛神经阻滞中的应用效果对比进展

Research Progress on the Comparative Effects of Preemptive Analgesia with Intravenous Hydromorphone and Sufentanil in Brachial Plexus Block

摘要: 氢吗啡酮与舒芬太尼在臂丛神经阻滞超前镇痛中的应用效果对比。背景：臂丛神经阻滞作为上肢手术的核心麻醉方式，常因单纯局麻药阻滞时间短导致术后镇痛不足。超前镇痛通过术前干预阻断疼痛信号传导，减轻中枢敏化。氢吗啡酮与舒芬太尼作为常用阿片类佐剂，其药效学特性、安全性及适用人群差异需系统评估。目的：对比两种药物静脉或局部注射用于臂丛阻滞超前镇痛的效果、安全性及临床适用性，为精准用药提供依据。方法：文献检索策略(1) 检索中英文数据库(PubMed、知网、万方等，2016~2024年)，关键词包括“氢吗啡酮”“舒芬太尼”“臂丛神经阻滞”“超前镇痛”。(2) 纳入标准：随机对照试验(RCT)及临床对照研究，直接比较两药效果。(3) 最终纳入10篇核心文献，涵盖喙突旁/腋路阻滞、骨折/关节手术及老年/肾功能不全人群。结果：① 氢吗啡酮阻滞更长、镇痛需求更低；舒芬太尼起效更快、运动恢复早；② 局部给药更优；③ 氢吗啡酮注意运动延迟，舒芬太尼警惕老年呼吸抑制；④ 老年减量，肾损优选舒芬太尼。结论：1. 复杂疼痛手术(如骨折内固定)首选氢吗啡酮(局部注射0.2~0.3 mg)，实现长效镇痛并降低术后需求；2. 需早期康复的关节手术优选舒芬太尼，兼顾快速起效与运动功能恢复；3. 核心策略：局部给药优先，老年及肾功能不全者需个体化调整药物与剂量。本结论基于近期临床研究整合，为臂丛阻滞超前镇痛的精准化实践提供循证指导。

Abstract: The efficacy of hydromorphone and sufentanil is compared in preemptive analgesia for brachial plexus nerve block. Background: Brachial plexus block, as the core anesthesia modality for upper limb surgery, often leads to insufficient postoperative analgesia due to the short block time of local anesthetic alone. Advance analgesia blocks pain signaling through preoperative intervention and reduces central sensitization. As commonly used opioid adjuvants, hydromorphone and sufentanil need to be systematically evaluated for their pharmacodynamic properties, safety and applicable population differences. Objective: To compare the efficacy, safety and clinical applicability of the two drugs injected intravenously or locally for brachial plexus block advanced analgesia, and to provide a basis for precise medication. Methods: Literature search strategy (1) Search Chinese and English databases (PubMed, CNKI, Wanfang, etc., 2016~2024) with keywords including “hydromorphone”, “sufentanil”, “brachial plexus block”, and “advanced analgesia”. (2) Inclusion Criteria: Randomized Controlled Trials (RCTs) and clinical controlled studies that directly compare the effects of the two drugs. (3) The final inclusion of 10 core literature papers covering paracoracoid/axillary blocks, fractures/joint surgeries, and geriatric/renal insufficiency. Results: (1) Hydromorphone block was longer and the analgesic demand was lower; sufentanil has a faster onset of action and early recovery from exercise; (2) topical administration is better; (3) hydromorphone pays attention to exercise delay, and sufentanil is wary of respiratory depression in the elderly; (4) dose reduction in the elderly, sufentanil is preferred for kidney damage. Conclusion: 1. Hydromorphone (0.2~0.3 mg local injection) is preferred for complex pain procedures (e.g., internal fixation of fractures) to achieve long-lasting analgesia and reduce postoperative needs; 2. Sufentanil is preferred for joint surgery that requires early recovery, taking into account the rapid onset of action and the recovery of motor function; 3. Core strategy: local administration is prioritized, and the elderly and those with renal insufficiency need to adjust the drug and dosage individually. This conclusion is based on the integration of recent clinical studies to provide evidence-based guidance for the precise practice of advanced analgesia of brachial plexus block.