目的 探究酒石酸布托啡诺作为罗哌卡因的佐剂用于臂丛神经阻滞是否能降低臂丛神经阻滞后反跳痛的发生率。 方法 本研究共纳入174例行上肢骨外科手术的患者，利用统计学软件将其随机分为3组：酒石酸布托啡诺复合局麻药组（B1组），使用0.25%罗哌卡因20 mL（包含佐剂布托啡诺1 mg）行臂丛神经阻滞；酒石酸布托啡诺静脉给药组（B2组），使用0.25%罗哌卡因20 mL行臂丛神经阻滞，此外静脉给予1 mg酒石酸布托啡诺；对照组（C组），仅使用0.25%罗哌卡因20 mL行臂丛神经阻滞。术前采用神经病理性疼痛量表（DN4）评估患者待手术部位是否存在神经病变成分（DN4≥4），并获取术前NRS值。手术当天术前30 min行超声引导下的臂丛神经阻滞，并检测阻滞效果是否完善，患者入手术室后进行全身麻醉。在术后6、12、18、24及36 h对患者进行随访获取术后各时间点的NRS值、阻滞作用消退的时间和消退后12 h内最高NRS值、首次使用抢救性镇痛药的时间、术后镇痛药的使用量、术后不良事件以及患者恢复质量。 结果 B1组患者术后反跳痛的发生率为31.6%，B2组发生率为48.2%，C组发生率为54.4%。组间比较结果表明B1组和C组间差异有统计学（P < 0.05）。反跳痛评分B1组 < B2组 < C组且差异有统计学意义（P < 0.05），组间比较结果表明B1组和C组间差异有统计学意义（P < 0.05）。术后阿片类药物的消耗量C组大于B1组且差异有统计学意义（P < 0.05）。3组患者术后各时间点的NRS评分且术后0 ~ 6 h以及术后6 ~ 24 h的疼痛曲线的曲线下面积（NRS-AUC）差异无统计学意义（P > 0.05）。3组在运动阻滞持续时间、感觉阻滞持续时间、镇痛持续时间、首次要求抢救性镇痛的时间及QoR-15恢复质量评分方面差异无统计学意义（P > 0.05）。3组患者在术后不良反应发生率方面差异无统计学意义（P > 0.05）。 结论 1 mg酒石酸布托啡诺作为罗哌卡因的佐剂行臂丛神经阻滞可以降低上肢骨科手术后的反跳痛发生率和反跳痛评分，且能减少术后阿片类药物的消耗量。

Objective To explore whether butorphanol tartrate as an adjuvant of ropivacaine for brachial plexus block can reduce the incidence of rebound pain after brachial plexus block. Methods Based on sample size calculation， 174 patients undergoing upper limb bone surgery were included in this study and randomized into three groups using statistical software： butorphanol tartrate compound local anesthetic （group B1）， brachial plexus block with 0.25% ropivacaine 20 mL （including adjuvant butorphanol 1mg）； intravenous butorphanol group （group B2）， brachial plexus block with 0.25% ropivacaine 20 mL， in addition， 1mg of butorphanol was administered i. v； control （group C）， only 0.25% ropivacaine 20ml for brachial plexus block. The patients were visited the day before operation， and the basic information of the patients was obtained. At the same time， the Douleur Neuropathique 4 questions （DN4） was used to evaluate whether there were neuropathic components （DN4 ≥ 4） in the site to be operated on， and the Numerical rating scale （NRS） was introduced to the patients， and the preoperative NRS value was obtained. 30 minutes before the operation， the same anesthesiologist with rich experience in nerve block completed the ultrasound-guided brachial plexus block （interscalene approach）， and tested whether the block effect was perfect. After entering the operating room， the patients were given general anesthesia， and the duration of operation， vital signs during operation， dosage of analgesics and whether or not using tourniquet were recorded. After the operation， the patients were sent to the postanesthesia care unit， and then sent to the ward when the patients reached the standard of leaving the room. Distribute pain diaries to patients and their families and instruct them to fill in relevant matters. The patients were followed up at 0 h， 6 h， 12 h， 18 h， 24 h and 36 h after operation to obtain the NRS value at each time point after operation， the time when the block disappeared and the highest NRS value within 12 hours， the first use of rescue analgesics， the use of postoperative analgesics， postoperative adverse events and the quality of patient recovery. Results The incidence of rebound pain was 31.6% in B1，48.2% in B2， and 54.4% in C. The pairwise comparison showed statistical difference between B1 and C （P < 0.05）. Rebound pain score in the three groups was B1 group < B2 group < C group and it was statistically different between the three groups（P < 0.05）. The pairwise comparison showed a statistical difference between B1 group and C group （P < 0.05）. Postoperative opioid consumption in Group C was greater than that in Group B1 and was statistically different （P < 0.05）.There was no statistically significant difference in NRS scores at each time point in the three groups and no difference in the area under the curve （NRS-AUC） of the pain curve at 0-6 hours and 6-24 hours after surgery （P > 0.05）. There were no statistical differences in the duration of motor block， sensory block duration， duration of analgesia， time to first request for rescue analgesia， and QoR-15 recovery quality score （P > 0.05）. There was no statistical difference in the incidence of postoperative adverse effects among the three groups （P > 0.05）. Conclusion This study found that brachial plexus block with 1mg butorphanol tartrate as an adjuvant for ropivacaine reduced the incidence of rebound pain and rebound pain scores after upper limb orthopedic surgery and reduced postoperative opioid consumption.