摘要
目的:探讨罗哌卡因连续髂筋膜间隙阻滞在髋关节置换术后镇痛的半数有效浓度(EC 50)及安全性。方法:选取2023年10月—2024年6月某院骨科行全身麻醉单侧髋关节置换术患者为研究对象,所有患者手术方式、术前麻醉诱导及术中麻醉维持相同,术后予以罗哌卡因连续筋膜间隙阻滞,并连接自控镇痛泵镇痛。罗哌卡因初始用药浓度0.1%,相邻患者用药浓度相差0.02%,至试验出现7个拐点后终止试验。以Probit回归分析法分析罗哌卡因连续髂筋膜间隙阻滞用药浓度对髋关节置换术后镇痛效果的影响及EC 50,比较有效组与无效组一般资料及术后不同时间点(术后12、24、36、48 h)静息、动态视觉模拟疼痛(VAS)评分,并观察阻滞过程中及阻滞后的安全性。结果:罗哌卡因用药浓度序贯试验共纳入26例患者,其中15例有效,11例无效;用药浓度0.02%~0.1%。0.1%浓度患者1例(有效),0.08%浓度患者4例(有效),0.06%浓度患者10例(7例有效,3例无效),0.04%浓度患者9例(3例有效,6例无效),0.02%浓度患者2例(无效)。Probit回归分析显示,罗哌卡因的EC 50为0.059%(95%CI:0.046%~0.067%),EC 95为0.131%(95%CI:0.111%~0.145%)。2组一般资料比较差异无统计学意义(P>0.05)。术后12、24、36、48 h,有效组静息及动态VAS评分逐渐降低,且各时间点评分均低于无效组,差异有统计学意义(P<0.05);无效组各时间点间静息及动态VAS评分比较差异无统计学意义(P>0.05)。阻滞期间均未发生生命体征波动、神经损伤、深部血肿等严重不良反应,无患者发生下肢运动功能障碍;有效组中1例出现恶心呕吐症状,无效组1例出现头晕症状,2组不良反应发生率比较差异无统计学意义(P>0.05)。结论:髋关节置换术后行罗哌卡因连续筋膜间隙阻滞镇痛的EC 50为0.059%;有效罗哌卡因连续髂筋膜间隙阻滞能够减轻患者术后48 h内静息及动态疼痛,且安全性好。
Objective:To analyze the 50%effective concentration(EC 50)and its safety of ropivacaine in continuous iliofascial space block after hip replacement.Methods:From October 2023 to June 2024,the patients who underwent unilateral hip replacement under general anesthesia in a hospital were selected as the research objects.All the patients had the same operation mode,preoperative anesthesia induction and intraoperative anesthesia maintenance.After surgery,ropivacaine was used for continuous fascial space block,and a patient-controlled analgesia pump was connected for pain relief.The initial dosage of ropivacaine was 0.1%,and the difference between the dosage of adjacent patients was 0.02%.The trial was terminated after seven inflection points appeared.The EC50 was analyzed by Probit regression,and the general data,resting and dynamic VAS scores at different postoperative time points(12,24,36 and 48 h)were compared between the effective group and the ineffective group,and the safety during and after the block was observed.Results:A total of 26 patients were included in the sequential trial of ropivacaine concentration,of which 15 patients were effective and 11 patients were ineffective.The drug concentration was 0.02%~0.1%.One patient at 0.1%concentration(effective),four patients at 0.08%concentration(effective),ten patients at 0.06%concentration(effective in 7 cases and ineffective in 3 cases),nine patients at 0.04%concentration(effective in 3 cases and ineffective in 6 cases)and two patients at 0.02%concentration(ineffective).Probit regression analysis showed that the EC50 of ropivacaine was 0.059%(95%CI=0.046%~0.067%),and EC95 was 0.131%(95%CI=0.111%~0.145%).There was no significant difference in general data between the two groups(P>0.05).12h,24h,36h and 48h after the operation,the rest and dynamic VAS scores in the effective group showed a decreasing trend,and the scores at all time points were lower than those in the ineffective group,with statistical significance(P<0.05).The rest and dynamic VAS scores in the ineffective group did not change in detail(P>0.05).During the block,no serious adverse reactions such as fluctuation of vital signs,nerve injury and deep hematoma occurred,and no patient developed motor dysfunction of lower limbs.One patient in the effective group was nauseous/vomited,and one patient in the ineffective group was dizzy.There was no significant difference in safety between the two groups(P>0.05).Conclusion:The EC50 of continuous compartment block analgesia with ropivacaine after hip replacement is 0.059%(95%CI=0.046%~0.067%).Effective continuous iliofascial space block with ropivacaine can relieve patients'rest and dynamic pain within 48 hours after operation,without causing serious adverse reactions and motor dysfunction of lower limbs.
作者
贺潇
张秀慧
潘富鹏
HE Xiao;ZHANG Xiuhui;PAN Fupeng(Department of Anesthesiology,The First People's Hospital of Xinxiang City,Xinxiang,Henan 453000,China)
出处
《淮海医药》
2025年第4期346-351,共6页
Journal of Huaihai Medicine
