0.5%罗哌卡因用于超声引导下肋锁间隙阻滞的半数有效容量-现代医学

0.5%罗哌卡因用于超声引导下肋锁间隙阻滞的半数有效容量

单位：汕头市中心医院麻醉科, 广东汕头 515000

分类号：R445.1

出版年·卷·期（页码）：2020·39·第八期（1011-1014）

摘要：

目的：测定0.5%罗哌卡因用于超声引导下肋锁间隙阻滞中的半数有效容量。方法：择期行上肢手术的患者35例为研究对象，年龄18~65岁，ASA分级Ⅰ—Ⅱ级，在超声引导下行肋锁间隙阻滞。采用序贯法进行实验，第1位患者剂量为0.5%罗哌卡因30 ml，后续患者的剂量取决于上一位患者的阻滞效果，根据上一位患者的神经阻滞评分是否达到标准，下一位患者的剂量增加或减少2.5 ml。操作完毕后，每间隔5 min进行一次阻滞效果的评估，包括感觉神经阻滞评分和运动神经阻滞评分，共进行6次，总时间为30 min，分数最高16分。总分数达到14分则认为达到标准，即患者可以耐受手术且术中手术区域无不适感。通过probit概率回归法计算0.5%罗哌卡因用于超声引导下肋锁间隙阻滞的半数有效容量及其95%可信区间。结果：浓度为0.5%的罗哌卡因的使用容量在7.5 ml至30 ml这一范围内，EV₅₀为12.4 ml（95% CI：9.3~14.9 ml），EV₉₀为19.3 ml（95% CI：15.7~46.5 ml）。结论：0.5%罗哌卡因在超声引导下肋锁间隙阻滞中的半数有效容量EV₅₀为12.4 ml，EV₉₀为19.3 ml。

Objective: To identify the median effective volume(EV₅₀) of 0.5% ropivacaine in ultrasound-guided costoclavicular block.Methods: This study contained 35 patients with elective upper extremity surgeryofultrasound-guided costoclavicular block at ages of 18~65 years old and the American Society of Anesthesiologists (ASA) physical status I to II. The volume of ropivacaine was determined by the up-and-down sequential method and the first patient received 30 ml. The volume of the next patient depends on the response of the previous one. If the previous patient obtained an unsuccessful block, then the volume of the next patient was increased by 2.5 ml; if the previous patient obtained a successful block, then the next patient received a lower volume (the previous volume with a decrement of 2.5 ml). After the operation was completed, measurements of the brachial plexus blockade were carried out every 5 minutes until 30 minutes. The score was up to 16 points and a total score of 14 suggests that the block was successful, which meant the patient could undergo the surgery and there was no discomfort during the surgery. The EV₅₀ of0.5% ropivacaine with 95% confidence interval (CI) was calculated by probit regression. Results: The used volume of 0.5% ropivacaine was in the range of 7.5 ml to 30 ml, EV₅₀ was 12.4 ml (95% CI:9.3~14.9 ml), EV₉₀ was 19.3 ml (95% CI:15.7~46.5 ml).Conclusion: The ultrasound-guided costoclavicular block is safe and effective. For ultrasound-guided costoclavicular block, the EV₅₀ of 0.5% ropivacaine is 12.4 and the EV₉₀ of 0.5% ropivacaine is 19.3 ml.

参考文献：

[1] KARMAKAR M K,SALA-BLANCH X,SONGTHAMWAT B,et al.Benefits of the costoclavicular space for ultrasound-guided infraclavicular brachial plexus block:description of a costoclavicular approach[J].Regional Anesthesia & Pain Medicine,2015,40(3):287-288.
[2] 李静,赵玲,韩彬,等.超声引导下肋锁间隙和喙突入路锁骨下臂丛神经阻滞在前臂或手部术中效果的比较[J].临床麻醉学杂志,2018,34(4):341-344.
[3] 陶红,杨曙光,陈超,等.超声引导下肋锁间隙神经阻滞在前臂手术中的应用[J].临床麻醉学杂志,2018,34(9):903-904.
[4] LI M,WAN L,MEI W,et al.Update on the clinical utility and practical use of ropivacaine in Chinese patients[J].Drug Design,Development and Therapy,2014,8(1):1269-1276.
[5] ZINK W,GRAF B M.Benefit-risk assessment of ropivacaine in the management of postoperative pain[J].Drug Safety,2004,27(14):1093-1114.
[6] SATHISH T,AAGUETA M F,SAMER C A,et al.Minimum effective volume of lidocaine for ultrasound-guided infraclavicular block[J].Regional Anesthesia and Pain Medicine,2017,42(5):571-574.
[7] TRAN D Q,DUGAN S,DYACHENKO A,et al.Minimum effective volume of lidocaine for ultrasound-guided infraclavicular block[J].Regional Anesthesia and Pain Medicine,2011,36(2):190-194.
[8] LIU S S,NGEOW J E,YADEAU J T.Ultrasound-guided regional anesthesia and analgesia:a qualitative systematic review[J].Regional Anesthesia and Pain Medicine,2009,34(1):47-59.
[9] TRAN D Q H,BERTINI P,ZAOUTER C,et al.A prospective randomized comparison between single-and double-injection ultrasound-guided infraclavicular brachial plexus block[J].Regional Anesthesia and Pain Medicine,2010,35(1):16-21.
[10] SALA-BLANCH X,REINA M A,PANGTHIPAMPAI P,et al.Anatomic basis for brachial plexus block at the costoclavicular space:a cadaver anatomic study[J].Regional Anesthesia and Pain Medicine,2016,41(3):387-391.
[11] LEURCHARUSMEE P,ELGUETA M F,TIYAPRASERTKUL W,et al.A randomized comparison between costoclavicular and paracoracoid ultrasound-guided infraclavicular block for upper limb surgery[J].Canadian Journal of Anesthesia,2017,64(6):617-625.
[12] LI J W,SONGTHAMWAT B,SAMY W,et al.Ultrasound-guided costoclavicular brachial plexus block sonoanatomy,technique,and block dynamics[J].Regional Anesthesia and Pain Medicine,2017,42(2):233-240.
[13] SARANTEAS T,FINLAYSON R,TRAN D Q.Dose-finding methodology for peripheral nerve blocks[J].Regional Anesthesia and Pain Medicine,2014,39(6):550-555.
[14] 伊军,林惠华,杨庆国.超声引导下连续胫神经阻滞时0.2%罗哌卡因半数有效背景量[J].临床麻醉学杂志,2015,31(8):753-755.
[15] SOTTHISOPHA T,ELGUETA M F,SAMERCHUA A,et al.Minimum effective volume of lidocaine for ultrasound-guided infraclavicular block[J].Regional Anesthesia and Pain Medicine,2017,42(5):571-574.
[16] 胡光俊,陶军,宋晓阳.不同容量和浓度罗哌卡因经喙突入路臂丛神经阻滞的效果[J].临床麻醉学杂志,2013,29(1):16-18.

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