患者不同浓度局麻药配伍坐骨神经阻滞的效果

Efficacy of different local anesthetic reghnens for sciatic nerve block

目的比较患者不同浓度局麻药配伍坐骨神经阻滞（经典后路法）的效果。方法择期行单侧膝关节及膝以下手术患者60例，随机分为2组（n=30）：高浓度组（1．5％利多卡因＋0．5％罗哌卡因）和低浓度组（1％利多卡因＋0．375％罗哌卡因）。依次给予腰丛阻滞和坐骨神经阻滞（经典后路法），以周围神经刺激器引出足跖屈为坐骨神经阻滞的目标运动反应。自注入所有局麻药后的45min内，每隔5分钟评价坐骨神经分支支配区域的感觉、运动阻滞情况。记录2组感觉阻滞和运动阻滞的起效时间、作用持续时间以及术中和术后并发症。结果2组坐骨神经阻滞的成功率差异无统计学意义（P〉0．05）。与高浓度组比较，低浓度组感觉、运动阻滞起效时间延长（P〈0．05），但2组感觉、运动阻滞作用时间比较差异无统计学意义（P〉0．05）。2组术中和术后均未出现并发症。结论采用低浓度的局麻药（1％利多卡因＋0．375％罗哌卡因）配伍即可提供满意的坐骨神经阻滞效果。

Objective To evaluate the efficacy of two mixtures of local anesthetics for Labat＇s sciatic nerve block. Methods Sixty ASA Ⅰ or Ⅱ patients aged 18-64 yr undergoing unilateral knee surgery or operation below the knee were randomly allocated into 2 groups （n = 30 each） ： group Ⅰ high concentration （H） （1.5% lidocaine ＋ 0.5 % ropivacaine） and group Ⅱ low concentration （L） （ 1% lidocaine ＋ 0. 375 % ropivacaine）. Lumbar plexus block and sciatic nerve block were performed with the assistance of peripheral nerve stimulator. Electric stimulation of sciatic nerve causes plantar flexion in all patients. The sensory and motor block of sciatic nerve was evaluated every 5 minutes during the 45 minutes after local anesthetic administration by an observer blinded to the solutions administered. Onset time, duration of analgesia, recovery of motor function, success rate and complications were compared between the two groups. Results There was no significant difference in success rate between the two groups. The onset time of complete sensory and motor block in group H was significantly shorter [ （16 ± 6） min and （21 ± 6） min] than that in group L[ （24 ± 7） min and（30 ± 6） mini （ P 〈 0.05）. There was no significant difference in the duration of anesthesia and recovery of motor function between the two groups. No complication occurred in both groups. Conclusion A mixture of 1% lidocaine and 0.375% ropivacaine can provide satisfactory sciatic nerve block.