罗哌卡因用于阑尾切除术患者超声引导下腹横肌平面阻滞的半数有效镇痛剂量

Median Effective Dose( ED_(50)) of Ropivacaine in Ultrasound-guided Transversus Abdominis Plane Block for Analgesia in Patients Undergoing Appendectomy

目的探讨罗哌卡因用于阑尾切除术患者超声引导下腹横肌平面阻滞的半数有效镇痛剂量。方法择期全身麻醉下行阑尾切除术的患者28例,术后行超声引导下双侧腹横肌平面阻滞。罗哌卡因使用剂量采用序贯法,第1例患者1.6 mg·kg^(-1),调整区间0.2 mg·kg^(-1)。采用数字疼痛量表(NRS)评估患者术后疼痛,并根据NRS评分增减罗哌卡因剂量。若NRS≤3,则下一例患者罗哌卡因降低0.2 mg·kg^(-1),反之则增加0.2 mg·kg^(-1)。计算罗哌卡因用于阑尾切除术患者超声引导下腹横肌平面阻滞半数有效镇痛剂量及其95%可信区间(95%CI)。记录患者腹横肌平面阻滞镇痛持续时间、术后不良反应发生情况。结果罗哌卡因用于阑尾切除术患者超声引导下腹横肌平面阻滞的半数有效镇痛剂量为2.73 mg·kg^(-1),95%CI为(1.94,3.84) mg·kg^(-1)。结论罗哌卡因在超声引导下腹横肌平面阻滞镇痛的半数有效量的确定,可提高麻醉有效性及安全性。

Objective To evaluate the median effective anesthetic dose of ropivacaine in ultrasound-guided transversus abdominis plane （TAP） block for analgesia in patients undergoing appendectomy.Methods Twenty-eight cases of appendectomy under general anesthesia were analyzed.After standardized general anaesthesia,a bilateral ultrasound-guided TAP block was performed on patients undergoing appendectomy using ropivacaine.Sequential method was applied.The initial dose of ropivacaine in first patient was 1.6 mg·kg -1 ,the dose adjustment interval was 0.2 mg·kg -1 .Numerical Rating Scale was used to estimate the level of pain postoperatively.If NRS≤3,dosage of ropivacaine was decreased by 0.2 mg·kg -1 .The transversus abdominis plane block analgesia duration and incidences of postoperative adverse reactions were analyzed.Results Median effective dose （ED 50 ） of ropivacaine in ultrasound-guided transversus abdominis plane block was 2.73 mg·kg -1 .95% CI （1.94,3.84） mg·kg -1 .Conclusion The determination of ED 50 of ropivacaine in ultrasound-guided transversus abdominis plane block improved the anesthesia efficacy and safety.