0.447%甲磺酸罗哌卡因用于超声引导锁骨下臂丛神经阻滞的半数有效剂量

The median effective dosage of 0.447% Methansulfonic Ropivacaine for ultrasound-guided infraclavicular brachial plexus nerve block

目的探讨0.447%甲磺酸罗哌卡因用于超声引导锁骨下臂丛神经阻滞的半数有效剂量。方法选择2015年12月~2017年12月于衡水市第五人民医院麻醉科行上肢手术患者100例,ASAⅠ~Ⅲ级。采用超声引导行锁骨下臂丛神经阻滞,在超声屏幕上实时显像腋动静脉、臂丛内(外、后)侧束、肋骨、胸膜、胸大小肌等组织,成功定位后注入0.447%甲磺酸罗哌卡因。采用Dixon序贯法(Up-and-Down)进行试验,以0.447%甲磺酸罗哌卡因溶液20 mL为起始容量,如果阻滞效果完全,则下一例患者减少2 mL;如果阻滞效果不完全,则下一例患者增加2 mL,依此类推。采用序贯公式计算超声引导锁骨下臂丛神经阻滞时0.447%甲磺酸罗哌卡因的半数有效剂量及95%可信区间(95%CI)。结果上肢患者行超声引导锁骨下臂丛神经阻滞,0.447%甲磺酸罗哌卡因的半数有效剂量及95%CI为17.5(17.0~18.0)mL。结论 0.447%甲磺酸罗哌卡因用于上肢患者超声引导锁骨下臂丛神经阻滞的半数有效剂量为17.5 mL。

Objective To determine the median effective dosage of 0.447%Methansulfonic Ropivacaine for ultrasound-guided infraclavicular brachial plexus nerve block.Methods From December 2015 to December 2017,100 cases carried out upper limb surgery in Anesthesia Department of the Fifth People's Hospital of Hengshui City were selected,ASAⅠ-Ⅲlevel.Subclavian brachial plexus nerve block guided by ultrasound was carried out,in ultrasonic axillary arteriovenous screen real-time imaging,at brachial plexus inside(outside,behind)lateral band,ribs,pleura,chest muscle groups such as size,0.447%Methansulfonic Ropivacaine was injected after successfull positioning.Dixon sequential method(Up-and-Down)experiment,with 0.447%Methansulfonic Ropivacaine,and 20 mL solution for the initial capacity,if the block effect was complete,reduce 2 mL to the next patient;if the block effect was incomplete,increase 2 mL to the next patient,and so on.Dixon sequential formula was used to calculate the median effective dosage of 0.447%Methansulfonic Ropivacaine and 95%confidence interval(95%CI)in subclavian brachial plexus nerve block guided by ultrasound.Results Upper limb in patients with subclavian brachial plexus nerve block guided by ultrasound,the median effective dosage of 0.447%Methansulfonic Ropivacaine and 95%CI of 17.5(17.0-18.0)mL.Conclusion 0.447%Methansulfonic Ropivacaine,for patients with upper limb subclavian brachial plexus nerve block guided by ultrasound,median effective dosage is 17.5 mL.