0.375%罗哌卡因用于老年患者超声引导下腹股沟韧带上髂筋膜间隙阻滞的半数有效容量

Median effective volume of 0.375%ropivacaine on supra-inguinal fascia iliaca compartment block under ultrasound guidance in elderly patients

目的采用序贯法测定0.375%罗哌卡因用于老年患者超声引导下腹股沟韧带上髂筋膜间隙阻滞(FICB)的半数有效容量(EV 50)。方法选择2020年1—9月择期行股骨近端手术患者25例,男9例,女16例,年龄≥65岁,BMI 18~24 kg/m^(2),ASAⅡ或Ⅲ级。在超声引导下行腹股沟韧带上FICB,定位成功后,间隙内注入0.375%罗哌卡因。采用序贯法测定半数有效容量,0.375%罗哌卡因初始给药容量为25 ml,相邻容量梯度变化为1.2 ml。注药后30 min内每5分钟采用针刺法评估大腿处股神经、股外侧皮神经、闭孔神经支配区的痛觉阻滞效果。上一例大腿处三根神经支配区的痛觉均完全阻滞视为阻滞有效,下一例患者采用低一级的剂量;反之,则采用高一级的剂量,获得7个上下交叉波形即停止试验。采用概率回归法计算0.375%罗哌卡因在腹股沟韧带上FICB中的EV 50、EV 95以及各自的95%可信区间(CI)。结果0.375%罗哌卡因用于老年患者超声引导下腹股沟韧带上FICB的EV 50为23.10 ml(95%CI 22.37~23.80 ml)。0.375%罗哌卡因用于老年患者超声引导下腹股沟韧带上FICB的EV 95为24.50 ml(95%CI 23.78~28.00 ml)。结论0.375%罗哌卡因用于老年患者超声引导下腹股沟韧带上FICB的EV 50为23.10 ml(95%CI 22.37~23.80 ml)。

Objective To determine the half effective volume(EV 50)of 0.375%ropivacaine for ultrasound-guided supra-inguinal fascia iliaca compartment block(FICB)by sequential method in elderly patients.Methods Twenty-five patients with elective proximal femoral surgery,9 males and 16 females,aged≥65 years,BMI 18-24 kg/m^(2),ASA physical statusⅡorⅢ,were selected in this study from January to September 2020.The supra-inguinal FICB was guided under ultrasound.After successful positioning,0.375%ropivacaine was injected into the space.Sequential method was used for the study,the initial dose was 25 ml,and the change of adjacent capacity gradient was 1.2 ml.To evaluate the sensory nerve block in the innervation area of the femoral nerve,lateral femoral cutaneous nerve and obturator nerve within 30 minutes after injection,the method of acupuncture was applied every 5 minutes.If a complete block of pain in the three innervated regions of the upper thigh was considered a successful block,the next patient was given a lower dose,on the contrary,a higher dose was given,and 7 inflection points were achieved.The EV 50,EV 95 and corresponding 95%confidence interval supra-inguinal FICB with 0.375%ropivacaine were calculated by probabilistic regression.Results The EV 50 and corresponding 95%confidence interval of 0.375%ropivacaine for ultrasound-guided supra-inguinal FICB was 23.10 ml(95%CI 22.37-23.80 ml).The EV 95 and corresponding 95%confidence interval of 0.375%ropivacaine for utrasound-guided supra-inguinal FICB was 24.50 ml(95%CI 23.78-28.00 ml).Conclusion The EV 50 of 0.375%ropivacaine used in ultrasound-guided supra-inguinal FICB in the old patients with proximal femoral surgery is 23.10 ml(95%CI 22.37-23.80 ml).