不同浓度罗哌卡因用于腹股沟上髂筋膜间隙阻滞的起效时间

Comparison of the Effective Time of Different Concentrations of Ropivacaine For Superior Inguinal Iliac Fascial Space Block

目的比较超声引导下两种不同浓度罗哌卡因用于腹股沟韧带上髂筋膜间隙阻滞(S-FICB)的起效时间。方法限期行股骨近端髓内针内固定术的股骨转子间骨折患者60例,男28例,女32例,年龄65~85岁,ASAⅠ~Ⅲ级,所有患者在行椎管内麻醉摆放体位前20 min,均在超声引导下行S-FICB,根据给药浓度不同,随机分为两组,每组30例,A组注射0.25%罗哌卡因30 ml,B组注射0.4%罗哌卡因30 ml。记录阻滞操作时间、股神经及股外侧皮神经阻滞起效时间及阻滞效果。记录阻滞前(T1)和阻滞后5 min(T2)、10 min(T3)、15 min(T4)及侧卧位即刻(T5)的VAS疼痛评分、MAP和HR。结果两组阻滞操作时间、股神经阻滞效果差异无统计学意义。B组股神经及股外侧皮神经阻滞起效时间明显短于A组(P<0.05),与T1时比较,T2~T5时两组VAS疼痛评分明显降低(P<0.05)。T2-4时B组VAS评分明显低于A组(P<0.05),T 1和T5时两组VAS疼痛评分差异无统计学意义。与T1时比较,T2~T5时两组患者MAP明显降低(P<0.05),HR变化及两组患者各时点MAP和HR差异无统计学意义。结论采用0.25%罗哌卡因30 ml和0.4%罗哌卡因30 ml用于超声引导下S-FICB对股骨转子间骨折患者术前摆放侧卧位时均有良好镇痛效果,后者起效更快。

Objective To compare the onset time of different concentrations of ropivacaine for supraginguinal ligament iliac fascial space block under ultrasound guidance before spinal canal anesthesia.Methods A total of 60 patients with intertrochanteric fracture,28 males and 32 females,aged 65~85,ASA Ⅰ~Ⅲ All patients underwent S-FICB under ultrasound guidance 20 min before intraspinal anesthesia.They were divided into two groups by random number table method according to the concentration:0.25%ropivacaine group(group A)and 0.4%ropivacaine group(group B),with 30 patients in each group.Before intraspinal anesthesia,group A was injected with 0.25%ropivacaine 30 ml and received S-FICB;group B was injected with 0.4%ropivacaine 30 ml and received S-FICB.The operation time of block,the onset time of block of femoral nerve and lateral femoral cutaneous nerve and the block effect were recorded.The visual analogue scale(VAS)scores,MAP and HR were recorded before block(T1)and at 5 min(T2),10 min(T3)and 15 min(T4)after block and position change immediately(T5)in the two groups.Results There was no significant difference in operation time,femoral nerve block effect and lateral femoral cutaneous nerve block effect among the two groups.The onset time of femoral nerve block and lateral femoral cutaneous nerve block in group B was shorter than that in group A(P<0.05).Compared with T1,the VAS pain score was significantly decreased at T2-T5(P<0.05).VAS score of group B was significantly lower than that in group A at T2-4(P<0.05),and there was no significant difference in VAS pain score between the two groups at T1 and T5.Compared with T1,The MAP of the two groups was significantly decreased at T2-T5(P<0.05),and there was no statistical significance in the change of HR and the difference in MAP and HR at each time point between the two groups.Conclusion Both 0.25%ropivacaine 30 ml and 0.4%ropivacaine 30 ml used in ultrasonic-guided S-FICB have good analgesic effect on patients with intertrochanteric fracture in lateral decubitus position before operation,and the latter has faster effect .