超声引导下0.5%罗哌卡因竖脊肌平面阻滞用于肺叶切除术后镇痛的半数有效容量

Median effective volume of 0.5%ropivacaine ultrasound-guided erector spinae plane block for postoperative analgesia after thoracoscopic lobectomy

目的采用序贯法测定超声引导下0.5%罗哌卡因竖脊肌平面阻滞(ESPB)用于胸腔镜肺叶切除术后镇痛的半数有效容量(EV_(50))。方法选择2021年4月至2022年1月行胸腔镜肺叶切除术患者24例,男9例,女15例,年龄18~64岁,BMI 18~35 kg/m^(2),ASAⅠ或Ⅱ级。在超声引导下以0.5%罗哌卡因行竖脊肌平面阻滞。选择20 ml作为起始容量,相邻两个容量梯度为2 ml。若阻滞效果完全,则下一例减少2 ml(10 mg);若阻滞效果不完全,则下一例增加2 ml(10 mg),获得7个拐点研究结束。记录阻滞后5、10、15、20、30 min的阻滞平面,术后2、6、12、48 h静息和活动(深呼吸)时VAS疼痛评分,术后0~12 h和13~48 h PCA按压总次数。采用Probit概率回归法计算0.5%罗哌卡因竖脊肌平面阻滞用于胸腔镜肺叶切除术患者镇痛的半数有效容量(EV_(50))及其95%可信区间(CI)。记录穿刺部位出血、术后感染和局麻药中毒等并发症发生情况。结果24例(100%)患者成功完成研究,0.5%罗哌卡因EV_(50)为24.5 ml(95%CI 23.3~25.7 ml)。患者均未出现穿刺部位出血及血肿、术后感染和局麻药中毒等并发症。结论超声引导下0.5%罗哌卡因竖脊肌阻滞用于胸腔镜肺叶切除术后镇痛的半数有效容量为24.5 ml(95%CI 23.3~25.7 ml)。

Objective To measure the median effective volume(EV_(50))of 0.5%ropivacaine in the ultrasound-guided erector spinal plane block(ESPB)for postoperative analgesia after video-assisted thoracoscopic lobectomy using sequential method.Methods Twenty-four patients scheduled for thoracoscopic lobectomy,9 males and 15 females,aged 18-64 years,BMI 18-35 kg/m^(2),ASA physical statusⅠorⅡ,were selected to undergo ultrasound-guided erector spinal plane block with 0.5%ropivacaine from April 2021 to January 2022.20 ml was selected as the starting dose from the previous reports,and the volume gradient was 2 ml.If the analgesic effect was good,the next case was deducted by 2 ml(10 mg).Otherwise,the next patients would be added 2 ml(10 mg).The test was completed until 7 consecutive inflection points appeared.The plane at 5,10,15,20,and 30 minutes after block,VAS at rest and activity(deep breathing)at 2,6,12,and 48 hours after operation,the total number of PCA at 0 to 12 hours and 13 to 48 hours after operation were recorded.Probit probability unit regression was adopted to calculate the EV_(50) and the 95%confidence interval(95%CI)of 0.5%ropivacaine in the ultrasound-guided erector spinal plane block for postoperative analgesia after video-assisted thoracoscopic lobectomy.The complications of hemorrhage in puncturing area,postoperative infection and local anesthetic intoxation were recorded.Results Twenty-four patients(100%)were successfully blocked.EV_(50) of 0.5%ropivacaine was 24.5 ml(95%CI 23.3-25.7 ml).None of the patients occurred hemorrhage and hematoma in puncturing area,postoperative infection and local anesthetic intoxation.Conclusion The median effective volume of ultrasound-guided 0.5%ropivacaine in the ultrasound-guided erector spinal plane block for postoperative analgesia after video-assisted thoracoscopic lobectomy is 24.5 ml(95%CI 23.3-25.7 ml).