0.5%罗哌卡因用于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

Meidian effective volume of 0.5%ropivacaine for ultrasound-guided supra-inguinal fascial iliaca compartment block

目的测定0.5%罗哌卡因用于患者超声引导下腹股沟韧带上髂筋膜间隙阻滞(S-FICB)的半数有效容量(EV_(50))。方法选择2021年3月至2022年4月骨科择期行股骨与膝关节手术的患者28例,男19例,女9例,年龄18~64岁,BMI 18~28 kg/m^(2),ASAⅠ或Ⅱ级,术前行超声引导下S-FICB,局麻药为0.5%罗哌卡因。阻滞30 min后分别测定股外侧皮神经、股神经、闭孔神经支配区皮肤感觉,三者痛觉均消失定义为阻滞成功,否则为阻滞失败。局麻药初始容量设为25 ml,容量梯度为5 ml,若阻滞成功则下一例患者容量减少5 ml,若阻滞失败则下一例患者容量增加5 ml,直至出现7个容量拐点后完成研究。采用概率回归法计算罗哌卡因EV_(50)和95%可信区间(CI)。记录患者穿刺部位血肿、穿刺针误入血管、局麻药中毒、恶心呕吐等并发症情况。结果本研究共阻滞成功15例(54%),罗哌卡因用于非老年患者超声引导下髂筋膜间隙阻滞EV_(50)为15.47 ml(95%CI 12.64~18.94 ml)。所有患者在阻滞后均未出现穿刺部位血肿、穿刺针误入血管、局麻药中毒和恶心呕吐等并发症。结论0.5%罗哌卡因用于非老年患者超声引导下髂筋膜间隙阻滞EV_(50)为15.47 ml(95%CI 12.64~18.94 ml)。

Objective To determine the median effective volume(EV_(50))of 0.5%ropivacaine for ultrasound-guided supra-inguinal fascia iliaca compartment block(S-FICB)in patients.Methods Twenty-eight patients who scheduled for elective femoral or knee surgery in orthopedics department from March 2021 to April 2022,19 males and 9 females,aged 18-64 years,BMI 18-28 kg/m^(2),ASA physical statusⅠorⅡ,were enrolled in this study.S-FICB block was applied under ultrasound guidance before operation,and the local anesthetic used for study was 0.5%ropivacaine.30 minutes after the S-FICB block,the sensory blockade of lateral femoral cutaneous nerve,femoral nerve and obturator nerve were measured respectively.A successful block was defined as the loss of sensation of pinprick in the territory of all three nerves above,otherwise the block failed.The initial volume of injected local anesthetic was set at 30 ml and the volume interval was 5 ml.If the current block was successful,a lower dose would be given for the next patient,otherwise a higher dose would be given.The trial was terminated until seven volume inflection points appeared.EV_(50)and 95%confidence interval(CI)of ropivacaine were calculated by probability logistic regression method.Results In this study,15 patients were successfully blocked(54%).The EV_(50)value of ropivacaine for ultrasound-guided S-FICB in non-elderly patients was 15.47 ml(95%CI 12.64-18.94 ml).Conclusion The EV_(50)value of 0.5%ropivacaine for ultrasound-guided S-FICB in non-elderly patients is 15.47 ml(95%CI 12.64-18.94 ml).