罗哌卡因在老年患者全髋关节置换术中髋关节囊周围神经阻滞的半数有效浓度

Median effective concentration of ropivacaine for pericapsular nerve group block in elderly patients undergoing total hip arthroplasty

目的测定全麻联合髋关节囊周围神经(PENG)阻滞用于全髋关节置换术老年患者的罗哌卡因半数有效浓度(EC_(50))。方法选择择期行全髋关节置换术的老年患者36例,男20例,女16例,年龄65~80岁,BMI 18~30 kg/m 2,ASAⅡ或Ⅲ级。在超声引导下行PENG阻滞,设定罗哌卡因容量为20 ml,浓度由序贯法确定,初始浓度为0.375%,若神经阻滞20 min后,静息NRS评分较阻滞前下降≥2分且活动时NRS评分较阻滞前下降≥3分时,则视为阻滞成功,反之则视为失败,阻滞失败则下1例患者提高1个浓度梯度,阻滞成功则下1例患者降低1个浓度梯度,相邻浓度比值为1.0∶1.2,直至出现7个拐点。采用Probit概率法计算罗哌卡因的EC_(50)及其95%可信区间(CI)。记录PENG阻滞前(阻滞前)、阻滞后20 min和术后2、6、12、24 h静息和活动(被动抬髋15°)时NRS评分,术后穿刺部位感染、血肿、神经损伤、局麻药中毒、恶心、呕吐、头晕等发生情况。结果罗哌卡因用于老年患者全髋关节置换术前行PENG阻滞的EC_(50)为0.185%(95%CI 0.154%~0.213%)。无一例患者穿刺部位感染、血肿、神经损伤、局麻药中毒并发症。结论罗哌卡因用于老年患者全髋关节置换术中PENG阻滞的EC_(50)为0.185%(95%CI 0.154%~0.213%)。

Objective To determine the median effective concentration(EC_(50))of ropivacaine ultrasound-guided pericapsular nerve group(PENG)block in elderly patients undergoing hip arthroplasty.Methods Thirty-six patients with total hip arthroplasty,20 males and 16 females,aged 65-80 yeas,BMI 18-30 kg/m 2,ASA physical statusⅡ-Ⅲ,scheduled for total hip arthroplasty were selected to undergo ultrasound-guided PENG block with 20 ml ropivacaine.Sequential administration of ropivacaine was performed with an initial concentration 0.375%and the ratio between the two successive concentrations was 1.0∶1.2.If the patients static NRS score decreased by at least 2 points and dynamic NRS score decreases by at least 3 points 20-minutes after nerve blockade,it was considered a successful blockade.Otherwise,it was considered a failure.If the block was effective,the next patient received a lower dose of ropivacaine,otherwise,a higher dose was given to the next patient.The test was completed until 7 consecutive inflection points appeared.Probit probability unit regression was adopted to calculate the EC_(50)and the 95%confidence interval(CI)of ropivacaine.The numeric rating pain scale(NRS)scores before block and 20 minutes after block,2,6,12,and 24 hours after surgery during rest and activity(passive hip lifting at 15°)were recorded.The complications of weakness of the quadriceps 20 minutes after block,postoperative infection,hemorrhage and hematoma in puncturing area,nerve injury,local anesthetic poisoning,nausea,vomiting,and dizziness after surgery was recorded.Results The EC_(50)of ropivacaine for ultrasound-guided PENG was 0.185%(95%CI 0.154%-0.213%).None of the patients occurred weakness of the quadriceps,postoperative infection,hemorrhage and hematoma in puncturing area,nerve injury,and local anesthetic poisoning.Conclusion The EC_(50)of ropivacaine used in ultrasound-guided pericapsular nerve group block in elderly patients undergoing total hip arthroplasty is 0.185%(95%CI 0.154%-0.213%).