超声引导下肋锁间隙径路臂丛神经阻滞0.375%罗哌卡因最低有效剂量的临床研究  

Minimum effective dosage of 0.375%ropivacaine in ultrasound-guided brachial plexus block through costo-clavicular space

作　　者：薛金配 杨婷 余学刚 胡祖荣[2] Xue Jinpei;Yang Ting;Yu Xuegang;Hu Zurong(Anesthesiological Teaching and Research Room,Guangzhou Medical University(Department of Anesthesiology,Orthopedics Hospital of Longgang District,Shenzhen),Shenzhen 518116,China;Guangdong Women and Children Hospital,Guangzhou 510010,China)

机构地区：[1]广州医科大学麻醉学教研室深圳市龙岗区骨科医院麻醉科,518116 [2]广东省妇幼保健院麻醉科,广州510010

出　　处：《国际医药卫生导报》2021年第9期1373-1377,共5页International Medicine and Health Guidance News

摘　　要：目的研究超声引导下肋锁间隙径路臂丛神经阻滞的最低有效剂量。方法选择2019年8月至10月在深圳市龙岗区骨科医院行上肢手术的患者,ASA分级Ⅰ~Ⅱ级。采用超声引导下行肋锁间隙径路臂丛神经阻滞,在超声屏幕上实时显示腋动静脉、臂丛神经的三束(外侧束、内侧束、后束)、胸膜及第二肋,采用平面内技术,将局麻药注入臂丛神经的三束之间。采用Dixon序贯法(up-and-down)进行试验,以0.375%盐酸罗哌卡因溶液20.00 ml为起始剂量,若经评估后达到阻滞成功标准,则下一例患者的罗哌卡因用量减2 ml;若未达标,则下一例患者的罗哌卡因用量增加2.00 ml。局麻药注射完5 min、10 min、15 min、20 min、25 min、30 min后,对患者进行感觉神经和运动神经阻滞效果评估,总分16分。阻滞成功定义为0.375%盐酸罗哌卡因注药后30 min,感觉神经阻滞评分和运动神经阻滞评分之和达14分。利用序贯法公式计算出超声引导下肋锁间隙径路臂丛神经阻滞时0.375%盐酸罗哌卡因的最低有效剂量及其95%可信区间。结果共27例患者完成试验,无不良反应发生。成功14例,男性10例,女性4例,年龄(37.00±11.03)岁;失败13例,全为男性,年龄(34.00±10.98)岁。超声引导下肋锁间隙径路臂丛神经阻滞0.375%罗哌卡因的最低有效剂量是16.74 ml,其95%可信区间为13.39~20.93 ml。结论超声引导下肋锁间隙径路臂丛神经阻滞0.375%盐酸罗哌卡因的最低有效剂量是16.74 ml。Objective To investigate the minimum effective dosage of ropivacaine in ultrasound-guided brachial plexus block through costo-clavicular space.Methods From August to October,2019,the patients whose ASA grade ranged from I to II were involved,and ultrasound-guided brachial plexus block through costo-clavicular space was performed in all the patients.During the anesthesia,the axillary artery,the axillary vein,the lateral cords of brachial plexus,the pleura and the 2nd rib were showed on the real-time imaging screen,and ropivacaine was injected in the cavity of the 3 branches of brachial plexus.An up-and-down method was used;the initial volume of ropivacaine was 20.00 ml;if the block was successful,the next patient's ropivacaine volume decreased 2.00 ml.Five,ten,fifteen,twenty-five,and thirty minutes after the injection of local anesthesia drug,the block effects on sensory and motor nerves were evaluated;the total score was 16.Thirty minutes after the injection of 0.375%ropivacaine,if the sum of the scores of sensory and motor nerve blocks≥14,the block is successful.Dixon sequential formula was used to calculate the minimum effective dosage of 0.375%ropivacaine and its 95%confidence interval(95%CI).Results Twenty-seven patients completed the experiment,with no adverse reactions.Fourteen did not fail,including 10 males and 4 females,with an age of(37.00±11.03);and the rest 13 male patients who were(34.00±10.98)years old failed.The minimum effective dosage of 0.375%ropivacaine in ultrasound-guided brachial plexus block through costo-clavicular space was 16.74 ml,and the 95%CI ranged from 13.39 to 20.93 ml.Conclusion The minimum effective dosage of 0.375%ropivacaine in ultrasound-guided brachial plexus block through costo-clavicular space is 16.74 ml.

关 键 词：肋锁间隙 臂丛 罗哌卡因 最低有效剂量 超声引导 

分 类 号：R614[医药卫生—麻醉学]