超声引导锁骨上臂丛三点注射法阻滞行前臂手术时罗哌卡因的半数有效浓度  

Median effective concentration of ropivacaine in forearm surgery by ultrasound-guided 3-point injection of supraclavicular brachial plexus block

作　　者：顾晨桃[1] 单宇[1] 张英[1] 王爱忠[1] GU Chen-tao;SHAN Yu;ZHANG Ying;WANG Ai-zhong(Department of Anesthesiology,Shanghai Sixth People’s Hospital,Shanghai Jiao Tong University,Shanghai 200233,China)

机构地区：[1]上海交通大学附属第六人民医院麻醉科,上海200233

出　　处：《海军军医大学学报》2023年第1期119-123,共5页Academic Journal of Naval Medical University

摘　　要：目的探索采用超声引导锁骨上臂丛三点注射法阻滞行前臂手术时罗哌卡因的最佳浓度。方法筛选择期前臂手术患者64例,均由同一位麻醉医师采用超声引导锁骨上臂丛神经阻滞方法进行麻醉。局部麻醉药为罗哌卡因30 mL,采用锁骨上臂丛三点注射法在锁骨上臂丛神经的内侧、上方和外侧分别注入10 mL罗哌卡因,起始浓度为0.50%,运用序贯法确定后续患者的用药浓度,浓度增减每级为0.05%。测定前臂5根主要神经桡神经、正中神经、尺神经、前臂内侧皮神经、前臂外侧皮神经自穿刺注药后30 min内的阻滞效果,5根神经均完全阻滞视为有效,下一病例使用的罗哌卡因浓度降低一级;只要有1根神经发生不完全阻滞即视为无效,下一病例使用的罗哌卡因浓度增加一级。采用logistic回归方法计算超声引导下锁骨上臂丛三点注射法中罗哌卡因的半数有效浓度(EC50)。结果64例前臂手术患者行超声引导锁骨上臂丛神经阻滞,基础生命体征在神经阻滞前后均维持在正常范围,阻滞有效34例、无效30例。罗哌卡因EC50为0.518%(95%CI 0.496%~0.547%)。2例患者发生霍纳综合征,无气胸、局部麻醉药中毒、血管损伤和呼吸困难等并发症发生。结论超声引导下锁骨上臂丛神经阻滞采用三点注射法,罗哌卡因容量为30 mL时,最佳浓度为0.518%。Objective To explore the optimal concentration of ropivacaine in forearm surgery by ultrasoundguided 3-point injection of supraclavicular brachial plexus block.Methods A total of 64 patients with selective forearm surgery were enrolled,and all were anesthetized by the same anesthesiologist using ultrasound-guided supraclavicular brachial plexus block.The local anesthetic was 30 mL of ropivacaine,and 10 mL of ropivacaine was injected into the medial,upper and lateral sides of the supraclavicular brachial plexus by 3-point injection method,with the initial concentration of 0.50%.After anesthesia within 30 min,the blocked effect of 5 nerves(radial nerve,median nerve,ulnar nerve,lateral antebrachial cutaneous nerve,and medial cutaneous nerve)of the forearm was assessed.By sequential increase and decrease method,if all 5 nerves were completely blocked,the next case would reduce the concentration of ropivacaine by 0.05%.If one nerve block was incomplete or ineffective,the next case would increase ropivacaine concentration by 0.05%.The median effective concentration(EC50)of ropivacaine was calculated by logistic analysis statistics.Results Sixty-four patients with forearm surgery underwent ultrasound-guided supraclavicular brachial plexus block.The basic vital indicators were maintained in the normal range before and after nerve block.The block anesthesia was effective in 34 cases and ineffective in 30 cases.The EC50of ropivacaine was 0.518%(95%confidence interval 0.496%-0.547%).Horner syndrome occurred in 2 patients,and no patients had complications such as pneumothorax,local anesthetic poisoning,vascular injury or dyspnea.Conclusion With 3-point injection method,the ropivacaine dose is 30 mL,and its optimal concentration is 0.518%in ultrasound-guided supraclavicular brachial plexus block.

关 键 词：罗哌卡因 剂量效应关系 锁骨上臂丛神经阻滞 超声检查 

分 类 号：R614.3[医药卫生—麻醉学]