改良髂筋膜间隙阻滞下罗哌卡因抑制老年患者全膝关节置换术后疼痛的有效浓度及不良反应分析  

Analysis on effective concentrations and adverse reactions of Ropivacaine in the modified fascial iliac compartment block for pain relief after total knee arthroplasty in elderly patients

作　　者：常小兰[1] 王晓 刘思兰[1] 嵇富海[1] 陆香红[1] 孟晓文[1] Chang Xiaolan;Wang Xiao;Liu Silan;Ji Fuhai;Lu Xianghong;Meng Xiaowen(Department of Anesthesiology,the First Affiliated Hospital of Soochow University,Suzhou 215006,China;Department of Anesthesiology,Xinghu Hospital,Suzhou Industrial Park,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院麻醉科,苏州215006 [2]苏州市工业园区星湖医院麻醉科,苏州215006

出　　处：《中华老年医学杂志》2023年第4期425-429,共5页Chinese Journal of Geriatrics

基　　金：北京医学奖励基金(YXJL-2021-1271-0655);江苏省医学创新团队(CXTDA2017043);苏州市科研基金((LCZX201603)BAR2018261)。

摘　　要：目的探索既不影响患肢活动又能有效控制老年患者全膝关节置换术(TKA)后疼痛的改良髂筋膜间隙阻滞(FICB)中罗哌卡因有效浓度,观察FICB后24 h的不良反应。方法本研究是一项前瞻性、单臂序贯试验。选择2021年9月至2022年3月苏州大学附属第一医院行TKA的老年患者45例,美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级。所有患者在全身麻醉后、手术开始前10 min给予超声引导下术侧FICB,注射容量均为30 ml。根据预实验及参考文献,罗哌卡因的初始浓度为0.1%,依据改良Dixon序贯法确定下1例患者的浓度,若前1例患者术后24 h患肢股四头肌肌力评分≥4分,静息痛为阴性[视觉模拟疼痛评分(VAS)≤1分],且活动时VAS评分≤3分,则下1例患者降低浓度;反之,则增加浓度;罗哌卡因浓度的增减梯度为0.01%,直到出现12次折返后停止试验。采用Probit概率法计算罗哌卡因的半数有效浓度(ED50)、95%有效浓度(ED95)及95%可信区间(CI)。同时观察FICB后24 h不良反应发生情况。结果43例老年患者完成试验,其中有效23例,无效20例。在保证不影响老年患者术后患肢活动的前提下,单次FICB 30 ml的罗哌卡因,能有效抑制患者术后疼痛的罗哌卡因浓度ED50为0.072%(95%CI:0.065%~0.078%),ED95为0.093%(95%CI:0.084%~0.124%)。FICB后24 h,共发生下肢无力,无法下床行走2例,疼痛剧烈,需要额外给予镇痛药物的5例,未见其他不良反应。结论罗哌卡因在老年患者TKA后抑制术后疼痛的有效浓度ED50为0.072%,ED95为0.093%;不良反应发生率低。Objective To identify the effective concentrations of Ropivacaine in the modified fascial iliac compartment block(FICB)that would not affect the movement of the affected limb but would offer effective pain relief after total knee arthroplasty(TKA)in elderly patients.In addition,adverse reactions within 24 hours of FICB were examined.Methods This study was a prospective,single-arm sequential trial.Forty-five elderly patients treated with TKA at the First Affiliated Hospital of Soochow University between September 2021 and March 2022 were selected,with an American Society of Anesthesiologists(ASA)score ofⅠorⅡ.All patients were given ultrasound-guided FICB on the surgical side under general anesthesia and 10 minutes before the operation,and the injection volume was 30 ml.According to preliminary experiments and relevant literature,the initial concentration of Ropivacaine was 0.1%,and the concentration for the next patient was determined using a modified Dixon sequential method.If the quadriceps femoris muscle strength score of the first patient was≥4,there was no resting pain[visual analogue scale(VAS)score≤1],and the VAS score during activity was≤3,the concentration for the next patient would be reduced.Conversely,the concentration would be increased.The Ropivacaine concentration was increased or decreased by 0.01%each time and the trial would be stopped after 12 reentries.The median effective concentration(ED50),95%effective concentration(ED95)and corresponding 95%confidence interval(CI)of ropivacaine were calculated using the probit model.Meanwhile,adverse reactions within 24 hours of FICB were monitored.Results Of 43 elderly patients who completed the trial,the intervention was effective in 23 and ineffective in 20.While ensuring that postoperative limb movement in elderly patients was not affected,a single injection of 30 ml ropivacaine through FICB was able to effectively inhibit postoperative pain,and the ED50 and ED95 of ropivacaine were 0.072%(95%CI:0.065%-0.078%)and 0.093%(95%CI:0.084%-0.124%),re

关 键 词：关节成形术 置换 膝 疼痛 髂筋膜间隙阻滞 

分 类 号：R614[医药卫生—麻醉学]