0.375%罗哌卡因用于老年患者股骨颈骨折髋关节囊周围神经阻滞的半数有效容量  

Median effective volume of 0.375%ropivacaine for ultrasound-guided pericapsular nerve block in elderly patients with femoral neck fracture

作　　者：郑龙彬 秦卫民 梁文波 尹宁 张晓静 马晴 任志强 ZHENG Longbin;QIN Weimin;LIANG Wenbo;YIN Ning;ZHANG Xiaojing;MA Qing;REN Zhiqiang(Department of Anesthesiology,Sir Run Run Hospital,Nanjing Medical University,Nanjing 210000,China)

机构地区：[1]南京医科大学附属逸夫医院麻醉科,210000

出　　处：《临床麻醉学杂志》2023年第8期842-845,共4页Journal of Clinical Anesthesiology

基　　金：南京医科大学科技发展基金一般项目(NMUB20210351)。

摘　　要：目的采用序贯法测定0.375%罗哌卡因用于老年患者股骨颈骨折超声引导下髋关节囊周围神经(PENG)阻滞麻醉前镇痛的半数有效容量(EV_(50))。方法选择2022年1—8月拟行髋关节置换手术的股骨颈骨折老年患者23例,男9例,女14例,年龄≥65岁,BMI 18~24 kg/m 2,ASAⅠ—Ⅲ级。在超声引导下行PE NG阻滞,定位成功后,于腰肌肌腱后方和耻骨支之间的肌筋膜平面单次注入0.375%罗哌卡因。采用序贯法测定0.375%罗哌卡因半数有效容量(EV_(50)),初始给药容量为12.5 ml,相邻容量梯度为1.5 ml。注药后20 min评估镇痛效果,若患肢活动时VAS疼痛评分<4分,视为镇痛有效,则下一例患者容量降低一个梯度;反之,则升高一个梯度,至出现7个镇痛有效-镇痛无效交叉点时结束研究。采用Probit概率回归法计算0.375%罗哌卡因用于老年患者股骨颈骨折超声引导下PENG阻滞的EV_(50)、95%有效容量(EV_(95))及其95%可信区间(CI)。结果0.375%罗哌卡因EV_(50)为8.84 ml(95%CI 7.50~9.85 ml),EV_(95)为11.12 ml(95%CI 9.78~17.09 ml)。结论0.375%罗哌卡因用于老年患者股骨颈骨折超声引导下单侧PENG阻滞进行麻醉前镇痛的EV_(50)为8.84 ml(95%CI 7.50~9.85 ml)。Objective To determine the median effective volume(EV_(50))of 0.375%ropivacaine for ultrasound-guided pericapsular nerve group(PENG)block using sequential method in elderly patients with femoral neck fracture.Methods Twenty-three elderly patients,9 males and 14 females,aged≥65 years,BMI 18-24 kg/m 2,ASA physical statusⅠ-Ⅲ,who underwent hip replacement surgery from January 2022 to August 2022 were selected.The PENG block was guided under ultrasound.After successful positioning,0.375%ropivacaine was injected into the myofascial plane between the psoas tendon and the pubic ramus.Sequential method was used for the study,the initial dose was 12.5 ml,and the adjacent capacity gradient was 1.5 ml.The analgesic effect was evaluated 20 minutes after injection.If the VAS pain score of active limb<4 points,it was considered effective,and the next patient was given a lower dose,on the contrary,a higher dose was given,and 7 analgesic effective-ineffective inflection points were achieved.The probabilistic regression was used for determining the EV_(50),95%effective volume(EV_(95))and corresponding 95%confidence interval(CI)of 0.375%ropivacaine for ultrasound-guided PENG block.Results The EV_(50)of 0.375%ropivacaine for ultrasound-guided PENG block is 8.84 ml(95%CI 7.50-9.85 ml).The EV_(95)of 0.375%ropivacaine for utrasound-guided PENG block is 11.12 ml(95%CI 9.78-17.09 ml).Conclusion The EV_(50)of 0.375%ropivacaine for ultrasound-guided PENG block is 8.84 ml(95%CI 7.50-9.85 ml).

关 键 词：半数有效容量 量-效关系 序贯法 髋关节囊周围神经阻滞 超声引导 老年 

分 类 号：R614[医药卫生—麻醉学]