有偏硬币设计序贯法测定罗哌卡因在超声引导下髋关节囊周围神经阻滞的90%最低有效剂量  

Determination of 90%minimum effective volume of ropivacaine for ultrasound-guided pericapsular nerve group block with the up-and-down biased coin design

作　　者：李春蓉 刘再英 陈萌 宋春霖 马鑫雨 周旋 Li Chunrong;Liu Zaiying;Chen Meng;Song Chunlin;Ma Xinyu;Zhou Xuan(The First Clinical School of Mudanjiang Medical University,Mudanjiang 157000,China;Department of Anesthesiology,Hongqi Hospi-tal Affiliated Mudanjiang Medical University,Mudanjiang 157000,China)

机构地区：[1]牡丹江医学院第一临床医学院,牡丹江157000 [2]牡丹江医学院附属红旗医院麻醉科,牡丹江157000

出　　处：《国际麻醉学与复苏杂志》2024年第4期372-378,共7页International Journal of Anesthesiology and Resuscitation

摘　　要：目的采用有偏硬币设计(BCD)序贯法测定罗哌卡因用于超声引导下髋关节囊周围神经(PENG)阻滞在髋部手术中能够阻滞股外侧皮神经的90%最低有效剂量(MEV90)。方法选择牡丹江医学院附属红旗医院2022年7月至2023年3月接受髋部手术、美国麻醉医师协会(ASA)分级Ⅱ级或Ⅲ级的患者为研究对象,在全麻诱导前30 min进行超声引导下PENG阻滞。采用BCD序贯法进行试验,初始患者注射0.375%罗哌卡因20 ml,下一位患者罗哌卡因的剂量将取决于上一位患者的阻滞结果,设置相邻剂量梯度为2 ml,若上一位阻滞失败则下一位患者的剂量增加2 ml,若上一位阻滞成功则下一位患者的剂量有11%的概率减少2 ml,有89%的概率保持不变,直到阻滞成功的患者有45例时研究结束。记录各患者使用的罗哌卡因剂量,采用保序回归计算出MEV90,通过自助算法计算出结果的95%置信区间(CI)。记录患者年龄、性别、体重指数(BMI)及手术时长;记录PENG阻滞操作时间、PENG阻滞成功的阻滞起效时间、术中瑞芬太尼和舒芬太尼的总用量、首次按压患者自控静脉镇痛(PCIA)泵的时间、术后48 h内补救镇痛的情况、48 h内股四头肌运动阻滞的发生率;记录所有患者围手术期其他不良反应的发生情况。结果共53例患者,其中23例男性,30例女性,ASA分级Ⅱ级29例、Ⅲ级24例,年龄(65±13)岁,BMI(21.7±1.3)kg/m^(2),手术时长(2.9±0.9)h。PENG阻滞能阻滞到股外侧皮神经的MEV90为27.09 ml,95%CI(25.93~29.79)ml。PENG阻滞操作时间(3.1±0.7)min,PENG阻滞成功的阻滞起效时间(18±5)min,术中舒芬太尼用量(18.7±2.0)μg,术中瑞芬太尼用量(0.26±0.08)mg,术后首次按压PICA时间(11±5)h,术后48 h内补救镇痛药酮咯酸氨丁三醇用量(22±21)mg。术后2 h有31%的患者出现股四头肌运动阻滞,术后48 h时无患者出现运动阻滞。围手术期患者出现一过性低血压6例、术后恶心呕吐5例、皮下血肿1例。�Objective To determine the 90%minimum effective volume(MEV90)of ropivacaine for ultrasound-guided pericapsular nerve group(PENG)block to anesthetize the lateral femoral cutaneous nerve during hip surgery with the up-and-down biased coin design(BCD).Methods Patients with American Society of Anesthesiologists(ASA)gradeⅡorⅢwho underwent hip surgery in Hongqi Hospital Affiliated to Mudanjiang Medical University from July 2022 to March 2023 were selected.They were subject to ultrasound-guided PENG block 30 min before general anesthesia induction.Then,the up-and-down BCD method was performed.The dose of 0.375%ropivacaine for the initial patient was 20 ml.The dose of ropivacaine for the next patient would depend on the block results of the previous patient,where the adjacent dose gradient was set to 2 ml.If the block failed,the dose of the next patient would increase by 2 ml.If the block succeeded,the dose of the next patient would be reduced by 2 ml at probability of 11%,and would remain the same at a probability of 89%.The test would come to the end when there were 45 successful cases.The dose of ropivacaine for each patient was recorded.MEV90 was calculated through isotonic regression and the 95%confidence interval(CI)of the result was calculated through the bootstrap algorithm.Their age,sex,body mass index(BMI)and operation time were recorded.The time of PENG block operation,the time to successful onset of PENG block,the total intraoperative dosage of remifentanil and sufentanil,the time of first compression of patient-controlled intravenous analgesia(PCIA)pump,rescue analgesia within 48 h after operation,the incidence of quadriceps movement block within 48 h after operation,and the incidence of other adverse reactions during the perioperative period were recorded.Results There were 53 patients,including 23 men and 30 women,where 29 patients were at ASA gradeⅡand 24 at ASA gradeⅢ.The age was(65±13)years,BMI was(21.7±1.3)kg/m^(2) and the operation time was(2.9±0.9)h.The MEV90 of PENG block to lateral femor

关 键 词：超声引导 髋关节囊周围神经阻滞 罗哌卡因 最低有效剂量 有偏硬币设计 保序回归 

分 类 号：R61[医药卫生—外科学]