下肢手术患者罗哌卡因连续FICB术后镇痛最低有效浓度的临床研究  

Clinical study on the minimum effective concentration of ropivacaine for continuous FICB as postoperative analgesia of patients undergoing lower limb surgery

作　　者：高洁彦 杨蕊 侯晓敏 沈徐 GAO Jieyan;YANG Rui;HOU Xiaomin(Anesthesia and Pain Medicine Center,The First Hospital of Jiaxing/Affiliated Hospital of Jiaxing University,Jiaxing 314000,China)

机构地区：[1]嘉兴市第一医院、嘉兴大学附属医院麻醉与疼痛医学中心,浙江嘉兴314000

出　　处：《全科医学临床与教育》2025年第2期122-124,128,共4页Clinical Education of General Practice

基　　金：嘉兴市公益性研究计划项目(2022AD30041)。

摘　　要：目的探讨罗哌卡因应用于连续髂筋膜间隙阻滞(FICB)术后镇痛的最低有效浓度。方法选取经手术治疗的24例下肢膝部以上骨折患者。所有患者于全麻手术结束后即在超声引导下行FICB,设定罗哌卡因初始浓度为0.1%,初始容量为20 mL,输注速率为10 mL/h,锁定时间为30 min,连续镇痛48 h。记录患者术后30 min(T_(0))、1 h(T_(1))、6 h(T_(2))、12 h(T_(3))、24 h(T_(4))、48 h(T_(5))被动与主动运动时的疼痛视觉模拟评分(VAS)、运动功能、外周神经阻滞自控镇痛(PCNA)按压次数及直腿抬高角度。运用Dixon序贯法确定罗哌卡因浓度,Probit概率法计算罗哌卡因的半数有效浓度(EC_(50))及95%CI。结果24例患者在T_(0)~T_(5)时间范围内,VAS评分逐渐降低,Bromage评分逐渐降低,PCNA按压次数逐渐减少,直腿抬高角度明显增加,差异均有统计学意义(F分别=19.54、28.11、33.37、328.59,P均<0.05)。罗哌卡因序贯试验结果显示,罗哌卡因用于连续FICB术后镇痛的EC_(50)为0.048%,95%CI为0.040%~0.059%。结论罗哌卡因应用于连续FICB术后镇痛最低有效浓度为0.048%。Objective To investigate the minimum effective concentration of ropivacaine for continuous fascia iliaca compartment block(FICB)as postoperative analgesia.Methods Twenty-four patients with lower limb fractures above the knee treated with surgery were selected.All patients were given ultrasound-guided FICB immediately after the end of surgery under general anesthesia.The initial concentration and volume,infusion rate and locking time of ropivacaine were 0.1%,20mL,10mL/h and 30 min,respectively.The analgesia lasted for 48 h.The visual analogue scale(VAS)scores for pain induced by passive and active movements,motor function,pressing times of patient-controlled neural analgesia(PCNA)at 30 min(T_(0)),1 h(T_(1)),6 h(T_(2)),12 h(T_(3)),24 h(T_(4)),and 48 h(T_(5))after surgery and the angle of straight leg elevation were recorded.Dixon sequential method was used to determine the concentration of ropivacaine,and Probit probability method was used to calculate the half effective concentration(EC_(50))and 95%confidence interval(CI)of ropivacaine.Results VAS scores,Bromage scores and the pressing times of PCNA decreased gradually,and the angle of straight leg elevation increased significantly from T_(0)to T_(5),with statistically significant differences(F=19.54,28.11,33.37,328.59,P<0.05).Ropivacaine sequential test results showed that EC_(50)and 95%CI of ropivacaine used for continuous FICB as postoperative analgesia were 0.048%and 0.040%-0.059%.Conclusion The minimum effective concentration of ropivacaine for continuous FICB as postoperative analgesia is 0.048%.

关 键 词：罗哌卡因 髂筋膜间隙阻滞 术后镇痛 最低有效浓度 Dixon序贯法 

分 类 号：R73[医药卫生—肿瘤]