不同容量罗哌卡因髂腰肌平面阻滞对髋关节置换术患者股四头肌肌力的影响  

Effects of different volumes of ropivacaine for iliopsoas muscle plane block on quadriceps strength in patients undergoing hip arthroplasty

作　　者：黄瑾 韩亚楠 王晟昱 白艳辉[1] 陈旭 刘一博 赵克非 王春光[1] Huang Jin;Han Yanan;Wang Shengyu;Bai Yanhui;Chen Xu;Liu Yibo;Zhao Kefei;Wang Chunguang(Department of Aneshesiology,Baoding First Central Hospital,Baoding 071000,China;Operating Room,Baoding First Central Hospital,Baoding 071000,China;Department of Ultrasound,Baoding First Central Hospital,Baoding 071000,China)

机构地区：[1]保定市第一中心医院麻醉科,保定071000 [2]保定市第一中心医院手术室,保定071000 [3]保定市第一中心医院超声科,保定071000

出　　处：《中华麻醉学杂志》2025年第3期320-324,共5页Chinese Journal of Anesthesiology

基　　金：保定市科技计划项目(2241ZF238)。

摘　　要：目的:不同容量罗哌卡因髂腰肌平面阻滞对髋关节置换术患者股四头肌肌力的影响。方法:本研究为前瞻性研究,2023年6月至12月择期行髋关节置术患者75例,性别不限,年龄40~80岁,BMI 18.5~30.0 kg/m 2,ASA分级Ⅰ-Ⅲ级。采用计算机生成的随机序列将患者随机分为3组(n=25):罗哌卡因5 ml组(Ⅰ组)、罗哌卡因10 ml组(Ⅱ组)和罗哌卡因15 ml组(Ⅲ组)。麻醉诱导前3组分别采用0.5%罗哌卡因5、10、15 ml行髂腰肌平面阻滞,3组均采用0.5%罗哌卡因5 ml行股外侧皮神经阻滞。分别于入PACU、术后2、4、6、24和48 h时评估患肢股四头肌肌力和股四头肌运动阻滞情况,并记录术后48 h内地佐辛用量、患者镇痛满意度评分和并发症发生情况。结果:与Ⅰ组比较,Ⅲ组入PACU、术后2、4和6 h时股四头肌肌力评分降低,Ⅱ组入PACU时股四头肌运动阻滞率升高,Ⅲ组入PACU、术后2和4 h股四头肌运动阻滞率升高(P<0.05),Ⅱ组和Ⅲ组术后地佐辛用量降低(P<0.05)。结论:髂腰肌平面阻滞用于髋关节置换术患者罗哌卡因的推荐容量为10 ml。Objective:To evaluate the effects of different volumes of ropivacaine for iliopsoas muscle plane block on quadriceps strength in patients undergoing hip arthroplasty.Methods:In this prospective study,75 patients of either sex,aged 40-80 yr,with a body mass index of 18.5-30.0 kg/m 2,of American Society of Anesthesiologists Physical Status classificationⅠ-Ⅲ,undergoing elective hip arthroplasty from June to December 2023 at Baoding First Central Hospital,were randomized into 3 groups(n=25 each)by using a computer-generated randomization sequence:ropivacaine 5 ml group(groupⅠ),ropivacaine 10 ml group(groupⅡ),and ropivacaine 15 ml group(groupⅢ).Before induction of anesthesia,iliopsoas muscle plane block was performed with 0.5%ropivacaine 5,10 and 15 ml inⅠ,ⅡandⅢgroups,respectively.The lateral femoral cutaneous nerve block was carried out using 0.5%ropivacaine 5 ml in all the three groups.The quadriceps muscle strength and status of quadriceps motor block in the affected limb were assessed on admission to postanesthesia care unit(PACU)and at 2,4,6,24 and 48 h after surgery.The consumption of dezocine,score for patient′s satisfaction with analgesia,and occurrence of complications were recorded.Results:Compared with groupⅠ,the quadriceps muscle strength scores were significantly decreased on admission to PACU and at 2,4 and 6 h postoperatively in groupⅢ,the rate of quadriceps motor block was significantly increased on admission to PACU in groupⅡ,and the rate of quadriceps motor block was significantly increased on admission to PACU and at 2 and 4 h postoperatively in groupⅢ(P<0.05),and the consumption of dezocine was significantly decreased in groupⅡand groupⅢ(P<0.05).Conclusions:The recommended volume of ropivacaine for iliopsoas plane block is 10 ml in patients undergoing hip arthroplasty.

关 键 词：罗哌卡因 腰肌 神经传导阻滞 关节成形术 置换 髋 镇痛 四头肌 肌力 

分 类 号：R614[医药卫生—麻醉学]