【罂粟摘要】实时超声引导下椎管内麻醉用于下肢手术时罗哌卡因的最小局麻药剂量:一项随机对照试验
实时超声引导下椎管内麻醉用于下肢手术时罗哌卡因的最小局麻药剂量:一项随机对照试验
翻译：何幼芹 编辑：佟睿 审校：曹莹
贵州医科大学 高鸿教授课题组
尽管实时超声引导下腰麻比传统腰麻有很多优点，但它似乎需要更高剂量的罗哌卡因。本研究旨在确定实时超声引导下腰麻用于下肢手术时不同浓度罗哌卡因的最小局麻药剂量(MLAD)和95%可信区间。
本研究共纳入60例行择期下肢手术的患者，将其随机分为高罗哌卡因组和低罗哌卡因组。采用改良序贯法，分别给予两组患者不同初始剂量和不同浓度罗哌卡因。高罗哌卡因组和低罗哌卡因组分别给予0.75%和0.5%浓度的罗哌卡因进行麻醉。评估患者的基线特征、MLAD和95%可信区间。记录两组患者感觉阻滞的最高平面、感觉阻滞到达T10的时间、感觉阻滞>T10的持续时间、感觉阻滞的最高平面、运动阻滞的起效时间和持续时间。并对患者的生命体征和不良反应进行了比较。
高罗哌卡因组和低罗哌卡因组的MLAD分别为17.176(16.276~18.124)mg和20.192(19.256~21.174)mg。此外，与0.75%罗哌卡因组相比，0.5%罗哌卡因组的运动阻滞维持时间显著减少(P=0.0309)。
在实时超声引导下椎管内麻醉用于下肢手术时，0.75%和0.5%浓度的罗哌卡因均能提供满意的麻醉效果。我们的结果表明，缩短运动阻滞时间对患者有好处，包括更早的活动和更快的康复过程。
原始文献来源：
Zheng T, Ye P, Wu W, et al. Minimum local anesthetic dose of ropivacaine in real-time ultrasound-guided intraspinal anesthesia for lower extremity surgery: a randomized controlled trial.[J].Ann Transl Med, 2020, 8: 861.
Minimum local anesthetic dose of ropivacaine in real-time ultrasound-guided intraspinal anesthesia for lower extremity: a randomized controlled trial
Background: Despite the many advantages real-time ultrasound-guided lumbar anesthesia has over traditional lumbar anesthesia, it seemingly involves a much higher dose of ropivacaine. This study aimed to determine the minimum local anesthetic dose (MLAD) and the 95% confidence interval of ropivacaine at different concentrations in real-time ultrasound-guided lumbar anesthesia for lower extremity surgery.
Methods: A total of 60 patients who were consecutively scheduled for selective lower extremity surgery were enrolled. The patients were randomly divided into two groups, which each received different concentrations of ropivacaine at different initial dosages when Dixon’s up-and-down sequential method was applied. The high ropivacaine group and the low ropivacaine group received 0.75% and 0.5% ropivacaine, respectively. The patients’ baseline characteristics, the MLAD, and the 95% confidence interval were assessed. The highest level of sensory block, time to reach the T10 sensory block, duration for sensory blocks higher than T10, highest plane for sensory block, and onset time and duration for motor block were recorded. Comparisons were also made between the patients’ vital signs and adverse reactions.
Results: The minimum local anaesthetic dose (MLAD) and 95% confidence interval in the high ropivacaine group and the low ropivacaine group were 17.176 (16.276 to 18.124) and 20.192 (19.256 to 21.174) mg, respectively. Moreover, motor block maintenance was greatly reduced in the 0.5% ropivacaine compared to the 0.75% ropivacaine group (P=0.0309).
Conclusions: In real-time ultrasound-guided intraspinal anesthesia for lower extremity surgery, both 0.75% and 0.5% ropivacaine provide satisfactory anesthesia. Our results suggest that shortened motor block duration can hold benefits for patients including earlier mobilization and a quicker rehabilitation process.