【罂粟摘要】超声引导下肋锁臂丛神经阻滞中0.5%罗哌卡因的最小有效容积：一项剂量研究
超声引导下肋锁臂丛神经阻滞中0.5%罗哌卡因的最小有效容积：一项剂量研究
肋锁径路臂丛神经阻滞(CC-BPB)（横向扫描锁骨下窝中部识别臂丛神经束）是一种较新的局部麻醉技术，目前尚无超声引导CC-BPB所需0.5%罗哌卡因最小有效容量(MEV90)的研究。
测定0.5%罗哌卡因在超声引导下CC-BPB用于外科麻醉所需的MEV90。
前瞻性升降序贯分配研究设计。
2016年3月至2017年12月，香港某大学教学医院。
纳入48名ASA分级为I~III级、年龄在70岁或以下，择期行前臂或手部手术的患者。
超声引导下的CC-BPB使用罗哌卡因的浓度为0.5%。采用Dixon顺序分配法测定0.5%罗哌卡因的MEV90。使用罗哌卡因的量是根据上一位接受测试的患者的结果而定的。在一次阻滞失败后，下一位患者再进行阻滞时增加2ml的容量。如果阻滞成功，则下一个患者按概率（b=0.11）接受的剂量减少2ml，或在1-b=0.89的概率下，给予相同容积的罗哌卡因。在注射后45min，使用感觉和运动阻滞综合评分，阻滞成功被定义为至少14分(16分)。当成功阻滞45次时，研究停止。在剂量的平均值和范围区间研究中，使用中心等张回归（ the centred isotonic regression）计算MEV90的95%可信区间。
在超声引导下CC-BPB中，0.5%罗哌卡因的MEV90为20.9(95%可信区间为20.7~21.8)ml。平均手术准备时间为31.4±12.60min。
超声引导下CC-BPB手术麻醉所需0.5%罗哌卡因的MEV90为20.9ml。
原始文献来源： Wong MH, Karmakar MK, Mok LYH,et,al.Minimum effective volume of 0.5% ropivacaine for ultrasound-guided costoclavicular brachial plexus block A dose finding study[J].Eur J Anaesthesiol 2020 Sep;379(9).
Minimum effective volume of 0.5% ropivacaine for ultrasound-guided costoclavicular brachial plexus block: A dose fifinding study
BACKGROUND Costoclavicular brachial plexus block (CC-BPB) is a relatively new regional anaesthetic technique and there are no data on the minimum effective volume 90 (MEV90) of 0.5% ropivacaine required for an ultrasound-guided CC-BPB.
OBJECTIVE To determine the MEV90 of 0.5% ropivacaine required to produce surgical anaesthesia with an ultrasound-guided CC-BPB.
DESIGN Prospective up-down sequential allocation study design.
SETTING University teaching hospital in Hong Kong from March 2016 to December 2017.
PATIENTS Forty-eight, ASA physical status I to III patients, aged 70 years or less and scheduled for elective forearm or hand surgery under an ultrasound-guided CC-BPB, were recruited.
INTERVENTION Ultrasound-guided CC-BPB was performed with the assigned volume of 0.5% ropivacaine. The Dixon 'up-and-down’ sequential allocation method using the biased coin design was used to determine the MEV90 of 0.5% ropivacaine. The assigned volume of ropivacaine was based on the outcome of the previous patient. After a block failure the next patient received a volume increase of 2 ml. If the block was a success, the next patient was allocated, with a probability of b=0.11, to receive 2 ml less, or, with a probability of 1-b=0.89, the same volume.
MAIN OUTCOME MEASURES A successful block was defifined as a minimum score of 14 of 16 points, using a composite sensory and motor block score at 45 min after the injection. The study was stopped when 45 successful blocks were achieved. MEV90 with 95% confifidence interval was calculated using the centred isotonic regression for point and interval dose response studies.
RESULTS The MEV90 of 0.5% ropivacaine for ultrasound-guided CC-BPB was 20.9 (95% confifidence interval, 20.7 to 21.8) ml. The mean±SD time to readiness for surgery was 31.4-12.60 min.
CONCLUSION The MEV90 of 0.5% ropivacaine required to produce surgical anaesthesia with an ultrasound-guided CC-BPB is 20.9 ml.
CLINICAL TRIAL REGISTRATION The trial was registered with the Chinese Clinical Trials Registry (www.chictr.org.cn, ChiCTR-IOR-15007515, principal investigator: Manoj Kumar Karmakar, date of registration: 4 December 2015).
CLINICAL TRIAL NUMBER AND REGISTRY URL ChiCTRIOR-15007515, Chinese Clinical Trials Registry (www.chictr. org.cn).
Published online 24 July 2020
翻译：牛振瑛
编辑：冯玉蓉 佟睿
审校：曹莹