臂丛神经阻滞不同温度罗哌卡因的EC50
摘要
目的通过序贯法观察低温(4℃)与室温(23℃)罗哌卡因经超声引导下腋路臂丛神经阻滞其半数有效浓度(EC50)。方法 60例成年患者,美国标准协会(ASA)分级Ⅰ～Ⅱ,随机分为2组,每组30例,A组为低温罗哌卡因,B组为室温罗哌卡因,每组容量定量为25mL。以医学序贯实验方法(up-down method)确定下一患者罗哌卡因浓度。初始的罗哌卡因浓度设定为0.5%,若阻滞开始至30min内感觉神经被阻滞能满足手术切皮要求则定义为"成功",否则定义为"失败"。如"成功",下一患者则降低一个浓度,相反则升高一个浓度,浓度相差比值为1.2,根据Dixon-Massey法计算出罗哌卡因的EC50及95%CI值,并记录不良反应。结果根据序贯法及Massey公式计算得出A组罗哌卡因的EC50为0.203%(95%CI:0.163%～0.252%),B组罗哌卡因的EC50为0.322%(95%CI:0.300%～0.345%),两组比较差异有统计学意义(P<0.05)。结论使用低温(4℃)罗哌卡因进行外周神经阻滞能明显降低其半数有效浓度,无明显不良反应,值得临床推广应用。
引文
[1]杨旭刚,冯昌盛.右美托咪定联合罗哌卡因连续股神经阻滞用于全膝关节置换术的镇痛效果分析[J].重庆医学,2018,47(22):2978-2980.
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[10]李振伟,李宪营,岳志香.局麻药温度影响硬膜外麻醉后寒战的临床研究[J].中国现代医学杂志,2005,15(1):96-97,100.
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[12]RAM D,HERMIDA L B,PERETZ B.A comparison of warmed and room-temperature anesthetic for local anesthesia in children[J].Pediatr Dent,2002,24(4):333-336.
[13]HOGAN M E,VANDERVAART S,PERAMPALADASK,et al.Systematic review and meta-analysis of the effect of warming local anesthetics on injection pain[J].Ann Emerg Med,2011,58(1):86-98.
[14]SONG J G,JEON D G,KANG B J,et al.Minimum effective volume of mepivacaine for ultrasound-guided supraclavicular block[J].Korean J Anesthesiol,2013,65(1):37-41.
[15]DIXON W J.Staircase bioassay:the up-and-down method[J].Neurosci Biobehav Rev,1991,15(1):47-50.
[2]KHANNA A,SAXENA R,DUTTA A,et al.Comparison of ropivacaine with and without fentanyl vs bupivacaine with fentanyl for postoperative epidural analgesia in bilateral total knee replacement surgery[J].J Clin Anesth,2017,37(11):7-13.
[3]SCHNEPPER G D,KIGHTLINGER B I,JIANG Y Y,et al.A retrospective study evaluating the effect of low doses of perineural dexamethasone on ropivacaine brachial plexus peripheral nerve block analgesic duration[J].Pain Med,2018,19(7):1485-1493.
[4]ROSENBERG P H,HEAVNER J E.Temperature-dependent nerve-blocking action of lidocaine and halothane[J].Acta Anaesthesiol Scand,1980,24(4):314-320.
[5]沈邮静.低温低浓度利多卡因臂丛神经阻滞用于肩关节复位临床观察[J].中华实用诊断与治疗杂志,2010,24(8):799-800.
[6]EHRENBERG R,MORITZ S,GRAF B,et al.Effect of temperature of ropivacaine on onset time and anaesthetic quality in an ultrasound guided axillary plexus blockade.Comparison of ropivacaine 0.75%in three different temperatures(7degrees C,21degrees C,37degrees C)[J].Eur J Anaesthesiol,2010,27(1):128.
[7]HARPER A A,MACDONALD A G,WANN K T.The effect of temperature on the nerve-blocking action of benzyl alcohol on the squid giant axon[J].J Physiol,1983,338(1):51-60.
[8]林卓鹏,刘念,李慧东,等.低温小容量罗哌卡因行神经刺激仪联合超声引导腋路臂丛神经阻滞的临床研究[J].中国医学创新,2017,14(26):94-97.
[9]LEE R,KIM Y M,CHOI E M,et al.Effect of warmed ropivacaine solution on onset and duration of axillary block[J].Korean J Anesthesiol,2012,62(1):52-56.
[10]李振伟,李宪营,岳志香.局麻药温度影响硬膜外麻醉后寒战的临床研究[J].中国现代医学杂志,2005,15(1):96-97,100.
[11]BAINBRIDGE L C.Comparison of room temperature and body temperature local anaesthetic solutions[J].Br JPlast Surg,1991,44(2):147-148.
[12]RAM D,HERMIDA L B,PERETZ B.A comparison of warmed and room-temperature anesthetic for local anesthesia in children[J].Pediatr Dent,2002,24(4):333-336.
[13]HOGAN M E,VANDERVAART S,PERAMPALADASK,et al.Systematic review and meta-analysis of the effect of warming local anesthetics on injection pain[J].Ann Emerg Med,2011,58(1):86-98.
[14]SONG J G,JEON D G,KANG B J,et al.Minimum effective volume of mepivacaine for ultrasound-guided supraclavicular block[J].Korean J Anesthesiol,2013,65(1):37-41.
[15]DIXON W J.Staircase bioassay:the up-and-down method[J].Neurosci Biobehav Rev,1991,15(1):47-50.