右美托咪定行超声引导下臂丛神经阻滞时罗哌卡因的半数有效剂量研究
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摘要
目的:探索行超声引导下臂丛神经阻滞联合应用右美托咪定时0.375%罗哌卡因的半数有效剂量(ED_(50))。方法:选取择期行肩关节镜手术的患者30例,性别不限,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级Ⅰ级或Ⅱ级。患者入手术室即开始泵注右美托咪定(0.5μg·kg~(-1)·h~(-1)),于超声引导下行肌间沟臂丛阻滞,给予0.375%罗哌卡因首剂量100 mg,后各相邻患者剂量之间的比值为1.2。采用改良序贯法计算0.375%罗哌卡因的ED_(50)及95%可信区间。观察患者的麻醉效果及有无药品不良反应(ADRs)发生。结果:肩关节镜手术患者行超声引导下臂丛神经阻滞复合右美托咪定时0.375%罗哌卡因的ED_(50)为19 ml,95%可信区间为17.5～21.5 ml。ADRs观察发现1例霍纳(Horner)综合征,1例低心率、低血压事件。结论:肩关节镜手术患者行超声引导下臂丛神经阻滞时复合右美托咪定,可减少罗哌卡因的剂量,且麻醉效果好,无严重ADRs发生。
Objective: To investigate the median effective dose(ED_(50)) of 0.375% ropivacaine combined with dexmedetomidine for ultrasound-guided interscalene brachial plexus block(ISBPB) of the patients undergoing arthroscopic shoulder surgery.Methods: Thirty patients who were classified as grade Ⅰ or Ⅱ according to American Society of Anesthesiologists(ASA) and underwent shoulder arthroscopic surgery were enrolled for the study regardless of gender.The patients started to have the pumping of dexmedetomidine(0.5 μg·kg~(-1)·h~(-1)) for ultrasound-guided interscalene brachial plexus block in arthroscopic shoulder surgery when they were admitted into the operating room.The starting dose of 0.375% ropivacaine was 100 mg for the first patient and the ratio between adjacent patients' doses was 1.2.The ED_(50) and 95% confidence interval of ropivacaine was calculated by up-and-down methodology.The anesthetic effect and adverse drug reactions(ADRs) of the patients were observed closely.Results: The ED_(50) of 0.375% ropivacaine combined with dexmedetomidine for ultrasound-guided interscalene brachial plexus block for arthroscopic shoulder surgery was 19 ml and 95% confidence interval was 17.5-21.5 ml.There was one case of Horner syndrome and one case of hypotensive bradycardia event during surgery.Conclusion: Ropivacaine combined with dexmedetomidine in ultrasound-guided brachial plexus block could reduce the dosage of ropivacaine in patients undergoing shoulder arthroscopic surgery,with good anesthetic effect and without severe ADRs.
Objective: To investigate the median effective dose(ED_(50)) of 0.375% ropivacaine combined with dexmedetomidine for ultrasound-guided interscalene brachial plexus block(ISBPB) of the patients undergoing arthroscopic shoulder surgery.Methods: Thirty patients who were classified as grade Ⅰ or Ⅱ according to American Society of Anesthesiologists(ASA) and underwent shoulder arthroscopic surgery were enrolled for the study regardless of gender.The patients started to have the pumping of dexmedetomidine(0.5 μg·kg~(-1)·h~(-1)) for ultrasound-guided interscalene brachial plexus block in arthroscopic shoulder surgery when they were admitted into the operating room.The starting dose of 0.375% ropivacaine was 100 mg for the first patient and the ratio between adjacent patients' doses was 1.2.The ED_(50) and 95% confidence interval of ropivacaine was calculated by up-and-down methodology.The anesthetic effect and adverse drug reactions(ADRs) of the patients were observed closely.Results: The ED_(50) of 0.375% ropivacaine combined with dexmedetomidine for ultrasound-guided interscalene brachial plexus block for arthroscopic shoulder surgery was 19 ml and 95% confidence interval was 17.5-21.5 ml.There was one case of Horner syndrome and one case of hypotensive bradycardia event during surgery.Conclusion: Ropivacaine combined with dexmedetomidine in ultrasound-guided brachial plexus block could reduce the dosage of ropivacaine in patients undergoing shoulder arthroscopic surgery,with good anesthetic effect and without severe ADRs.
引文
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[11] 李挺,曹亲亲,李军.不同浓度罗哌卡因用于臂丛神经感觉与运动分离阻滞的效果[J].中华麻醉学杂志,2010,30(12):1462-1464.LI Ting,CAO Qinqin,LI Jun.Appropriate concentration of ropivacaine for differential sensory and motor block of brachial plexus[J].Chin J Anesthesiol,2010,30(12):1462-1464.In Chinese with English abstract.
[12] 肖实,曲良超,曾剑文,等.罗哌卡因臂丛运动与感觉分离阻滞在显微手术中的应用[J].中华显微外科杂志,2011,34(4):311-312.XIAO Shi,QU Liangchao,ZENG Jianwen,et al.Application of brachial plexus motor and sensory separation blocked by ropivacaine in microsurgery[J].Chin J Microsurg,2011,34(4):311-312.In Chinese.
[13] Chierichini A,Frassanito L,Vergari A,et al.The effect of norepinephrine versus epinephrine in irrigation fluid on the incidence of hypotensive/bradycardic events during arthroscopic rotator cuff repair with interscalene block in the sitting position[J].Arthroscopy,2015,31(5):800-806.
[14] Orebaugh S L,Williams B A,Bigeleisen P E.The up-down methodology and practical peripheral nerve blockade[J].Reg Anesth Pain Med,2010,35(5):480-481.
[2] McNaught A,Shastri U,Carmichael N,et al.Ultrasound reduces the minimun effective local anaesthetic volume compared with peripheral nerve stimulation for interscalene block[J].Br J Anaesth,2011,106(1):124-130.
[3] Kang R,Jeong J S,Yoo J C,et al.Effective dose of intravenous dexmedetomidine to prolong the analgesic duration of interscalene brachial plexus block:a single-center,prospective,double-blind,randomized controlled trial[J].Reg Anesth Pain Med,2018,43(5):488-495.
[4] 吴新民,薛张纲,马虹,等.右美托咪定临床应用专家共识(2018)[J].临床麻醉学杂志,2018,34(8):820-823.WU Xinmin,XUE Zhanggang,MA Hong,et al.Expert consensus on clinical application of dexmedetomidine(2018)[J].J Clin Anesthesiol,2018,34(8):820-823.In Chinese.
[5] Saranteas T,Finlayson R J,Tran D Q.Dose-finding methodology for peripheral nerve blocks[J].Reg Anesth Pain Med,2014,39(6):550-555.
[6] Stylianou M,Proschan M,Flournoy N.Estimating the probability of toxicity at the target dose following an up-and-down design[J].Stat Med,2003,22(4):535-543.
[7] Pace N L,Stylianou M P.Advances in and limitations of up-and-down methodology:a précis of clinical use,study design,and dose estimation in anesthesia research[J].Anesthesiology,2007,107(1):144-152.
[8] Vorobeichik L,Brull R,Abdallah F W.Evidence basis for using perineural dexmedetomidine to enhance the quality of brachial plexus nerve blocks:a systematic review and meta-analysis of randomized controlled trials[J].Br J Anaesth,2017,118(2):167-181.
[9] Gautier P,Vandepitte C,Ramquet C,et al.The minimum effective anesthetic volume of 0.75% ropivacaine in ultrasound-guided interscalene brachial plexus block[J].Anesth Analg,2011,113(4):951-955.
[10] Shin S W,Byeon G J,Yoon J U,et al.Effective analgesia with ultrasound-guided interscalene brachial plexus block for postoperative pain control after arthroscopic rotator cuff repair[J].J Anesth,2014,28(1):64-69.
[11] 李挺,曹亲亲,李军.不同浓度罗哌卡因用于臂丛神经感觉与运动分离阻滞的效果[J].中华麻醉学杂志,2010,30(12):1462-1464.LI Ting,CAO Qinqin,LI Jun.Appropriate concentration of ropivacaine for differential sensory and motor block of brachial plexus[J].Chin J Anesthesiol,2010,30(12):1462-1464.In Chinese with English abstract.
[12] 肖实,曲良超,曾剑文,等.罗哌卡因臂丛运动与感觉分离阻滞在显微手术中的应用[J].中华显微外科杂志,2011,34(4):311-312.XIAO Shi,QU Liangchao,ZENG Jianwen,et al.Application of brachial plexus motor and sensory separation blocked by ropivacaine in microsurgery[J].Chin J Microsurg,2011,34(4):311-312.In Chinese.
[13] Chierichini A,Frassanito L,Vergari A,et al.The effect of norepinephrine versus epinephrine in irrigation fluid on the incidence of hypotensive/bradycardic events during arthroscopic rotator cuff repair with interscalene block in the sitting position[J].Arthroscopy,2015,31(5):800-806.
[14] Orebaugh S L,Williams B A,Bigeleisen P E.The up-down methodology and practical peripheral nerve blockade[J].Reg Anesth Pain Med,2010,35(5):480-481.