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| 全麻复合肌间沟臂丛神经阻滞镇痛时罗哌卡因的半数有效浓度 |
| Determination of EC50 of ropivacaine for postoperative analgesia under general anesthesia combined with single interscalene brachial plexus block |
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| DOI：10.12089/jca.2018.01.004 |
| 中文关键词: 肌间沟臂丛神经阻滞 序贯法 罗哌卡因 镇痛 |
| 英文关键词: Interscalene brachial plexus block Sequential method Ropivacaine Analgesia |
| 基金项目: |
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| 中文摘要: |
| 目的 测定全麻复合肌间沟臂丛神经阻滞用于肩关节镜手术拔除气管插管后伤口镇痛的罗哌卡因半数有效浓度(EC50)。方法 选择择期行肩关节镜手术的患者22例,男9例,女13例,BMI 18～28 kg/m2，ASA Ⅰ或Ⅱ级,在超声和神经刺激器辅助下在C6水平以罗哌卡因5 ml行臂丛神经阻滞,其浓度由上下序贯法确定,起始浓度0.5%,间隔浓度比值1.2。研究终点为:7个上-下周期,或者罗哌卡因浓度≤0.1%或≥1%,并持续7例。按照Dixon-Massey EC50序贯法计算公式计算罗哌卡因的EC50及其95%CI。统计术后患者的膈神经阻滞率,使用配对t检验分析患者术前、拔管后的肺功能指标的变化。结果 罗哌卡因行肌间沟臂丛神经阻滞镇痛的EC50为0.21%（95%CI 0.18%～0.25%）。膈神经阻滞率为9例(40.9%)。拔管后FVC、FEV1/FVC明显低于术前(P<0.05)。术前、拔管后FEV1差异无统计学意义。结论 全麻复合罗哌卡因行肌间沟臂丛神经阻滞镇痛时的EC50为0.21%,其95%CI为（0.18%～0.25%）。 |
| 英文摘要: |
| Objective To determine the 50% minimum effective concentration (EC50) of ropivacaine for postoperative analgesia after shoulder arthroscopy under general anesthesia combined with interscalene brachial plexus block. Methods Patients undergoing selective shoulder arthroscopy were included in this study. There were 9 males and 13 females, BMI 18-28 kg/m2, falling into ASA physical status Ⅰ or Ⅱ. The interscalene brachial plexus block was achieved under the guidance of ultrasound and nerve stimulator at the level of C6. The upper trunk of interscalene brachial plexus was blocked with 5 ml ropivacaine. The concentration of ropivacaine intially was 0.5% and then depended on the response of the previous patient’s postoperative NRS scale. The target ropivacaine concentration was determined by up and down sequential method. The ratio of two consecutive ropivacaine was 1.2. Two termination conditions were, firstly, to achieve seven negative-positive up-and-down deflections required to calculate EC50, and secondly, to deriminate if 7 were positive outcomes using 5 ml of 0.1% ropivacaine or 7 were negative outcomes using 5 ml of 1% ropivaciane. EC50 and 95%CI of ropivacaine was calculated using the formula of Dixon-Massey sequential method. The incidence of hemidiaphragmatic paresis was evaluated. Pre- and post-operative pulmonary function was compared using paired t test. Results The EC50 of ropivacaine was 0.21% (95%CI 0.18%-0.25%). The incidence of hemidiaphragmatic paresis was 9 cases(40.9%). Postoperative FVC and FEV1/FVC was significantly decreased than preoperative, but FEV1 (P=0.116) was not. Conclusion For patients undergoing shoulder arthroscopy under general anesthesia and interscalene brachial plexus block, the minimum effective concentration of ropivacaine for analgesia of EC50 is 0.21%, 95% CI 0.18%-0.25%. |
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