文章摘要
不同浓度罗哌卡因髂腰肌平面阻滞对中老年患者髋关节置换术后镇痛效果及股四头肌肌力的影响
Effect of different concentrations of ropivacaine for iliopsoas plane block on postoperative analgesia and quadriceps muscle strength in middle-aged and elderly patients after hip arthroplasty
  
DOI：10.12089/jca.2025.04.003
中文关键词: 罗哌卡因  髂腰肌平面阻滞  髋关节置换术  镇痛效果  股四头肌肌力
英文关键词: Ropivacaine  Iliopsoas plane block  Hip replacement  Analgesia effect  Quadriceps muscle strength
基金项目:保定市科技计划项目（2241ZF238）
作者单位E-mail
黄瑾 071000,河北省保定市第一中心医院麻醉科  
王晟昱 071000,河北省保定市第一中心医院麻醉科  
韩亚楠 071000,河北省保定市第一中心医院麻醉科  
乔琳珊 071000,河北省保定市第一中心医院麻醉科  
袁利娟 071000,河北省保定市第一中心医院麻醉科  
白艳辉 071000,河北省保定市第一中心医院麻醉科  
陈旭 071000,河北省保定市第一中心医院手术室  
刘一博 071000,河北省保定市第一中心医院超声科  
宋立杰 071000,河北省保定市第一中心医院泌尿外科  
王春光 071000,河北省保定市第一中心医院麻醉科 13831253611@163.com 
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中文摘要:
      
目的：探讨术前不同浓度罗哌卡因髂腰肌平面阻滞对中老年患者髋关节置术后镇痛效果及股四头肌肌力的影响。
方法：选择择期行髋关节置换术患者90例，男48例，女42例，年龄40～74岁，BMI 18.5～30.0 kg/m 2，ASAⅠ—Ⅲ 级。将患者随机分为三组：0.25%罗哌卡因组（R1组）、0.375%罗哌卡因组（R2组）、0.5%罗哌卡因组（R3组），每组30例。麻醉诱导前三组分别采用0.25%、0.375%和0.5%罗哌卡因10 ml行髂腰肌平面阻滞。三组均采用0.5%罗哌卡因5 ml行股外侧皮神经阻滞。分别于入PACU、术后2、4、6、24和48 h时评估静息和活动时VAS疼痛评分、患肢股四头肌肌力，记录术中丙泊酚、瑞芬太尼和罗库溴铵用量、首次下床活动时间、术后48 h内地佐辛用量、患者镇痛满意度评分和头晕、尿潴留、恶心呕吐、神经损伤、血管损伤、下肢深静脉血栓形成、院内跌倒等并发症发生情况。
结果：与R1组比较，R2和R3组术后2、4、6和24 h静息时VAS疼痛评分明显减少（P<0.05），术后2、4和6 h活动时VAS疼痛评分明显降低（P<0.05），R3组术后2、4和6 h股四头肌肌力明显降低（P<0.05），R2和R3组术后地佐辛用量明显减少（P<0.05）。与R2组比较，R3组术后6 h股四头肌肌力明显降低（P<0.05）。
结论：术前0.375%罗哌卡因髂腰肌平面阻滞用于中老年患者髋关节置换术后的镇痛效果及对股四头肌肌力的影响优于0.25%和0.5%罗哌卡因。
英文摘要:
      
Objective: To investigate the effect of different concentrations of ropivacaine for iliopsoas plane block on postoperative analgesia and quadriceps muscle strength in hip arthroplasty.
Methods: Ninety patients who underwent elective hip arthroplasty, including 48 males and 42 females, aged 40-74 years, BMI 18.5-30.0 kg/m 2, and ASA physical status Ⅰ-Ⅲ, were selected. They were randomly divided into three groups: 0.25% ropivacaine group (group R1), 0.375% ropivacaine group (group R2), and 0.5% ropivacaine group (group R3), with 30 patients in each group. Before induction of anesthesia, the patients received 10 ml of 0.25%, 0.375%, or 0.5% ropivacaine for iliopsoas plane block in group R1, R2, R3, respectively. All three groups received 5 ml of 0.5% ropivacaine for lateral femoral cutaneous nerve block. VAS pain scores at rest and during activity, as well as quadriceps muscle strength, were recorded in the PACU and at 2, 4, 6, 24, and 48 hours postoperatively. The dosages of propofol, remifentanil, and rocuronium used during surgery, time to first ambulation, dosage of dezocine, and patient satisfaction were also recorded. Complications including dizziness, urinary retention, nausea and vomiting, nerve injury, vascular injury, deep vein thrombosis of the lower limbs, and hospital falls were documented.
Results: Compared with group R1, groups R2 and R3 had significantly lower VAS pain scores at rest 2, 4, 6, and 24 hours postoperatively (P < 0.05), and significantly lower VAS pain scores during activity at 2, 4, and 6 hours postoperatively (P < 0.05), group R3 exhibited significantly reduced quadriceps muscle strength at 2, 4, and 6 hours postoperatively (P < 0.05). The postoperative doses of dezocine were also lower in groups R2 and R3 compared with group R1 (P < 0.05). Compared with group R2, group R3 had significantly reduced quadriceps muscle strength 6 hours postoperatively (P < 0.05).
Conclusion: The effect of preoperative 0.375% ropivacaine for iliopsoas plane block on postoperative analgesia and quadriceps muscle strength in middle-aged and elderly patients after hip arthroplasty are better than 0.25% and 0.5% ropivacaine.
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