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| 超声引导下不同浓度罗哌卡因横突间阻滞在经皮肾镜碎石取石术中的比较 |
| Comparison of ultrasound-guided intertransverse process block with different concentrations of ropivacaine in percutaneous nephrolithotomy |
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| DOI：10.12089/jca.2025.10.006 |
| 中文关键词: 横突间阻滞 经皮肾镜碎石取石术 超声引导 罗哌卡因 加速术后康复 |
| 英文关键词: Intertransverse process block Percutaneous nephrolithotomy Ultrasound-guided Ropivacaine Enhanced recovery after surgery |
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| 中文摘要: |
目的：观察和比较超声引导下不同浓度罗哌卡因横突间阻滞在经皮肾镜碎石取石术的术中麻醉效果及术后早期镇痛作用。
方法：选择2024年1月至2025年1月择期行单侧经皮肾镜碎石取石术患者87例，男53例，女34例，年龄18～64岁，BMI 18.5～28.0 kg/m2，ASAⅠ或Ⅱ级。采用随机数字法将患者分为三组：0.25%罗哌卡因组（L组）、0.375%罗哌卡因组（M组）和0.5%罗哌卡因组（H组），每组29例。三组均于T10水平肋横突上韧带后间隙使用不同浓度罗哌卡因25 ml行单点超声引导下横突间阻滞，术中VAS疼痛评分≥4分时静注芬太尼0.1 mg。记录术后0～24 h平均VAS疼痛评分的曲线下面积（AUCVAS）。记录阻滞起效时间、阻滞平面数、术中芬太尼使用情况、术后1、2、6、12、24 h静息和活动时VAS疼痛评分、术后首次按压镇痛泵时间、术后24 h内舒芬太尼总用量以及术后24 h内恶心呕吐、低血压、穿刺点血肿、感染、局麻药中毒等不良反应发生情况。
结果：与L组比较，M组阻滞起效时间明显缩短，术中芬太尼使用率明显降低（P＜0.05）；H组术后0～24 h的AUCVAS明显减小，阻滞起效时间明显缩短，术中芬太尼使用率和术后1、2、6 h静息和活动时VAS疼痛评分明显降低，术后首次按压镇痛泵时间明显延长，术后24 h内舒芬太尼总用量明显减少，术后使用镇痛泵累积概率明显降低（P＜0.05）。与M组比较，H组术后0～24 h的AUCVAS明显减小，阻滞起效时间明显缩短，术后1、2、6 h静息和活动时VAS疼痛评分均明显降低（P＜0.05）。Cox回归分析显示，与L组比较，H组按压镇痛泵的概率降低43% （HR=0.57，95%CI 0.37～0.90，P=0.02）。L组和M组各有2例（7%）患者出现恶心呕吐，H组有3例（10%）患者出现恶心呕吐、1例（3%）出现低血压，三组不良反应发生率差异无统计学意义。
结论：与0.25%和0.375%罗哌卡因比较，0.5%罗哌卡因用于超声引导下横突间阻滞起效更快、镇痛维持时间更长，术后早期镇痛效果更佳，可作为经皮肾镜碎石取石术患者以横突间阻滞为主要麻醉方式时的推荐浓度。 |
| 英文摘要: |
Objective: To evaluate and compare the intraoperative anesthetic efficacy and early postoperative analgesia of ultrasound-guided intertransverse process block using different concentrations of ropivacaine in patients undergoing percutaneous nephrolithotomy.
Methods: Eighty-seven patients scheduled for unilateral percutaneous nephrolithotomy from January 2024 to January 2025 were selected, 53 males and 34 females, aged 18-64 years, BMI 18.5-28.0 kg/m2, ASA physical status Ⅰ or Ⅱ, were randomly divided into three groups using the random number method: 0.25% ropivacaine group (group L), 0.375% ropivacaine group (group M), and 0.5% ropivacaine group (group H), 29 patients in each group. All patients received ropivacaine 25 ml for single-point ultrasound-guided intertransverse process block at the T10 level in the retro-superior costotransverse ligament space, and fentanyl 0.1 mg was administered intravenously when intraoperative VAS pain scores were ≥ 4 points. The area under the curve of the average VAS pain scores (AUCVAS) within 24 hours postoperatively were recorded. The onset time of sensory block, number of blocked dermatomes, the usage of intraoperative fentanyl consumption, VAS pain scores at rest and during movement at 1 hour, 2, 6, 12, and 24 hours postoperatively, the first time of using patient-controlled analgesia, total sufentanil consumption within 24 hours postoperatively, and adverse events within 24 hours postoperatively, including postoperative nausea and vomiting, hypotension, hematoma at the puncture site, infection, and local anesthetic toxicity were recorded.
Results: Compared with group L, the nerve block onset time was significantly shortened and the usage rate of intraoperative fentanyl was significantly decreased in group M (P < 0.05), the AUCVAS within 24 hours postoperatively was significantly decreased, the onset time of nerve block was significantly shortened,the usage rate of intraoperative fentanyl, the VAS pain scores at rest and during movement 1 hour, 2, and 6 hours after surgery were significantly decreased, the time to first patient-controlled analgesia was significantly prolonged, the cumulative sufentanil consumption at 24 hours postoperatively, and the cumulative probability of patient-controlled analgesia were significantly decreased in group H (P < 0.05). Compared with group M, the AUCVAS within 24 hours postoperatively was significantly decreased, the onset time of nerve block was significantly shortened, the VAS pain scores at rest and during movement 1 hour, 2, and 6 hours after surgery were significantly decreased in group H (P < 0.05). Cox regression analysis showed that, compared with group L, the probability of patient-controlled analgesia was reduced by 43% in group H (HR = 0.57, 95% CI 0.37-0.90, P = 0.02). There were 2 patients (7%) in both group L and group M experienced nausea and vomiting, while there were 3 patients (10%) reported nausea and vomiting, and 1 patient (3%) developed hypotension in group H. There were no significant differences in the incidence of adverse events among the three groups.
Conclusion: Compared with 0.25% and 0.375% ropivacaine, 0.5% ropivacaine used for ultrasound-guided intertransverse process block demonstrated a faster onset, longer duration of analgesia, and superior early postoperative pain relief. This concentration may be recommended as the optimal choice when using intertransverse process block as the primary anesthetic technique for percutaneous nephrolithotomy. |
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