| 摘要: |
| 目的 采用Dixon上下序贯法测定胸腔镜手术镇痛时竖脊肌平面阻滞中0.5%罗哌卡因的有效容量。方法 选取2020年1-9月在上海中医药大学附属岳阳中西医结合医院行胸腔镜下肺叶切除术的患者31例，均根据手术部位在超声引导下行相应脊神经节段的0.5%罗哌卡因竖脊肌平面阻滞。0.5%罗哌卡因初始容量为35 mL，若第1例患者达到最佳有效镇痛标准则第2例患者的药物容量下降1个阶梯即减少2 mL，相反若第1例患者未达到最佳有效镇痛标准则第2例患者药物容量需增加2 mL，以此类推，直至出现7个无效容量的拐点。同时符合以下3项标准即判断达到最佳有效镇痛标准：（1）手术开始切皮时生命体征无明显波动（平均动脉压及心率上升不超过切皮前的20%）；（2）术后患者苏醒拔管时无疼痛相关躁动；（3）术后2 h未使用补救性镇痛药物时，患者疼痛视觉模拟量表（VAS）评分≤ 3分。采用Probit回归分析法计算50%有效容量（EV50）、95%有效容量（EV95）及其95% CI。结果 共30例患者完成试验，男21例、女9例，年龄为（60.0±6.8）岁，BMI为（22.7±3.1） kg/m2，美国麻醉医师协会（ASA）分级Ⅱ级9例、Ⅲ级21例。18例（60.0%）患者达到最佳有效镇痛，0.5%罗哌卡因的EV50为23.6 mL （95% CI 21.8~25.0 mL），EV95为26.9 mL （95% CI 25.3~35.2 mL）。所有患者均未出现出血、血肿、局部麻醉药中毒、感染、神经损伤等并发症。结论 超声引导下竖脊肌平面阻滞用于胸腔镜手术镇痛时，0.5%罗哌卡因达到最佳有效镇痛标准的EV50为23.6 mL、EV95为26.9 mL。 |
| 关键词: 超声引导 竖脊肌平面阻滞 胸腔镜检查 罗哌卡因 有效容量 |
| DOI：10.16781/j.0258-879x.2021.11.1314 |
| 投稿时间：2021-03-15修订日期：2021-06-04 |
| 基金项目:上海中医药大学预算内项目（2020LK059），上海中医药大学附属岳阳中西医结合医院院内科研项目（2019YYQ13）. |
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| Effective volume of 0.5% ropivacaine in patients receiving thoracoscopic analgesia with erector spinae plane block |
| SHI Hai-feng,SHEN Hua,XU Hua,LOU Yi* |
(Department of Anesthesiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
*Corresponding author) |
| Abstract: |
| Objective To determine the effective volume of 0.5% ropivacaine in patients receiving thoracoscopic analgesia with erector spinae plane block (ESPB) by Dixon's up-and-down sequential method. Methods A total of 31 patients who underwent thoracoscopic lobectomy in Yueyang Hospital of Integrated Traditional Chinese and Western MediCIne, Shanghai University of Traditional Chinese MediCIne from Jan. to Sep. 2020 were selected. Ultrasound-guided 0.5% ropivacaine ESPB of corresponding spinal ganglion segment was performed according to the operation site. The initial volume of 0.5% ropivacaine was 35 mL. If the first patient reached the best effective analgesic standard, the drug volume of the second patient decreased by 2 mL; on the contrary, the drug volume increased by 2 mL. The trial was terminated when 7 inflection points of invalid volume appeared. The following 3 criteria were met, and the best effective analgesic standard was achieved:(1) there was no significant fluctuation in vital signs at the beginning of skin inCIsion (the rise of mean arterial pressure and heart rate did not exceed 20% before skin inCIsion); (2) there was no pain-related agitation after extubation; and (3) when no remedial analgesics were used 2 h after operation, the visual analogue scale score of pain was ≤ 3. Probit probability regression analysis was used to calculate 50% effective volume (EV50), 95% effective volume (EV95) and their 95% confidence interval (CI). Results A total of 30 patients were enrolled, including 21 males and 9 females, aged (60.0±6.8) years, with body mass index of (22.7±3.1) kg/m2 and American SoCIety of Anesthesiologists gradeⅡ(9 cases) orⅢ(21 cases). Eighteen (60.0%) patients achieved the best effective analgesia. The EV50 of 0.5% ropivacaine was 23.6 mL (95% CI 21.8-25.0 mL), and the EV95 was 26.9 mL (95% CI 25.3-35.2 mL). No complications such as bleeding, hematoma, local anesthetic poisoning, infection or nerve injury occurred in the patients. Conclusion EV50 and EV95 of 0.5% ropivacaine in patients receiving thoracoscopic analgesia with ultrasound-guided ESPB are 23.6 and 26.9 mL, respectively. |
| Key words: ultrasound-guided erector spinae plane block thoracoscopy ropivacaine effective volume |
