三叶草腰丛阻滞：一项剂量探索性研究。

The Shamrock lumbar plexus block: A dose-finding study.

作者信息

Sauter Axel R, Ullensvang Kyrre, Niemi Geir, Lorentzen Håvard T, Bendtsen Thomas Fichtner, Børglum Jens, Pripp Are Hugo, Romundstad Luis

机构信息

From the Division of Emergencies and Critical Care, Department of Anaesthesiology, Oslo University Hospital Rikshospitalet (ARS, KU, GN, LR), Department of Anaesthesiology, Lovisenberg Diakonale Hospital, Oslo, Norway (HTL), Department of Anaesthesia and Intensive Care Medicine, Aarhus University Hospital, Aarhus (TFB), Department of Anaesthesia and Intensive Care Medicine, Roskilde Hospital, University of Copenhagen, Copenhagen, Denmark (JB), and Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway (AHP).

出版信息

Eur J Anaesthesiol. 2015 Nov;32(11):764-70. doi: 10.1097/EJA.0000000000000265.

DOI:10.1097/EJA.0000000000000265

PMID:26426575

Abstract

BACKGROUND

The Shamrock technique is a new method for ultrasound-guided lumbar plexus blockade. Data on the optimal local anaesthetic dose are not available.

OBJECTIVE

The objective of this study is to estimate the effective dose of ropivacaine 0.5% for a Shamrock lumbar plexus block.

DESIGN

A prospective dose-finding study using Dixon's up-and-down sequential method.

SETTING

University Hospital Orthopaedic Anaesthesia Unit.

INTERVENTION

Shamrock lumbar plexus block performance and block assessment were scheduled preoperatively. Ropivacaine 0.5% was titrated with the Dixon and Massey up-and-down method using a stepwise change of 5 ml in each consecutive patient. Combined blocks of the femoral, the lateral femoral cutaneous and the obturator nerve were prerequisite for a successful lumbar plexus block.

PATIENTS

Thirty patients scheduled for lower limb orthopaedic surgery completed the study.

MAIN OUTCOME MEASURES

The minimum effective anaesthetic volume of ropivacaine 0.5% (ED50) to achieve a successful Shamrock lumbar plexus block in 50% of the patients. Further analysis of the data was performed with a logistic regression model to calculate ED95 and to estimate the effective doses for a sensory lumbar plexus block not requiring a motor block of the femoral nerve.

RESULTS

The Dixon and Massay estimate of the ED50 was 20.4 [95% confidence interval (95% CI) 13.9 to 30.0] ml ropivacaine 0.5%. The logistic regression estimate of the ED95 was 36.0 (95% CI 19.7 to 52.2) ml ropivacaine 0.5%. For a sensory lumbar plexus block, the ED50 was 17.1 (95% CI 12.3 to 21.9) ml and the ED95 was 25.8 (95% CI 18.6 to 33.1) ml.

CONCLUSION

A volume of 20.4 ml ropivacaine 0.5% provided a successful Shamrock lumbar plexus block in 50% of the patients. A volume of 36.0 ml would be successful in 95% of the patients.

TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT01956617.

摘要

背景

三叶草技术是一种超声引导下腰丛神经阻滞的新方法。目前尚无关于最佳局麻剂量的数据。

目的

本研究旨在评估0.5%罗哌卡因用于三叶草腰丛神经阻滞的有效剂量。

设计

采用狄克逊上下序贯法进行前瞻性剂量探索研究。

地点

大学医院骨科麻醉科。

干预

术前安排三叶草腰丛神经阻滞操作及阻滞评估。采用狄克逊和梅西上下法对0.5%罗哌卡因进行滴定，每连续一名患者的剂量逐步变化5毫升。股神经、股外侧皮神经和闭孔神经联合阻滞是成功进行腰丛神经阻滞的前提条件。

患者

30例计划行下肢骨科手术的患者完成了本研究。

主要观察指标

0.5%罗哌卡因使50%的患者成功完成三叶草腰丛神经阻滞的最小有效麻醉容量（ED50）。使用逻辑回归模型对数据进行进一步分析，以计算ED95并估计不需要股神经运动阻滞的感觉性腰丛神经阻滞的有效剂量。

结果

狄克逊和马西法估计的ED50为20.4[95%置信区间（95%CI）13.9至30.0]毫升0.5%罗哌卡因。逻辑回归估计的ED95为36.0（95%CI 19.7至52.2）毫升0.5%罗哌卡因。对于感觉性腰丛神经阻滞，ED50为17.1（95%CI 12.3至21.9）毫升，ED95为25.8（95%CI 18.6至33.1）毫升。