关节镜下前交叉韧带重建术后超声引导坐骨神经阻滞中罗哌卡因的半数有效镇痛浓度：一项双盲上下浓度探索性研究。
The Median Effective Analgesic Concentration of Ropivacaine in Sciatic Nerve Block Guided by Ultrasound After Arthroscopic Anterior Cruciate Ligament Reconstruction: A Double-Blind Up-Down Concentration-Finding Study.
作者信息
Xu Cheng, Gu Fei, Wang Chengyu, Liu Yang, Chen Rui, Zhou Quanhong, Lu Jie
机构信息
Department of Anaesthesiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
出版信息
Front Med (Lausanne). 2022 May 6;9:830689. doi: 10.3389/fmed.2022.830689. eCollection 2022.
BACKGROUND
The median effective analgesic concentration (MEAC; EC50 = effective concentration in 50% patients) of ropivacaine in sciatic nerve block guided by ultrasound (US) required for effective postoperative analgesia following arthroscopic anterior cruciate ligament (ACL) reconstruction has not yet been found. This study aimed to determine the effectiveness of MEAC of 20 ml ropivacaine of postoperative anesthesia for patients after ACL reconstruction.
METHODS
In total, 29 patients who underwent elective arthroscopic ACL reconstruction were enrolled in this study. All the subjects were given 20 ml of 0.2% ropivacaine for femoral nerve block. A concentration of 20 ml ropivacaine administered to the sciatic nerve was measured by applying the up-and-down sequential method (UDM). The starting concentration was 0.2% in the first patient, and the next patient received decremented 0.025% ropivacaine if the prior patient's postoperative visual analog pain score was <4 in the initial 8 h. Otherwise, the participant was given an incremental dose of 0.025% ropivacaine. The EC50 of ropivacaine was determined by using centered isotonic, linear-logarithmic, exponential regressions, and linear regression. The "goodness of fit" was compared among various models by calculating the residual standard errors.
RESULTS
The concentration of ropivacaine administered ranged from 0.1 to 0.2%. The EC50 [95% confidence interval (CI)] determined by four statistical methods (centered isotonic, exponential regressions, linear-logarithmic, and linear regression) was 0.115, 0.113% (0.108, 0.343%), 0.142% (0.112, 0.347%), and 0.129% (0.103, 0.359%), respectively. Among all models, the residual standard error was the smallest for the exponential regression (0.2243).
CONCLUSION
The EC50 of ropivacaine in US-guided sciatic nerve block was 0.113-0.142%, and exponential regression model best matched the data.
背景
在超声（US）引导下进行坐骨神经阻滞时，罗哌卡因用于关节镜下前交叉韧带（ACL）重建术后有效镇痛的半数有效镇痛浓度（MEAC；EC50 = 50%患者的有效浓度）尚未明确。本研究旨在确定20 ml罗哌卡因的MEAC对ACL重建术后患者术后麻醉的有效性。
方法
本研究共纳入29例行择期关节镜下ACL重建术的患者。所有受试者均接受20 ml 0.2%罗哌卡因进行股神经阻滞。采用序贯法（UDM）测量给予坐骨神经的20 ml罗哌卡因浓度。首位患者的起始浓度为0.2%，若前一位患者术后最初8小时的视觉模拟疼痛评分<4分，则下一位患者接受递减0.025%的罗哌卡因。否则，给予递增剂量0.025%的罗哌卡因。采用中心等渗、线性对数、指数回归和线性回归确定罗哌卡因的EC50。通过计算残差标准误比较不同模型的“拟合优度”。
结果
罗哌卡因给药浓度范围为0.1%至0.2%。通过四种统计方法（中心等渗、指数回归、线性对数和线性回归）确定的EC50 [95%置信区间（CI）]分别为0.115、0.113%（0.108，0.343%）、0.142%（0.112，0.347%）和0.129%（0.103，0.359%）。在所有模型中，指数回归的残差标准误最小（0.2243）。
结论
超声引导下坐骨神经阻滞中罗哌卡因的EC50为0.113 - 0.142%，指数回归模型与数据拟合最佳。
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