关节镜检查术后，使用较低浓度罗哌卡因行股神经阻滞可保留股四头肌肌力，同时提供相似的镇痛效果。
Femoral nerve block using lower concentration ropivacaine preserves quadriceps strength while providing similar analgesic effects after knee arthroscopy.
机构信息
Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Anesthesiology, Sichuan Cancer Hospital and Institute, University of Electronic Science and Technology of China, Chengdu, China.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2023 Nov;31(11):4988-4995. doi: 10.1007/s00167-023-07549-y. Epub 2023 Aug 28.
PURPOSE
Femoral nerve block (FNB) is widely used in patients undergoing knee arthroscopy. However, the most commonly used concentration of ropivacaine (0.2% or above) may cause an unexpected decrease in the muscle strength of the quadriceps. Therefore, a lower concentration of ropivacaine (0.1%) for FNB was administered to investigate the effect on quadriceps strength and postoperative pain after knee arthroscopy.
METHODS
This was a double-blind, randomized, controlled trial (ChiCTR2000041404). A total of 83 patients scheduled for elective knee arthroscopy were randomized to receive 0.1% or 0.2% ropivacaine for FNB under ultrasound guidance. The primary outcomes were quadriceps strength and numerical rating scale (NRS) pain score. Quadriceps strength was measured before surgery and 6 h and 24 h after surgery, while NRS score was recorded before surgery, at the postanaesthesia care unit (PACU), and 6 h and 24 h after surgery. Multiple linear regression tests were used to compare the differences in quadriceps strength and NRS score between the two groups. Two-factor analysis of variance, using the factors group and time of measurement, was used for repeated NRS scores. Secondary outcomes included knee mobility, side effects, patient satisfaction, and length of hospital stay.
RESULTS
The mean (SD) quadriceps strength at 6 h after surgery was 7.5 (5.7) kg for the 0.1% ropivacaine group and 3.0 (4.4) kg for the 0.2% ropivacaine group. The mean difference adjusted for baseline characteristics was - 5.2 (95% CI - 7.2 to - 3.1) kg (P < 0.001). There was no significant difference between the two groups in quadriceps strength at 24 h after surgery. The mean differences in the average NRS score and maximum NRS score in the PACU were - 0.6 (P = 0.008) and - 1.0 (P < 0.001), respectively. There was no significant difference in NRS score at 6 h or 24 h after surgery. Two-factor analysis of variance showed no significant difference in the interaction factors of time and group for average NRS score and maximum NRS score.
CONCLUSIONS
Compared with 0.2% ropivacaine, 0.1% ropivacaine for FNB preserved quadriceps strength at 6 h after knee arthroscopy while providing similar analgesic effects.
LEVEL OF EVIDENCE
I.
目的
股神经阻滞（FNB）广泛应用于膝关节镜手术患者。然而，最常使用的罗哌卡因浓度（0.2%或以上）可能导致股四头肌肌力意外下降。因此，我们对 FNB 采用较低浓度的罗哌卡因（0.1%），以研究其对膝关节镜术后股四头肌肌力和术后疼痛的影响。
方法
这是一项双盲、随机、对照试验（ChiCTR2000041404）。共 83 例拟行择期膝关节镜手术的患者，随机分为接受超声引导下 0.1%或 0.2%罗哌卡因 FNB。主要结局指标为股四头肌肌力和数字评分量表（NRS）疼痛评分。股四头肌肌力在术前和术后 6 h 和 24 h 进行测量，NRS 评分在术前、麻醉后恢复室（PACU）以及术后 6 h 和 24 h 进行记录。采用多线性回归检验比较两组股四头肌肌力和 NRS 评分的差异。采用组间和时间测量的两因素方差分析比较重复 NRS 评分的差异。次要结局指标包括膝关节活动度、不良反应、患者满意度和住院时间。
结果
术后 6 h 时，0.1%罗哌卡因组的股四头肌肌力平均（标准差）为 7.5（5.7）kg，0.2%罗哌卡因组为 3.0（4.4）kg。调整基线特征后的平均差异为-5.2（95%置信区间-7.2 至-3.1）kg（P<0.001）。两组患者术后 24 h 时的股四头肌肌力无显著差异。PACU 中平均 NRS 评分和最大 NRS 评分的平均差值分别为-0.6（P=0.008）和-1.0（P<0.001）。术后 6 h 和 24 h 时的 NRS 评分无显著差异。两因素方差分析显示，时间和组间的交互因素对平均 NRS 评分和最大 NRS 评分均无显著影响。
结论
与 0.2%罗哌卡因相比，膝关节镜术后 6 h 时，0.1%罗哌卡因用于 FNB 可保留股四头肌肌力，同时提供相似的镇痛效果。
证据水平
I 级。
Zotero 插件