Tang Lingkai, Xu Caomei, Xie Jianfen, Xu Jiahao, Chen Chen, Shen Jiang, Hu Nan, Qiu Lan
Department of Anesthesiology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, China.
Department of Pharmacy, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, China.
Clin Ther. 2025 Jan;47(1):62-69. doi: 10.1016/j.clinthera.2024.11.003. Epub 2024 Dec 4.
Investigate the analgesia effects and pharmacokinetics of ropivacaine at different concentrations in Serratus Anterior Plane Block (SAPB) and assess the efficacy and safety.
Thirty-six patients undergoing video-assisted thoracoscopic surgery (VATS) pulmonary resections were enrolled. Ultrasound-guided SAPB was induced with 3 mg/kg ropivacaine at different concentrations (0.25%, 0.5%, and 0.75%, referred to as Group L, Group M, and Group H, respectively). The concentration of ropivacaine in the plasma at 1, 15, 30, 45, 60 min, 2, 4, 8, 12, and 24 h after SAPB was determined by LC-MS/MS. Other evaluated measures included the Numerical Rating Scale (NRS) scores at rest and on movement, the frequency of dermatomes blocked, onset time and effective plane, Quality of Requirements(QoR)-15 scale, chronic postsurgical pain, and the level of IL-6 and IL-8.
The NRS scores were significantly higher in Group L than those in other groups (P < 0.05), indicating that the analgesic effect of Group L was the worst among the three groups. Group H had a lower effective plane of anesthesia and significantly higher incidence of chronic postsurgical pain. The IL-8 level was significantly lower in Group H than in other groups at 1 min, 1 h, and 24 h after SAPB. The ropivacaine concentrations were the highest in Group H, followed by Group M and Group L. The high blood concentration of ropivacaine in Group H may increase the risk of systemic toxicity from local anesthetics. Compared to Group L and Group H, Group M had superior analgesic effects and better safety. Among the three groups, C, t, and AUC differed significantly.
For patients undergoing VATS, using 0.5% ropivacaine for SAPB is recommended.
研究不同浓度罗哌卡因在胸大肌平面阻滞（SAPB）中的镇痛效果和药代动力学，并评估其有效性和安全性。
纳入36例行电视辅助胸腔镜手术（VATS）肺切除术的患者。采用超声引导，分别用不同浓度（0.25%、0.5%和0.75%）的3mg/kg罗哌卡因进行SAPB诱导，分别称为L组、M组和H组。通过液相色谱-串联质谱法测定SAPB后1、15、30、45、60分钟、2、4、8、12和24小时血浆中罗哌卡因的浓度。其他评估指标包括静息和运动时的数字评分量表（NRS）评分、阻滞皮节频率、起效时间和有效平面、需求质量（QoR）-15量表、术后慢性疼痛以及IL-6和IL-8水平。
L组的NRS评分显著高于其他组（P<0.05），表明L组在三组中的镇痛效果最差。H组的有效麻醉平面较低，术后慢性疼痛发生率显著较高。SAPB后1分钟、1小时和24小时，H组的IL-8水平显著低于其他组。罗哌卡因浓度在H组最高，其次是M组和L组。H组罗哌卡因血药浓度高可能增加局部麻醉药全身毒性的风险。与L组和H组相比，M组具有更好的镇痛效果和更高的安全性。三组之间的C、t和AUC差异显著。
对于行VATS的患者，建议使用0.5%罗哌卡因进行SAPB。
