Deng Ying, Wang Liwei, Zhang Hua, Xu Zhichao, Jiang Ling, Zhou Yang
Department of Anesthesiology, Peking University Third Hospital, Beijing, People's Republic of China.
Beijing Center of Quality Control and Improvement on Clinical Anesthesia, Beijing, People's Republic of China.
J Pain Res. 2025 Mar 17;18:1341-1349. doi: 10.2147/JPR.S505238. eCollection 2025.
This study aims to evaluate the degree of diaphragmatic paralysis by assessing diaphragmatic excursion and pulmonary function following an ultrasound-guided interscalene brachial plexus block with two different concentrations of ropivacaine (0.2% and 0.5%).
Forty patients undergoing shoulder arthroscopic surgery were randomly assigned to receive ultrasound-guided interscalene brachial plexus block with 20 mL of either 0.2% or 0.5% ropivacaine. Diaphragmatic excursion (DE) and diaphragm thickening fraction (TF) were measured using M-mode ultrasound before and 30 minutes after the block. Pulmonary function was assessed using a portable spirometer. Additional outcomes included pain scores and the occurrence of adverse effects.
DE was significantly reduced 30 minutes after block in the 0.5% group compared to the 0.2% group (p<0.01), as well as the TF (p<0.01). Forced vital capacity (FVC) was also significantly reduced in the 0.5% group 30 minutes after block in the preparation room compared to the 0.2% group (p<0.001). Both 0.2% and 0.5% ropivacaine had similar effects in improving postoperative pain. There were no serious block-related complications in either group.
0.2% ropivacaine may impair pulmonary function less than 0.5% ropivacaine. The clinical significance of these differences requires further investigation.
本研究旨在通过评估超声引导下使用两种不同浓度罗哌卡因（0.2%和0.5%）进行肌间沟臂丛神经阻滞术后的膈肌活动度和肺功能，来评估膈肌麻痹的程度。
40例行肩关节镜手术的患者被随机分配接受超声引导下肌间沟臂丛神经阻滞，分别注射20 mL 0.2%或0.5%的罗哌卡因。在阻滞前和阻滞后30分钟，使用M型超声测量膈肌活动度（DE）和膈肌增厚分数（TF）。使用便携式肺活量计评估肺功能。其他结果包括疼痛评分和不良反应的发生情况。
与0.2%组相比，0.5%组在阻滞后30分钟时DE显著降低（p<0.01），TF也显著降低（p<0.01）。在准备室中，与0.2%组相比，0.5%组在阻滞后30分钟时用力肺活量（FVC）也显著降低（p<0.001）。0.2%和0.5%的罗哌卡因在改善术后疼痛方面效果相似。两组均未出现严重的与阻滞相关的并发症。
0.2%罗哌卡因对肺功能的损害可能小于0.5%罗哌卡因。这些差异的临床意义需要进一步研究。
