Li Ping, Yang Zhongsai, Zhang Long, Wu Ruilan, Zhu Manhua, Xie Junran
Department of Anesthesiology, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang Province, 310016, People's Republic of China.
Department of Anesthesiology, Ningbo Medical Centre Lihuili Hospital, Ningbo, Zhejiang Province, 315040, People's Republic of China.
Drug Des Devel Ther. 2025 May 20;19:4151-4161. doi: 10.2147/DDDT.S520427. eCollection 2025.
Postoperative pain management is essential after video-assisted thoracoscopic surgery (VATS). The rhomboid intercostal and sub-serratus (RISS) block is effective in providing analgesia. This study aims to determine the minimum effective concentration (MEC) of ropivacaine for ultrasound-guided RISS block in patients undergoing VATS, thereby optimizing the analgesia protocol and enhancing its clinical significance.
The biased coin design sequential method and isotonic regression were used. The ropivacaine initial concentration was 0.25% with a gradient of 0.025%. If the previous patient had a negative block, the concentration for the next patient would increase by 0.025%. If positive, the concentration would be adjusted based on biased coin randomization: an 11% chance of reducing it by 0.025% and an 89% chance of keeping it unchanged. MEC was calculated using isotonic regression with 95% confidence intervals (CI).
A total of 49 patients were included in the analysis. The MEC of 40mL ropivacaine for RISS block in VATS was 0.220% (95% CI, 0.198 to 0.260%), the MEC was 0.248% (95% CI, 0.223 to 0.338%) and the MEC was 0.270% (95% CI, 0.261 to 0.351%). There was a negative correlation between ropivacaine concentration and VAS at 0h, 0.5h, and 6h after surgery and the time of initial analgesia (r = -0.396, -0.594, -0.309, 0.363; = 0.005, 0.001, 0.031, 0.01). No significant correlation was observed between the VAS at 12h and 24h after surgery and analgesia consumption (r = -0.184, -0.165; = 0.205, 0.256).
The MEC of 40 mL ropivacaine for RISS block was 0.220%. While the MEC was 0.248% and the MEC was 0.270%.
电视辅助胸腔镜手术（VATS）术后疼痛管理至关重要。菱形肌间和锯肌下（RISS）阻滞在提供镇痛方面有效。本研究旨在确定罗哌卡因用于VATS患者超声引导下RISS阻滞的最低有效浓度（MEC），从而优化镇痛方案并提高其临床意义。
采用偏倚硬币设计序贯法和等渗回归。罗哌卡因初始浓度为0.25%，梯度为0.025%。如果前一位患者阻滞阴性，下一位患者的浓度将增加0.025%。如果阳性，则根据偏倚硬币随机化调整浓度：降低0.025%的概率为11%，保持不变的概率为89%。使用等渗回归计算MEC及95%置信区间（CI）。
共纳入49例患者进行分析。VATS中40mL罗哌卡因用于RISS阻滞的MEC为0.220%（95%CI，0.198至0.260%），MEC为0.248%（95%CI，0.223至0.338%），MEC为0.270%（95%CI，0.261至0.351%）。术后0h、0.5h、6h及首次镇痛时间时，罗哌卡因浓度与视觉模拟评分（VAS）呈负相关（r = -0.396，-0.594，-0.309，0.363；P = 0.005，0.001，0.031，0.01）。术后12h和24h的VAS与镇痛药物消耗量之间未观察到显著相关性（r = -0.184，-0.165；P = 0.205，0.256）。
40mL罗哌卡因用于RISS阻滞的MEC为0.220%。而MEC为0.248%，MEC为0.270%。
