Lin Chao, Xian Wen-Lin, Xu Jun, Zhao Ting, Wu Zhi-Qiang, Wang Fang-Jun
Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
Department of Anesthesiology, People's Hospital of Yilong County, Nanchong, China.
Front Med (Lausanne). 2025 Jul 24;12:1571574. doi: 10.3389/fmed.2025.1571574. eCollection 2025.
The spinal block was limited to the operative side during unilateral spinal anesthesia, which has less physiological interference and fewer complications for the patient. The optimal dose of ropivacaine for unilateral spinal anesthesia is still unclear. The aim of this trial was to investigate the ED and ED of hypobaric ropivacaine during unilateral spinal anesthesia in older patients undergoing hip arthroplasty.
All patients were administered hypobaric ropivacaine at a spinal anesthetic drug concentration of 0.4%. The trial was conducted using the Dixon sequential method with an initial dose of 10 mg of ropivacaine and a dose difference of 0.5 mg between two consecutive patients. If the subject's post-block non-surgical leg Bromage score is greater than 0, the next subject's dose of ropivacaine is reduced by 0.5 mg. If the subject's post-block non-surgical leg Bromage score is equal to 0, the next patient's dose of ropivacaine is increased by 0.5 mg. The trial was terminated when alternating positive-negative results were obtained for 7 pairs of patients. ED, ED, and the corresponding 95% confidence intervals (CI) for unilateral spinal anesthesia with 0.4% hypobaric ropivacaine were calculated using probit regression analysis. Patients with motor block in the non-surgical leg were identified as the positive group, and patients without motor block in the non-surgical leg were identified as the negative group. Anesthesia onset time, sensory block duration, duration of motor block, the highest dermatomes blocked on the surgical side, and postoperative complications were compared between the two groups.
The ED and ED of hypobaric ropivacaine during unilateral spinal anesthesia in older patients undergoing hip arthroplasty were 11.13 mg (95% CI: 10.85-11.42 mg) and 10.30 mg (95% CI: 9.04-10.65 mg), respectively. The drug dosage was higher in the positive group than in the negative group. There was no differences in the onset of anesthesia, block plane of the affected side, the sensory and motor block time of affected side, and the incidences of low blood pressure, nausea and vomiting, chills, urinary retention between groups ( > 0.05).
The ED and ED of hypobaric ropivacaine during unilateral spinal anesthesia in older patients undergoing hip arthroplasty were 11.13 mg (95% CI: 10.85-11.42 mg) and 10.30 mg (95% CI: 9.04-10.65 mg), respectively. Unilateral spinal anesthesia limits the level of block to the operative side with less physiologically disruptive to the patient, more stable perioperative hemodynamics and fewer complications.
单侧脊髓麻醉时脊髓阻滞局限于手术侧，对患者生理干扰较小且并发症较少。但用于单侧脊髓麻醉的罗哌卡因最佳剂量仍不明确。本试验旨在研究老年髋关节置换术患者单侧脊髓麻醉时低比重罗哌卡因的半数有效剂量（ED）和95%有效剂量（ED95）。
所有患者均以0.4%的脊髓麻醉药物浓度给予低比重罗哌卡因。试验采用Dixon序贯法，初始剂量为10mg罗哌卡因，连续两名患者之间的剂量差异为0.5mg。如果受试者阻滞后腰麻 Bromage 评分非手术侧大于0，则下一名受试者的罗哌卡因剂量减少0.5mg。如果受试者阻滞后腰麻 Bromage 评分非手术侧等于0，则下一名患者的罗哌卡因剂量增加0.5mg。当获得7对患者的交替阳性和阴性结果时，试验终止。采用概率回归分析计算0.4%低比重罗哌卡因单侧脊髓麻醉的ED、ED95及相应的95%置信区间（CI）。非手术侧出现运动阻滞的患者被确定为阳性组，非手术侧未出现运动阻滞的患者被确定为阴性组。比较两组患者的麻醉起效时间、感觉阻滞持续时间、运动阻滞持续时间、手术侧最高阻滞节段以及术后并发症。
老年髋关节置换术患者单侧脊髓麻醉时低比重罗哌卡因的ED和ED95分别为11.13mg（95%CI：10.85 - 11.42mg）和10.30mg（95%CI：9.04 - 10.65mg）。阳性组的药物剂量高于阴性组。两组之间在麻醉起效时间、患侧阻滞平面、患侧感觉和运动阻滞时间以及低血压、恶心呕吐、寒战、尿潴留的发生率方面无差异（P＞0.05）。
老年髋关节置换术患者单侧脊髓麻醉时低比重罗哌卡因的ED和ED95分别为11.13mg（95%CI：10.85 - 11.42mg）和10.30mg（95%CI：9.04 - 10.65mg）。单侧脊髓麻醉将阻滞水平局限于手术侧，对患者生理干扰较小，围手术期血流动力学更稳定，并发症更少。
