罗哌卡因用于超声引导下腹股沟上髂筋膜间隙阻滞在全髋关节置换术后镇痛的最低有效浓度：一项剂量探索性研究。

90% minimum effective concentration of ropivacaine for ultrasound-guided supra-inguinal fascia Iliaca compartment block for postoperative analgesia following total hip arthroplasty: a dose-finding study.

作者信息

Zhang Yanping, Zhang Qin, Guo Bo, Zhang Liang

机构信息

Department of Anesthesiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, 400021, China.

Chongqing College of Traditional Chinese Medicine, Chongqing, 402760, China.

出版信息

BMC Anesthesiol. 2025 Oct 3;25(1):480. doi: 10.1186/s12871-025-03372-9.

DOI:10.1186/s12871-025-03372-9

PMID:41044516

Abstract

BACKGROUND

The ultrasound-guided supra-inguinal fascia iliaca compartment block (S-FICB) is a widely utilized regional anesthesia technique for postoperative pain management following total hip arthroplasty. Current evidence suggests that effective analgesia with S-FICB necessitates the administration of relatively high volumes of local anesthetic, which may consequently elevate the risk of local anesthetic toxicity and contribute to postoperative lower limb motor block.

METHODS

Fifty-four patients with total hip arthroplasty were enrolled. Ultrasound-guided S-FICB was applied, the volume of the local anesthetic ropivacaine was set to 30 ml. Using the biased-coin design (BCD) sequential allocation method. The initial concentration of 30 ml ropivacaine was 0.25% and the interval concentration at 0.025%. Positive postoperative analgesia following S-FICB was defined by the simultaneous fulfillment of the following criteria: (1) The S-FICB block was successful. (2) The Visual Analogue Scale (VAS) scores maintained < 4 at 6, 12, 24 h postoperatively. (3) The effective compression times of Patient-Controlled Intravenous Analgesia (PCIA) < 5 within 24 h postoperatively. Failure to meet any one of these criteria was classified as negative postoperative analgesia. If the previous patient had a positive postoperative analgesia, the next patient was randomized to a lower concentration (defined as the previous concentration with a decrement of 0.025%), with an 11% probability (b = 0.11), or it would be administered the same concentration, with an 89% probability (1-b = 0.89). If a negative postoperative analgesia occurred, the next patient received a higher concentration (defined as the previous concentration with a increment of 0.025%). The study was terminated when 45 positive postoperative analgesia were achieved.

RESULTS

Forty-five patients (83%) were positive postoperative analgesia. The 90% minimum effective concentration (MEC90) of 30 ml ropivacaine for ultrasound guided S-FICB for postoperative analgesia following total hip arthroplasty was 0.286 (95% CI, 0.242 ~ 0.338) and the 95% minimum effective concentration (MEC95) was 0.314 (95% CI, 0.241 ~ 0.410).

CONCLUSION

The MEC90 and MEC95 of 30 ml ropivacaine for ultrasound guided S-FICB for postoperative analgesia were 0.286% and 0.314%, respectively.

TRIAL REGISTRATION

The trial was registered at the Chinese Clinical Trial Registry (registration number: ChiCTR2400092413, registration date: 2024 November 15).

摘要

背景

超声引导下腹股沟上髂筋膜间隙阻滞（S-FICB）是全髋关节置换术后用于疼痛管理的一种广泛应用的区域麻醉技术。目前的证据表明，S-FICB要实现有效的镇痛，需要注射相对大量的局部麻醉药，这可能会增加局部麻醉药毒性的风险，并导致术后下肢运动阻滞。

方法

纳入54例行全髋关节置换术的患者。采用超声引导下的S-FICB，局部麻醉药罗哌卡因的用量设定为30ml。采用偏倚硬币设计（BCD）序贯分配方法。30ml罗哌卡因的初始浓度为0.25%，间隔浓度为0.025%。S-FICB术后镇痛效果为阳性的定义为同时满足以下标准：（1）S-FICB阻滞成功。（2）术后6、12、24小时视觉模拟评分（VAS）维持在<4。（3）术后24小时内患者自控静脉镇痛（PCIA）的有效按压次数<5次。未满足上述任何一条标准则分类为术后镇痛效果为阴性。如果前一位患者术后镇痛效果为阳性，下一位患者随机分配至较低浓度（定义为前一浓度减去0.025%），概率为11%（b = 0.11），或者给予相同浓度，概率为89%（1 - b = 0.89）。如果术后镇痛效果为阴性，下一位患者接受较高浓度（定义为前一浓度加上0.025%）。当有45例术后镇痛效果为阳性时，研究终止。