罗哌卡因浓度对髋关节置换术中腰丛神经阻滞的影响

Effect of ropivacaine concentration in lumbar plexus block during total hip arthroplasty

摘要:

[目的] 探讨罗哌卡因浓度对髋关节置换术中腰丛神经阻滞效果的影响。[方法] 2022 年 1 月—2023 年 8 月 100 例全麻联合腰丛神经阻滞下行初次单侧髋关节置换术的患者纳入本研究。采用抛硬币法随机分为三组，所有患者术前均行腰丛神经阻滞，其中，32 例采用 0.25%罗哌卡因，34 例采用 0.30%罗哌卡因，另外 34 例采用 0.35%罗哌卡因。比较三组围手术期资料。[结果] 三组手术时间、术中出血量、苏醒时间、拔管时间、下床时间差异无统计学意义 （P＞0.05），0.25%组术中不同时间点平均动脉压 (mmHg) [(98.8±1.2), (96.4±3.4), (90.4±4.8), (84.8±2.5), P=0.208] 和心率 (次/min) [(78.5±6.0), (77.4±6.9), (74.7±7.3), (75.2±6.3), P=0.076] 均无显著变化， 相比之下，0.30%组和 0.35%组术中平均动脉压和心率均有显著变化 （P＜0.05）。但是，三组间不良反应发生率的差异无统计学意义（P＞0.05）。术后疼痛情况方面，三组术后 VAS 评分、首次补救镇痛时间、镇痛泵按压次数、血管活性药物使用次数差异均无统计学意义（P＞0.05）。[结论]低浓度罗哌卡因用于髋关节置换术中腰丛神经阻滞血流动力学更稳定，且镇痛效果较更高浓度罗哌卡因无明显差异。

Abstract:

[Objective] To investigate the clinical effect of ropivacaine concentration used in lumbar plexus block during total hip arthroplasty (THA). [Methods] From January 2022 to August 2023, 100 patients undergoing initial unilateral THA under general anesthesia combined with lumbar plexus block were included in this study. The patients were randomly divided into three groups by coin tossing method, and received lumbar plexus block before operation. Among them, 32 patients received 0.25% ropivacaine, 34 patients received 0.30% ropivacaine, and 34 patients received 0.35% ropivacaine. The documents regarding perioperative period were compared among the three groups. [Results] There were no significant differences in operation time, intraoperative blood loss, recovery time, extubation time and getting out of bed time among the three groups (P＞0.05). The 0.25% group had mean arterial pressure (mmHg) [(98.8±1.2), (96.4±3.4), (90.4± 4.8), (84.8±2.5), P=0.208] and heart rate (b/min) [(78.5±6.0), (77.4±6.9), (74.7±7.3), (75.2±6.3), P=0.076] remained unchanged significantly during different time points intraoperatively, whereas the 0.30% group and 0.35% group got significant changes in mean arterial pressure and heart rate (P＜0.05). However, there was no significant difference in the incidence of adverse reactions among the three groups (P＞0.05). In terms of postoperative pain, there were no statistically significant differences in postoperative VAS score, time of first additional analgesia, number of analgesic pump compression, and frequency of vasoactive drug use among the three groups (P＞0.05). [Conclusion] Low concentration of ropivacaine is more stable in hemodynamic treatment of lumbar plexus block during THA, which is not significantly different in analgesic effect compared with higher concentration of ropivacaine.