关节镜下前交叉韧带重建术中应用罗哌卡因行坐骨神经阻滞的半数效应浓度研究

Median effective concentration of ropivacaine for sciatic nerve block during arthroscopic anterior cruciate ligament reconstruction

摘要:

目的 探究关节镜下前交叉韧带重建术（ACLR）中应用罗哌卡因行坐骨神经阻滞的半数效应浓度（EC50）。方法 选取2023年5月－2024年11月于该院行单侧关节镜下ACLR治疗的患者33例。手术当日进手术室后，行收肌管神经阻滞（15 mL罗哌卡因）和大腿外侧入路坐骨神经阻滞（20 mL罗哌卡因），初始浓度为0.20%，相邻浓度梯度为0.01%。感觉阻滞但运动未阻滞者纳入阻滞成功组（16例），感觉与运动均阻滞者纳入阻滞失败组（17例）。阻滞成功组在下1例时降低1级浓度，阻滞失败组则增加1级浓度。通过Probit模型，分析罗哌卡因用于关节镜下ACLR中坐骨神经阻滞运动感觉分离的EC50。比较两组患者首次补救性镇痛治疗时间、手术时间、麻醉时间、瑞芬太尼用量、住院时间、神经阻滞30 min后患者等速肌力评定的峰力矩，术后6、12和24 h视觉模拟评分法（VAS）评分及Lovett肌力，以及并发症发生情况。结果 罗哌卡因用于关节镜下ACLR中坐骨神经阻滞的EC50为0.23%（95%CI：0.21%～0.24%）。两组患者首次补救性镇痛治疗时间、手术时间、麻醉时间和瑞芬太尼用量比较，差异均无统计学意义（P > 0.05）。阻滞成功组住院时间较阻滞失败组短，神经阻滞30 min后的伸膝肌力和屈膝肌力的峰力矩较阻滞失败组高，差异均有统计学意义（P < 0.05）。术后6和12 h，阻滞成功组Lovett肌力4级和5级的占比高于阻滞失败组，差异有统计学意义（P < 0.05）。两组患者术后24 h VAS比较，差异无统计学意义（P > 0.05）。两组患者住院期间均未发生穿刺部位血肿和出血等并发症。结论 关节镜下ACLR中应用罗哌卡因行坐骨神经阻滞的EC50为0.23%，在此浓度下行坐骨神经阻滞，可在保障感觉阻滞的同时，还不影响患者运动功能，且患者早期康复效果好。值得临床推广应用。

Abstract:

Objective To explore the median effective concentration (EC50) of ropivacaine for motor and sensory separation in sciatic nerve block during arthroscopic anterior cruciate ligament reconstruction (ACLR).Methods 33 patients who underwent unilateral arthroscopic ACLR treatment from May 2023 to November 2024 were selected. On the day of the operation, after entering the operating room, adductor canal nerve block (15 mL ropivacaine) and lateral thigh approach sciatic nerve block (20 mL ropivacaine) were performed. The initial concentration was 0.20%, and the adjacent concentration gradient was 0.01%. Those with sensory block but no motor block were included in the successful block group (16 cases), and those with both sensory and motor block were included in the failed block group (17 cases). In the successful block group, the concentration was reduced by grade 1 in the next case, while in the failed block group, it was increased by grade 1. The EC50 of motor-sensory separation in sciatic nerve block under arthroscopic ACLR was calculated by the Probit model using ropivacaine. The time of the first remedial analgesia treatment, operation time, anesthesia time, dosage of remifentanil, the length of hospital stay, the peak torque of isokinetic strength test 30 minutes after nerve block, the visual analogue scale (VAS) scores and Lovett muscle strength at 6, 12 and 24 hours after surgery, as well as the occurrence of complications were compared between the two groups.Results The EC50 of ropivacaine for sciatic nerve block in arthroscopic ACLR was 0.23% (95%CI: 0.21% ~ 0.24%). There was no statistically significant difference between the two groups in the time to first remedial analgesia, operation time, anesthesia time, or remifentanil dosage (P > 0.05). The hospitalization time of the successful block group was shorter than that of the failed block group, the peak torque of the knee extension muscle strength and knee flexion muscle strength 30 minutes after nerve block were higher than those in the failed block group, and the differences were statistically significant (P < 0.05). At 6 and 12 hours postoperatively, the proportion of Lovett muscle strength grades 4 and 5 in the successful block group was higher than that in the failed block group, with a statistically significant difference (P < 0.05). There was no statistically significant difference in the VAS of the two groups of patients 24 hours after the operation (P > 0.05). Both groups of patients didn't experience complications such as puncture site hematoma and bleeding during hospitalization.Conclusion The EC50 of ropivacaine for arthroscopic ACLR sciatic nerve block is 0.23%. At this concentration, sciatic nerve block can ensure sensory block without affecting the patient's motor function, and the patient recovers well in the early stage. It is worthy of clinical promotion and application.