【罂粟摘要】0.2%罗哌卡因用量与坐骨神经阻滞时间：一项在健康志愿者中进行的随机、双盲试验
0.2%罗哌卡因用量与坐骨神经阻滞时间：一项在健康志愿者中进行的随机、双盲试验
贵州医科大学 麻醉与电生理课题组
翻译：马艳燕 编辑：佟睿 审校：曹莹
坐骨神经阻滞用于膝关节、小腿、脚和踝关节的许多骨科手术。然而，由于神经阻滞持续时间差异很大，补充镇痛的时机是具有挑战性的。因此，了解增加局麻药（LA）剂量对阻滞持续时间的影响比其导致局麻药全身毒性反应更加有益。在这项随机、双盲试验中，我们旨在探讨0.2%罗哌卡因用量与坐骨神经阻滞时间之间的关系。我们假设增加左房容积会延长阻滞时间。
我们随机选择了60名健康志愿者，分别接受5,10,15,20或30毫升0.2%罗哌卡因。我们使用超声引导、基于导管技术在臀下区定位坐骨神经。主要观察指标是感觉阻滞持续时间，其定义为对冷刺激不敏感的时间。使用单因素方差分析比较组间差异。
胫神经感觉阻滞时间随容积增加的平均时间分别为：9.3h，10.4h，9.7h，10.7h，9.9h。腓总神经感觉阻滞平均时间分别为：10.6h，11.9h，11.0h，13.2h，13.5h。组间比较差异无统计学意义(P=0.67(TN)；P=0.25(CPN))。
0.2%罗哌卡因从5ml增加到30ml对感觉神经阻滞时间无影响。
Christiansen CB, Madsen MH, Rothe C, et al. Volume of ropivacaine 0.2% and sciatic nerve block duration: A randomized, blinded trial in healthy volunteers. Acta Anaesthesiol Scand. 2020 Feb;64(2):238-244.
Volume of ropivacaine 0.2% and sciatic nerve block duration: a randomised, blinded trial in healthy volunteers
Background: Sciatic nerve blocks are used for many orthopaedic procedures on the knee, lower leg, foot and ankle.However, as nerve block durations vary considerably, timing of supplemental analgesia is challenging. Therefore, knowledge on the effect of local anaesthetic (LA) dose on block duration is important to outweigh the benefits of increasing LA dose against the risk of LA systemic toxicity. In this randomised, double-blind trial, we aimed to explore the relationship between the volume of ropivacaine 0.2% and sciatic nerve block duration. We hypothesised that increasing LA volume would prolong block duration.
Methods: We randomised 60 healthy volunteers to receive one of five volumes of ropivacaine 0.2%: 5, 10, 15, 20, or 30 ml. We used an ultrasound-guided, catheter-based technique targeting the sciatic nerve in the infragluteal region. Primary outcome was sensory block duration defined as time of insensitivity to a cold stimulus. Intergroup differences were tested using one-way ANOVA.
Results: Mean (SD) sensory block durations for the tibial nerve(TN)with increasing volume were: 9.3 h (1.7), 10.4 h (1.6), 9.7 h (2.9), 10.7 h (2.8), 9.9 h (2.6). Mean (SD) sensory block durations for the common peroneal nerve(CPN) were: 10.6 h (2.7), 11.9 h (1.5), 11.0 h (3.3), 13.2 h (3.7), 13.5 h (6.1). There were no intergroup differences (P =0.67 (TN); P = 0.25 (CPN)).
Conclusion: We found no effect of increasing the volume of ropivacaine 0.2% from 5 ml to 30 ml on sensory sciatic nerve block duration.