固定剂量\不同浓度罗哌卡因对腓总神经阻滞时间的影响：健康志愿者的随机双盲试验
本公众号每天分享一篇最新一期Anesthesia & Analgesia等SCI杂志的摘要翻译，敬请关注并提出宝贵意见
The effect of ropivacaine concentration on common peroneal nerve block duration using a fixed dose A randomised, double-blind trial in healthy volunteers
背景与目的
局麻药浓度对周围神经阻滞时间的影响尚不清楚。最近的临床试验发现，尽管改变了局麻药浓度，但局麻药剂量固定，神经阻滞的持续时间相同。对这些研究的争议是，使用的局麻药剂量高于建议的局麻药剂量-时间上限水平，掩盖了不同局麻药浓度对神经阻滞时间的任何潜在影响。我们使用低于局麻药剂量上限水平的固定局麻药剂量来研究局麻药浓度对神经阻滞持续时间的影响。我们假设改变局麻药浓度会影响神经阻滞时间。
方 法
每位受试者在超声引导下接受腓总神经阻滞，固定剂量为10 mg的罗哌卡因溶于2.5、5、10、15或20ml 0.9%生理盐水中，使局麻药浓度分别为4、2、1、0.67和0.5 mg. ml-1。主要结果是感觉阻滞的持续时间，定义为对冷刺激无感觉或不敏感。次要结果是运动阻滞持续时间，定义为轻度阻滞或完全阻滞。组间差异采用单因素方差分析进行检验。
结 果
所有受试者均产生感觉阻滞，60名受试者中有56人产生运动阻滞。感觉阻滞时间由高到低依次为13.1+/-2.7、13.4+/-3.3、12.6+/-3.9、10.4+/-2.9和11.0+/-2.1h(P≤0.073)，运动阻滞持续时间分别为8.5+/-2.0、7.9+/-3.0、6.1+/-3.1、5.9+/-3.5、4.0+/-1.9h(P=0.002)。
结 论
与我们的假设相反，我们发现平均感觉神经阻滞持续时间没有变化。然而，局麻药稀释导致运动阻滞持续时间缩短。
原始文献摘要
Christiansen CB1, Madsen MH, Mølleskov E, et,al.The effect of ropivacaine concentration on common peroneal nerve block duration using a fixed dose A randomised, double-blind trial in healthy volunteers[J].Eur J Anaesthesiol. 2020 Apr;37(4):316-322.doi: 10.1097/EJA.00000000000 01112.
BACKGROUND The effect of local anaesthetic concentration on peripheral nerve block duration is unclear. Recent clinical trials found nerve blocks of equivalent duration Despite changing local anaesthetic concentration but with a fixed local anaesthetic dose. A criticism of these studies is that the local anaesthetic doses used were above the proposed local anaesthetic dose-duration ceiling level, masking any potential effect of different local anaesthetic concentrations on nerve block duration.
OBJECTIVE We investigated the effect of local anaesthetic concentration on nerve block duration using a fixed local anaesthetic dose below the local anaesthetic dose-duration ceiling level. We hypothesised that changing local anaesthetic concentration would affect nerve block duration.
DESIGN Randomised, double-blind trial.
SETTING Single-centre, academic hospital.
PARTICIPANTS Healthy volunteers.
INTERVENTIONS Each participant received an ultrasound-guided common peroneal nerve block with a fixed dose of 10 mg of ropivacaine dissolved in either 2.5, 5, 10, 15 or 20 ml of 0.9% saline according to group allocation, yielding local anaesthetic concentrations of 4, 2, 1, 0.67 and 0.5 mg ml-1.
MAIN OUTCOME MEASURES The primary outcome was duration of sensory block defined as altered or no sensitivity to a cold stimulus. The secondary outcome was duration of motor block defined as either paresis or paralysis. Intergroup differences were tested using one-way Analysis of variance .
RESULTS All participants had sensory block, and 56 out of 60 participants had motor block. From the highest to the lowest concentration groups, mean+/-SD sensory block durations were 13.1+/-2.7, 13.4+/-3.3, 12.6+/-3.9,10.4+/-2.9 and 11.0+/-2.1 h (P=0.073), and mean+/-SD motor block durations were 8.5+/-2.0, 7.9+/-3.0, 6.1+/-3.1,5.9+/-3.5, 4.0 1.9 h (P=0.002).
CONCLUSION In contrast to our hypothesis, we found no changes in mean sensory nerve block duration. However,local anaesthetic dilution resulted in reduced moto rblock duration.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：人文鑫 编辑：冯玉蓉 审校：王贵龙