罗哌卡因的最低有效浓度

本文由“小麻哥的日常”授权转载

摘要译文（供参考） 不同体积罗哌卡因用于超声引导硬膜外阻滞的最小有效浓度（MEC95）：一项剂量发现研究

背景： 骶 管阻滞（CEB）在肛肠手术中可能是有益的，因为它的使用可以延长术后镇痛。 这项剂量发现研究旨在估计CEB中20或25ml罗哌卡因95%患者（MEC95）的最低有效麻醉剂浓度。

患者和方法： 在这项双盲、前瞻性研究中，超声引导CEB使用20ml和25ml的罗哌卡因浓度，采用二元反应变量的样本上下顺序分配的研究设计。 第一名参与者使用0.5%罗哌卡因。 根据阻滞成功与否，下一位患者的局部麻醉浓度降低或增加0.025%。 每5分钟持续30分钟，在30分钟内每5分钟评估一次S3区域皮肤与T6区域皮 肤的针刺感觉的感觉阻滞情况。 有效的CEB定义为S3区域皮肤的感觉减轻和肛门括约肌松弛。 如果外科医生可以在没有额外麻醉的情况下进行手术，则认为麻醉是成功的。 我们使用Dixon和Massey上下法确定MEC50，并使用概率回归估计MEC95。

结果： CEB在20ml内给药的罗哌卡因浓度范围为0.2%至0.5%。 通过自举法得出的经偏差校正的Morris 95%CI的问题回归显示，用于肛肠手术麻醉的罗哌卡因的MEC50和MEC95分别为0.27%（95%CI，0.24至0.31）和0.36%（95%CI，0.32至0.61）。CEB在25ml内给药剂量范围为0.175至0.5。用自举法导出的经偏差校正的Morris 95%CI的Probit回归显示，CEB的MEC50和MEC95分别为0.24%（95%CI，0.19至0.27）和0.32%（95%可信区间，0.28至0.54）。

结论：

在超声引导下CEB，0.36%罗哌卡因20ml和0.32%罗哌嗪25ml的MEC95为接受肛肠手术的95%患者提供了足够的手术麻醉/镇痛。

原文摘要 The Minimum Effective Concentration (MEC95) of different volumes of ropivacaine for ultrasound-guided caudal epidural block:a dose-finding study

Background: Caudal epidural block (CEB) may be beneficial in anorectal surgery because its use may extend postoperative analgesia. This dose-finding study aimed to estimate the minimum effective anesthetic concentrations for 95% patients(MEC95) of 20 ml or 25 ml of ropivacaine in with CEB. 

Patients and methods: In this double-blind, prospective study, the concentration of ropivacaine administered in 20 ml and 25 ml for ultrasound-guided CEB were determined using the sample up-and-down sequential allocation study design of binary response variables. The first participant was given 0.5% ropivacaine. Depending on whether a block was successful or unsuccessful, the concentration of local anesthesia was decreased or increased by 0.025% in the next patient. Every five minutes for 30 min, the sensory blockade using a pin-prick sensation at S3 dermatome compared to at T6 dermatome were evaluated every 5 min within 30 min. An effective CEB was defined as a a reduction of sensation at S3 dermatome and the existence of flaccid anal sphincter. Anesthesia was considered successful if the surgeon could perform the surgery without additional anesthesia. We determined the MEC50 using the Dixon and Massey up-and-down method and estimated the MEC95 using probit regression. 

Results: The concentration of ropivacaine administered in 20 ml for CEB ranged from 0.2% to 0.5%. Probit regression with a bias-corrected Morris 95% CI derived by bootstrapping showed an MEC50 and MEC 50 of ropivacaine for anorectal surgical anesthesia were 0.27% (95% CI, 0.24 to 0.31) and 0.36%(95% CI, 0.32 to 0.61). The concentration of ropivacaine administered in 25 ml for CEB ranged from 0.175 to 0.5. Probit regression with a bias-corrected Morris 95% CI derived by bootstrapping showed an MEC50 and MEC95 for CEB were 0.24% (95% CI, 0.19 to 0.27) and 0.32% (95% CI, 0.28 to 0.54). 

Conclusion: With ultrasound-guided CEB, the MEC95 of 0.36% ropivacaine at 20 ml and 0.32% ropivacaine at 25 ml provide adequate surgical anesthesia/analgesia 95% of patients undergoing anorectoal surgery.

文中所涉及药物使用、疾病诊疗等内容仅供医学专业人士参考。

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编辑：MiSuper.米超

校对：Michel.米萱