中国内镜杂志2025，Vol.31Issue(12)：1-8,8.DOI:10.12235/E20250142
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
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.关键词
关节镜下前交叉韧带重建术(ACLR)/罗哌卡因/坐骨神经/神经阻滞/运动感觉分离/半数效应浓度(EC50)Key words
arthroscopic anterior cruciate ligament reconstruction(ACLR)/ropivacaine/sciatic nerve/nerve block/motor-sensory separation/median effective concentration(EC50)分类
医药卫生引用本文复制引用
于天雷,庞圣丁,杨波,姚富..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[J].中国内镜杂志,2025,31(12):1-8,8.基金项目
四川省骨科医院科研项目(No:PY202409) （No:PY202409）
