0.33%罗哌卡因用于超声引导下腘窝坐骨神经阻滞在踝关节骨折手术中的应用OA
Application of 0.33%Ropivacaine in Ultrasound-Guided Popliteal Sciatic Nerve Block for Ankle Fracture Surgery
目的:探讨 0.33%罗哌卡因用于超声引导下腘窝坐骨神经阻滞在踝关节骨折手术中的麻醉效果与术后恢复质量.方法:回顾性分析 2020 年4月～2022年12 月于本院行踝关节骨折切开复位内固定或复合韧带修复术的180 例患者临床资料,根据所用罗哌卡因浓度分为对照组(0.50%罗哌卡因,n=98)和观察组(0.33%罗哌卡因,n=82).所有患者均接受超声引导下腘窝坐骨神经阻滞,对照组注入 0.50%盐酸罗哌卡因注射液 20 ml,观察组注入 0.33%盐酸罗哌卡因注射液 20 ml.待腘窝坐骨神经阻滞效果完善后行椎管内麻醉.比较两组临床资料、术后运动功能恢复指标、临床功能恢复指标、术中麻醉效果与阻滞效果、术后镇痛指标及并发症发生情况.采用Kaplan-Meier法与Log-rank检验比较术后首次镇痛需求时间.采用多因素Logistic回归分析术后6 h运动功能恢复的影响因素.结果:两组基线资料比较无统计学差异(P＞0.05).观察组术后6 h足部可主动活动占比高于对照组,术后首次下床活动时间短于对照组(P＜0.05).对照组运动阻滞起效时间和阻滞完善时间均短于观察组(P＜0.05),两组感觉阻滞起效时间比较无统计学差异(P＞0.05).观察组术后阻滞持续时间和术后首次镇痛需求时间均短于对照组,术后24 h阿片类药物消耗量高于对照组(P＜0.05).经Log-rank检验,两组术后首次镇痛需求的中位时间比较具有统计学差异(12.8 h vs 11.2 h,χ2=6.365,P=0.012).两组并发症总发生率比较无统计学差异(P＞0.05).多因素Logistic回归分析显示,使用 0.33%罗哌卡因是术后 6 h 运动功能恢复的独立保护因素(OR=2.160,95%CI:1.112～4.195,P=0.023).结论:0.33%罗哌卡因用于超声引导下腘窝坐骨神经阻滞,其术中麻醉效能与 0.50%浓度相当,但能显著缩短术后阻滞持续时间,加速术后运动功能恢复,且未增加相关并发症.
Objective:To compare the anesthetic effect and postoperative recovery quality of 0.33%ropivacaine in ultrasound-guided popliteal sciatic nerve block for ankle fracture surgery.Methods:A retrospective analysis was performed on 180 patients undergoing open reduction and internal fixation or ligament repair for ankle fracture from April 2020 to December 2022.Patients were divided into control group(0.50%ropivacaine,n=98)and observation group(0.33%ropivacaine,n=82).All patients received ultrasound-guided popliteal sciatic nerve block with 20 ml corresponding concentration of ropivacaine hydrochloride injection,followed by spinal anesthesia after satisfactory block.Baseline data,postoperative motor and functional recovery indexes,intraoperative anesthetic and block effect,postoperative analgesia indexes and complications were compared.Kaplan-Meier method and Log-rank test were used to compare the time to first analgesic requirement.Multivariate Logistic regression was used to analyze the influencing factors of 6-hour postoperative motor function recovery.Results:There was no significant difference in baseline data between the two groups(P>0.05).At 6 hours after operation,the proportion of active foot movement in the observation group was higher,and the time to first ambulation was shorter than that in the control group(P<0.05).The onset time and completion time of motor block in the control group were shorter(P<0.05),while no significant difference was found in sensory block onset time(P>0.05).The postoperative block duration and time to first analgesic requirement in the observation group were shorter,while 24-hour opioid consumption was higher(P<0.05).Log-rank test showed a significant difference in median time to first analgesic requirement(12.8 h vs 11.2 h,χ2=6.365,P=0.012).No significant difference was observed in the total incidence of complications(P>0.05).Multivariate Logistic regression showed that 0.33%ropivacaine was an independent protective factor for 6-hour postoperative motor function recovery(OR=2.160,95%CI:1.112～4.195,P=0.023).Conclusion:In ultrasound-guided popliteal sciatic nerve block for ankle fracture surgery,0.33%ropivacaine has equivalent intraoperative anesthetic efficacy to 0.50%ropivacaine.It can shorten postoperative block duration,accelerate motor function recovery,and does not increase the incidence of complications.
毕路甲;张秀珍;闫军杰;黄美洁;冯东亮
漯河医学高等专科学校第二附属医院,麻醉科,漯河 462300漯河医学高等专科学校第二附属医院,麻醉科,漯河 462300漯河医学高等专科学校第二附属医院,儿科,漯河 462300漯河医学高等专科学校第二附属医院,麻醉科,漯河 462300漯河医学高等专科学校第二附属医院,骨科,漯河 462300
医药卫生
罗哌卡因浓度超声引导神经阻滞腘窝坐骨神经踝关节骨折
ropivacaineconcentrationultrasound-guidednerve blockpopliteal sciatic nerveankle fracture
《中国合理用药探索》 2026 (5)
86-92,7
河南省医学科技攻关计划项目(LHGJ20221034)
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