不同剂量罗哌卡因腰麻在膝关节镜手术中的临床观察

目的比较不同剂量罗哌卡因腰麻用于膝关节镜手术的安全性和有效性。方法择期行膝关节镜手术ASAⅠ~Ⅱ级患者75例,随机分为三组(Ⅰ组、Ⅱ组、Ⅲ组)。于L3-4间隙蛛网膜下腔注入罗哌卡因2m(l分别含罗哌卡因7.5mg、10mg、15mg),观察记录感觉、运动阻滞情况和不良反应的发生情况。结果感觉阻滞起效时间为Ⅰ组>Ⅱ组>Ⅲ组(P<0.05或P<0.01),感觉阻滞最高平面、运动阻滞程度和运动阻滞维持时间均为Ⅰ组<Ⅱ组<Ⅲ组(P<0.05或P<0.01),Ⅰ组患者有2例痛觉阻滞不完善而改用硬膜外药才能行手术,注药20min后双下肢运动阻滞0级者Ⅰ组、Ⅱ组分别有5例和2例,而Ⅲ组则无。Ⅰ组和Ⅱ组分别有4例和1例出现止血带胀痛等反应。Ⅲ组有2例出现低血压。结论 10mg罗哌卡因腰麻可满足大部分患者膝关节镜手术需要,但仍应根据手术时间长短、患者性别和身高等酌情增减剂量。

Clinical observation on different dosages of ropivacaine in spinal anaesthesia during knee arthroscopy

Objective To evaluate the safety and efficacy of different dosages of ropivacaine in spinal anaesthesia during knee arthroscopic surgery. Methods Seventy-five patients (ASA physical status Ⅰ~Ⅱ) scheduled to knee arthroscopy were randomly divided into three groups (group Ⅰ,Ⅱ and Ⅲ), which receive 7.5 mg, 10 mg and 15 mg ropivacaine injected intrathecally at the L3~4 intervertebral space, respectively. The solutions were prepared to a total volume of 2 ml. Results The onset time of sensory block and motor block was significantly longer in group Ⅰ than group Ⅱ and group Ⅲ (P<0.05 or P<0.01). The highest level of sensory block was significantly higher, the potencies of motor block was significantly severe, and ambulation time was significantly longer in patients received larger dosages of ropivacaine. Two patients in group Ⅰ received epidural injection before surgery because of inadequate anaesthesia. Five and two patients in group Ⅰ and group Ⅱ had no motor block 20 minutes after injected intrathecally. Two patients in group Ⅲ reveived ephedrine because of hypotension. Conclusion Subarachnoid block with 10 mg ropivacaine can be used in most patients during knee arthroscopy. But the dosage of ropivacaine must be changed to be suitable for surgery duration, the gender and stature of the patient.