不同浓度罗哌卡因在椎间孔镜手术中的应用

目的观察硬膜外盐酸罗哌卡因复合芬太尼用于椎间孔镜手术的麻醉效果及罗哌卡因合适的浓度配比。方法选择拟在硬膜外阻滞下行椎间孔镜腰椎间盘切除术的患者60例,采用随机数字表法分为三组,Ⅰ组(n=20)硬膜外麻醉药物选择0.2%盐酸罗哌卡因复合2μg/mL芬太尼,硬膜外穿刺成功后先注入3 mL混合药液,5 min后再注入8 mL混合药液,Ⅱ组(n=20)麻醉方式与Ⅰ组相同,混合药液为0.3%罗哌卡因复合2μg/mL芬太尼,Ⅲ组(n=20)混合药液为0.4%罗哌卡因复合2μg/mL芬太尼,观察患者麻醉效果,记录疼痛评分,肌力Bromage评分,术中生命体征,及添加辅助静脉药情况。结果三组均能产生运动感觉分离,Ⅲ组镇痛效果优于Ⅱ组,Ⅱ组优于Ⅰ组,Ⅲ组肌力评分高于Ⅰ组,与Ⅱ组无统计学意义。结论硬膜外麻醉采用0.4%盐酸罗哌卡因复合2μg/mL芬太尼能产生明显运动感觉分离,安全,镇痛效果好。

Application of Different Concentrations of Ropivacaine in Intervertebral Foramen Surgery

Objective To observe the anesthetic effect of epidural hydrochloric acid ropivacaine combined with fentanyl in intervertebral foramen surgery and the suitable concentration ratio of ropivacaine. Methods 60 cases of lumbar discectomy under intervertebral foramen under epidural block were selected and randomly divided into three groups. Group Ⅰ(n = 20) was given 0.2% ropivacaine hydrochloride combined with 2 μg/mL fentanyl as epidural anesthesia drug. After successful epidural puncture, 3 mL mixed drug was injected first, and then 8 minutes later Group Ⅱ(n = 20) was anesthetized in the same way as Group Ⅰ(0.3% ropivacaine combined with 2 μg/mL fentanyl), Group Ⅲ(n = 20) was anesthetized in 0.4% ropivacaine combined with 2 μg/mL fentanyl. The anesthesia effect, pain score, muscle strength Bromage score, intraoperative vital signs and addition of auxiliary intravenous drugs were observed. Results All three groups could produce motor sensory separation, the analgesic effect of Ⅲ Group was better than that of Ⅱ Group, Ⅱ Group was better than Ⅰ Group, Ⅲ Group muscle strength score was higher than that of Ⅰ group, and Ⅱ Group was not statistically significant. Conclusion epidural anesthesia using 0.4% ropivacaine hydrochloride can produce obvious motor sensation separation, safety and good analgesic effect because of compound 2 μg/mL fentanyl.