| The purpose of this study is to investigate the half effective capacity of ultrason-guided Supra-inguina Fascia Iliaca space Block(S-FICB)with ropivacaine for total hip replacement.This study was divided into two parts:In the first part,the optimal concentration should be confirmed by observing the analgesic effect of S-FICB with different low concentrations(0.2%,0.25%,0.3%)of ropivacaine in total hip replacement surgery and its influence on early postoperative ambulation.In the second part,we will discuss half of the Effective Volume(50%Effective Volume(EV50)of ultrasound guided S-FICB with the optimal concentration of ropivacaine by ensuring the effectiveness of S-FICB block.It aims to reduce the dosage of local anesthetics.Therefore,it can provide reference for the selection of ropivacaine volume for SFICB in this kind of surgery.Part Ⅰ:Clinical effect observation of Supra-inguina fascia iliaca compartment block with different low concentration ropivacaine for total hip replacementObjective:To investigate the analgesic effect of different low concentrations of ropivacaine(0.2%,0.25%,0.3%)in total hip replacement and the influence of S-FICB on early postoperative activities of getting out of bed,in this way we can determine the optimal concentration.Methods:We chose 117 patients who would undergo total hip replacement in the Second Hospital of Shandong University from July 2021 to July 2022 and divided them into three groups by random number table method:Patients in group A(0.2%ropivacaine 40ml,n=39,),Group B(0.25%ropivacaine 40ml,n=39),and group C(0.3%ropivacaine 40ml,n=39)receive S-FICB for perioperative analgesia before surgery.We recorded MAP and HR of the patients after 3min of calm,30min after block completion,before dermectomy,and lmin after dermectomy;We recorded Visual analog Scale(VAS)scores of resting state and motor state after entry,30min after completion of block,and 3h,6h,12h,and 24h after surgery;The names and dosage of additional analgesic drugs were recorded during and after surgery;We recorded quality of recovery-15 Score(QoR-15)of 24 hours after operation;and the first time of getting out of bed after surgery.Results:(1)Compared with group A,the amount of intraoperative and postoperative analgesic drugs in groups B and C was significantly reduced(P<0.05);there was no significant difference between group B and group C in the amount of intraoperative and postoperative analgesic drugs(P>0.05).(2)The VAS scores of resting state and motor state 30min after completion of block in 3 groups were lower than those at entry(P<0.05).(3)As time went by,the VAS scores of resting state and exercise state in the three groups gradually increased,and the time when the VAS scores of resting state and exercise state began to increase in group A was earlier than that in group B and C,the difference was statistically significant(P<0.05);(4)Compared with group A,the resting VAS scores in group B and group C were lower 30min after completion of block,6h and 12h after surgery(P<0.05).Compared with group A,VAS scores of exercise status in group B and group C were lower 30min after completion of block.3h,6h,12h and 24h after surgery(P<0.05).There were no significant differences in resting status and exercise VAS scores between group B and group C at each time point(P>0.05).(5)Compared with group A,15 recovery quality scores of patients in group B and group C were higher 24h after surgery(P<0.05);There was no statistical significance between group B and group C in 15 recovery quality scores 24h after surgery(P>0.05).(6)Compared with group A,the postoperative getting out of bed activity time of group B was similar,with no statistical significance(P>0.05),while the postoperative getting out of bed activity time of group C was later,with statistical significance(P<0.05);Compared with group B,the postoperative activity time of patients in group C was significantly prolonged,the difference was statistically significant(P<0.05).Conclusion:In this study,we compared the clinical effects of three commonly used low concentration ropivacaine for ultrasound guided S-FICB in total hip replacement,and we concluded that 0.25%ropivacaine can meet the analgesic requirements of total hip replacement without affecting the time of patients getting out of bed for the first time.Therefore,0.25%ropivacaine was selected for the half effective volume study of S-FICB in THA.Part Ⅱ:Half effective volume of 0.25%ropivacaine for supra-inguina fascia iliaca compartment blockObjective:We used the sequential method to initially explore the 50%effective volume of 0.25%ropivacaine for fascial space block above the inguinal ligament,and observed its effect on recovery after total hip replacement,so as to provide reference for the selection of ropivacaine volume for S-FICB in this type of surgery.Methods:We selecte thirty patients with ASA Ⅱ-Ⅲ grade(13/17)from the Second Hospital of Shandong University from August 2022 to December 2022 for elective total hip replacement.Before surgery,we use 0.25%ropivacaine in S-FICB under ultrasound guidance,and the sequential method was used to calculate half of the effective volume.The initial dosage of 0.25%ropivacaine was 40ml,and the ratio between the adjacent volumes was the common ratio r=1.13,then we calculate the upper and lower doses.We should calculate the blocking effect of femoral nerve,lateral femoral cutaneous nerve and obturator nerve after injection.If three nerves are blocked at the same time in the previous patient,the block is considered complete,and the next patient was given a lower dose.Conversely,if all three nerves are not blocked at the same time,the block is considered incomplete and a higher dose is given in the next case until the seventh turning point occurs to complete the test.We use Probit probability regression to calculate EV50,EV95 and 95%Confidence Interval(CI)of 0.25%ropivacaine line S-FICB.Results:In this study,30 patients were studied by the sequential method,among which 17 patients had the femoral nerve,lateral femoral nerve and obturator nerve blocked,and 13 patients did not have the above three nerves blocked simultaneously.None of the 30 patients had any anesthesia related adverse reactions,such as puncture site bleeding,hematoma,puncture needle entering blood vessel,local anesthetic toxicity,hypoxemia,etc.No injury was found in femoral nerve,lateral femoral cutaneous nerve and obturator nerve during postoperative follow-up.None of the patients developed postoperative delirium and cognitive dysfunction.We use Probit probability regression to calculate the EV50 and the EV95 of 0.25%ropivacaine in total hip replacement with S-FICB guided by ultrasound.The EV50 of 0.25%ropivacaine was 27.35ml(95%CI 24.95～29.43ml).EV95 was 32.81ml(95%CI 30.15-35.67 ml).Conclusion:The half effective volume of 0.25%ropivacaine line for ultrasound-guided superior inguinal ligament iliac fascia gap block for total hip arthroplasty was 27.35 ml(95%CI 24.95 to 29.43 ml). |
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