| 摘要: |
| 比较低浓度罗哌卡因硬膜外麻醉与局麻行经皮椎间孔镜下髓核摘除术的麻醉效果。方法：择期行椎间孔镜微创手术患者50例，采用随机数字表法分为硬膜外组（R组）和局麻组（L组），每组25例。R组选L2-L3间隙行硬膜外穿刺，向头侧置入硬膜外导管5 cm，平卧位后注入1%利多卡因3 mL，10 min内分2次注入0.3%罗哌卡因总量共计15 mL。L组直接侧卧位定位局部注射0.5%利多卡因20 mL。术中以视觉模拟评分（VAS）评估痛觉阻滞程度，以改良Bromage评分测定下肢运动阻滞程度。结果：两组改良Bromage评分均为0，R组与L组相比术中生命体征平稳（P<0.05）；在刺激脊神经根钳取髓核时，痛觉阻滞良好，VAS评分更低（P<0.05），需静脉辅助舒芬太尼的例数少(P<0.05)。结论：0.3%罗哌卡因15 mL硬膜外麻醉运动神经阻滞轻，在椎间孔镜手术中麻醉效果优于局麻。 |
| 关键词: 低浓度 罗哌卡因 硬膜外麻醉 椎间孔镜 |
| DOI：10.3969/j.issn.1007-6948.2019.01.010 |
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| 基金项目: |
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| The Application of Low Concentration Ropivacaine Epidural Anesthesia in The Operation of Transforaminal Endoscopic |
| LUO Man,GENG Li-cheng,GAO Tao |
| Department of Anesthesiology, Tianjin Union Medical Center, Tianjin (300121), China |
| Abstract: |
| Objective To compare the anesthesia effect of low concentration ropivacaine epidural anesthesia and local anesthesia in Percutaneous Transforaminal Endoscopic Discectomy (PTED) Methods 50 cases of patients, scheduled for the operation of transforaminal endoscopic：epidural anesthesia group (R group) and local anesthesia group (L group) (n=25 each group). R group of patients epidural punctured at L2-L3 clearance , implanted the epidural catheter 5 cm toward the side of head, after injection of 1% lidocaine 3 mL in the supine position, injected 0.3% ropivacaine amount of 15 mL in 10 minutes. L group of patients was performed with 0.5% lidocaine 20 mL at the location of surgical site in the lateral position. The intraoperative pain block was assessed by Visual Analogue Score (VAS) and the motor block was assessed by modified Bromage score. Results The modified Bromage score was 0 in both groups .Compared with the L group, the intraoperartive vital signs of group R were stabler (P<0.05), and the feeling block was better (P<0.05)during stimulation of the spinal nerve root and removal of the nucleus pulposus. VAS score in group R was lower and the number of cases requiring intravenous sufentanil was less. Conclusion The effect of 0.3% ropivacaine 15 mL epidural anesthesia, with lower degree of motor block, was superior to local anesthesiain in the operation of transforaminal endoscopic. |
| Key words: Low concentration ropivacaine epidural anesthesia transforaminal endoscopic |
