局麻药注射速度与周围神经阻滞持续时间的研究
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Local Anesthetic Injection Speed and Common Peroneal Nerve Block Duration: A Randomized Controlled Trial in Healthy Volunteers
背景：局麻药（LA）应用于外周神经局部麻醉时，其注射速度的范围可从缓慢持续输注（3～12 ml/h）到快速手动注射（＞7500ml/h）变化。适宜的注射速度有利于局麻药向目标神经的扩散，并影响神经阻滞的变化过程。本研究旨在探讨局麻药的单次注射速度差异是否会影响周围神经阻滞的持续时间。
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方法：本研究共纳入60例健康成人志愿者。使用超声引导置管技术进行腓总神经周围导管留置术。采用随机双盲法进行分组研究。据双盲原则，受试者随机接受0.2%的罗哌卡因4ml，注射速度为12ml/h、60ml/h、300ml/h、600ml/h或1800ml/h其中之一。主要指标为感觉神经阻滞（对低温感知不明显）的持续时间。次要指标为运动神经阻滞的持续时间、感觉神经阻滞的开始时间以及感觉与运动神经阻滞的程度。组间差异使用单因素方差分析比较。
结果：局麻药物注射速度不同的5组患者（12ml/h、60ml/h、300ml/h、600ml/h或1800ml/h）之间感觉阻滞持续时间无统计学差异（P=0.294）。运动神经阻滞的持续时间、感觉神经阻滞的开始时间和感觉和运动神经阻滞的程度也均无统计学意义。
结论：局麻药注射速度范围在12～1800ml/h之间变化时，局麻药不会影响腓总神经阻滞的时间。
Madsen M H, Christiansen C B, Rothe C, et al. Local Anesthetic Injection Speed and Common Peroneal Nerve Block Duration: A Randomized Controlled Trial in Healthy Volunteers.[J]. Reg Anesth Pain Med, 2018, online first:1.
Background and Objectives: The speed of local anesthetic (LA) injections in
peripheral regional anesthesia ranges from slow continuous infusions (3–12 mL/h) to rapid manual injections (>7500 mL/h). Optimizing injection speed could augment the spread of LA toward the targeted nerves and influence nerve block characteristics. The objective of this study was to investigate whether injection speed of a single dose of LA affects peripheral nerve block duration.
Methods: After approval fromthe Danish Regional Scientific Ethics Committee,
we enrolled 60 healthy adult volunteers. We used an ultrasoundguided catheter-based technique to perform a common peroneal nerve block. Participants were randomized to receive 4.0 mL of ropivacaine 0.2% with 1 of 5 injection speeds: 12, 60, 300, 600, or 1800 mL/h. Investigators and participants were blinded to group assignment and intervention. Primary outcome was duration of sensory nerve block defined by insensitivity toward cold. Secondary outcomes were duration of motor nerve block, time to onset of sensory nerve block, and grades of sensory and motor nerve block.
Intergroup differences were tested by one-way analysis of variance.
Results: We found no differences in sensory block duration between the 5 groups. Durations were median [range]: 11 [6–14], 12 [9–14], 10.5 [2–15], 11 [8–17], and 12 [9–18] hours, respectively (P = 0.294). In addition, we found no differences in secondary outcomes.
Conclusions: Injection speed of LA in the range of 12 to 1800 mL/h did not affect common peroneal nerve block duration.
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