亚甲蓝复合罗哌卡因行髂筋膜阻滞用于老年髋关节置换术病人术后镇痛的半数有效剂量和不良反应分析

doi:10.3969/j.issn.1003-9198.2026.02.010

摘要/Abstract

摘要： 目的测定亚甲蓝作为局麻药佐剂与罗哌卡因复合应用于老年髂筋膜阻滞在髋关节置换术病人术后24 h有效镇痛和不影响下肢肌力的半数有效剂量(ED₅₀)及95%有效剂量(ED₉₅),并观察病人术后24 h的不良反应。方法选取泰州市姜堰中医院2024年7—11月择期行全髋关节置换术的老年病人29例,在全麻诱导前行超声引导下髂筋膜阻滞,注射药液为不同剂量的亚甲蓝复合0.25%罗哌卡因共30 mL。首例病人使用亚甲蓝剂量为40 mg,使用Dixon序贯法确定下一例病人使用亚甲蓝的剂量,若前一例病人在术后24 h内出现股四头肌肌力≥4分,同时静息VAS评分≤1分,且活动时VAS评分≤3分,则下一例病人降低一个阶梯的亚甲蓝剂量,反之,增加一个阶梯剂量,直至出现7个交叉点时研究终止。采用Probit回归分析法计算亚甲蓝的ED₅₀、ED₉₅及其95%CI。同时观察髋关节置换术后24 h的不良反应。结果亚甲蓝复合罗哌卡因行髂筋膜阻滞在老年髋关节置换术后能有效镇痛且不影响下肢肌力的ED₅₀为26.956 mg(95%CI:18.929~32.231 mg),ED₉₅为40.070 mg(95%CI:33.878~84.708 mg)。髋关节置换术后24 h内,有2例病人需要额外使用镇痛药物,均出现在使用低于ED₅₀剂量时。仅有1例病人出现下肢无力而无法下床走动,亚甲蓝的使用剂量为20 mg。没有病人因为术后肌无力而出现摔倒现象。所有病人均未出现神经损伤、穿刺点感染及药物中毒等神经阻滞并发症。结论亚甲蓝复合罗哌卡因行髂筋膜阻滞在老年髋关节置换术术后镇痛的ED₅₀为26.956 mg,ED₉₅为40.070 mg,同时,亚甲蓝没有增加罗哌卡因的运动阻滞风险,术后不良反应发生率低。

关键词: 亚甲蓝, 髂筋膜阻滞, 髋关节置换, 老年人, 半数有效剂量, 95%有效剂量

Abstract: Objective To determine the median effective dose (ED₅₀) and 95% effective dose (ED₉₅) of methylene blue as an adjuvant to ropivacaine in elderly patients undergoing fascia iliaca compartment block for postoperative 24-hour effective analgesia without affecting lower limb muscle strength after hip replacement surgery, and to observe adverse reactions within 24 hours postoperatively. Methods A total of 29 patients scheduled for elective total hip arthroplasty in Taizhou Jiangyan Hospital of TCM from July to November 2024 were enrolled. Prior to general anesthesia induction, an ultrasound-guided fascia iliaca compartment block was performed using 30 mL of 0.25% ropivacaine combined with varying doses of methylene blue. The first patient received 40 mg of methylene blue, and subsequent doses were adjusted using Dixon’s up-and-down sequential method. If a patient achieved quadriceps muscle strength ≥4, resting VAS score ≤1, and movement VAS score ≤3 within 24 hours, the next patient received a lower dose; otherwise, the dose was increased. The study terminated after seven crossover points. Probit regression analysis was used to calculate the ED₅₀, ED₉₅, and their 95% confidence intervals. Adverse reactions within 24 hours postoperatively were recorded. Results The ED₅₀ of methylene blue combined with ropivacaine for effective analgesia without motor block was 6.956 mg (95%CI:18.929-32.231 mg), and the ED₉₅ was 0.070 mg (95%CI: 33.878-84.708 mg). Two patients required additional analgesics, both occurring at doses below the ED₅₀. Only one case (20 mg methylene blue) experienced lower limb weakness preventing ambulation. No falls due to muscle weakness occurred. None of the patients developed nerve injury, puncture-site infection, drug toxicity, or other nerve block-related complications. Conclusions The ED₅₀ of methylene blue combined with ropivacaine for postoperative analgesia via fascia iliaca compartment block in elderly hip arthroplasty was 26.956 mg, with an ED₉₅ of 40.070 mg. Importantly, the addition of methylene blue did not potentiate the motor-blocking risk of ropivacaine, while maintaining a favorable safety profile with low incidence of postoperative adverse effects.

Key words: methylene blue, iliac fascia block, hip replacement, aged, half-effective dose, 95% effective dose

中图分类号:

R 614.4

张扬, 杨顺, 陆咨儒, 沙荔荔. 亚甲蓝复合罗哌卡因行髂筋膜阻滞用于老年髋关节置换术病人术后镇痛的半数有效剂量和不良反应分析[J]. 实用老年医学, 2026, 40(2): 154-158.

ZHANG Yang, YANG Shun, LU Ziru, SHA Lili. Analysis of the median effective dose and adverse effects of methylene blue combined with ropivacaine for fascia iliaca compartment block in postoperative analgesia in elderly patients undergoing hip arthroplasty[J]. Practical Geriatrics, 2026, 40(2): 154-158.

参考文献

[1] MURPHY J, PAK S, SHTEYNMAN L, et al. Mechanisms and preventative strategies for persistent pain following knee and hip joint replacement surgery: a narrative review[J]. Int J Mol Sci, 2024, 25(9): 4722.
[2] ANGER M, VALOVSKA T, BELOEIL H, et al. PROSPECT guideline for total hip arthroplasty: a systematic review and procedure-specific postoperative pain management recommendations[J]. Anaesthesia, 2021, 76(8): 1082-1097.
[3] 邱灿金, 刘孝国, 陈燕勤, 等. 髂筋膜阻滞联合罗哌卡因混合右美托咪定和地塞米松对老年全髋关节置换术患者术后谵妄及血流动力学的影响[J]. 中国老年学杂志, 2024, 44(9): 2097-2100.
[4] RILEY M, TASSIE B, GAWTHORNE J, et al. Increased opioid consumption after regional nerve blockade: association of fascia iliaca block with rebound pain in neck of femur fracture[J]. Br J Anaesth, 2021, 127(1): e15-e17.
[5] GOLA W, ZAJA,C M, CUGOWSKI A. Adjuvants in peripheral nerve blocks - the current state of knowledge[J]. Anaesthesiol Intensive Ther, 2020, 52(4):323-329.
[6] ZHANG Y, YANG S, LU Z R, et al. Analgesic effect of ropivacaine combined with methylene blue in fascia iliaca block for patients undergoing hip arthroplasty[J]. BMC Musculoskelet Disord, 2025, 26(1): 256.
[7] GONABAL V, AGGARWAL S, RANI D, et al. Comparison of ultrasound-guided suprainguinal fascia iliaca compartment block and pericapsular nerve group block for postoperative analgesia and associated cognitive dysfunction following hip and proximal femur surgery[J]. J Anaesthesiol Clin Pharmacol, 2024, 40(3): 432-438.
[8] 张扬, 杨顺, 臧刘雪, 等. 罗哌卡因复合不同浓度亚甲蓝行髂筋膜阻滞对髋关节置换术病人术后镇痛和康复效果的影响[J]. 实用老年医学, 2025, 39(5): 466-471.
[9] 常小兰, 王晓, 刘思兰, 等. 改良髂筋膜间隙阻滞下罗哌卡因抑制老年患者全膝关节置换术后疼痛的有效浓度及不良反应分析[J]. 中华老年医学杂志, 2023, 42(4): 425-429.
[10] DENG Y, YANG Y, ZHU F, et al. Analgesic efficacy and safety of methylene blue combined with cocktail for periarticular infiltration following total knee arthroplasty: a prospective, randomized, controlled study[J]. Perioper Med: Lond, 2025, 14(1): 9.
[11] JI M, YAO P, HAN Z, et al. Pulsed radiofrequency combined with methylene blue paravertebral nerve block effectively treats thoracic postherpetic neuralgia[J]. Front Neurol, 2022, 13: 811298.
[12] LEE S W, HAN H C. Methylene blue application to lessen pain: its analgesic effect and mechanism[J]. Front Neurosci, 2021, 15: 663650.
[13] 李美睿, 张广建. 罗哌卡因、倍他米松联合亚甲蓝经胸膜外肋间神经阻滞治疗肺癌开胸术后慢性切口痛的疗效观察[J]. 中华疼痛学杂志, 2023, 19(1): 93-98.
[14] 谭树颖, 徐昕, 崔晓, 等. 超声引导下亚甲蓝神经阻滞治疗腰脊神经后支综合征患者的临床研究[J]. 实用疼痛学杂志, 2019, 15(4): 269-272.
[15] 王亮, 丁芳. 小剂量罗哌卡因麻醉在老年膝髋关节置换中的价值[J]. 中国临床药理学杂志, 2019, 35(1): 28-30.
[16] JIANG G, WANG T, YOU X. Application of methylene blue combined with ropivacaine intercostal nerve block in postoperative analgesia of autologous costal cartilage augmentation rhinoplasty[J]. Anaesthesiologie, 2022, 71(Suppl 2): 233-239.
[17] LIU Q Q, MAO M, LIN N H, et al. Effective dose of epidural hydromorphone for analgesia following caesarean section in using modified Dixon sequential method[J]. J Pain Res, 2024, 17: 3671-3679.
[18] DELEENS R, PICKERING G, HADJIAT Y. Pain in the elderly and cognition: state of play[J]. Geriatr Psychol Neuropsychiatr Vieil, 2017, 15(4): 345-356.