Safe and effective concentration of ropivacaine in interscalene brachial plexus block for children aged 6 to 10 years: a sequential allocation study

LI Shangyingying; YANG Li; YANG Fei; TIAN Yaqiong; LIU Ling; GAO Wen; SHI Yuan; TU Shengfen

doi:10.16016/j.2097-0927.202507017

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Safe and effective concentration of ropivacaine in interscalene brachial plexus block for children aged 6 to 10 years: a sequential allocation study

Clinical Medicine | 更新时间：2025-11-13

- Safe and effective concentration of ropivacaine in interscalene brachial plexus block for children aged 6 to 10 years: a sequential allocation study
- Journal of Army Medical University Vol. 47, Issue 21, Pages: 2698-2705(2025)
- 作者机构：
  
  重庆医科大学附属儿童医院麻醉科，国家儿童健康与疾病临床医学研究中心，儿童发育疾病研究教育部重点实验室，儿童神经发育与认知障碍重庆市重点实验室，重庆
- 作者简介：
  
  TU Shengfen， E-mail： 15213324272@163.com
- 基金信息：
  
  the General Project of Clinical Medical Research From National Clinical Research Center for Child Health and Disorders(NCRCCHD-2022-GP-0X);the General Project of Natural Science Foundation of Chongqing(CSTB2023NSCQ-MSX0434)
- DOI：10.16016/j.2097-0927.202507017
  CLC： R181.32;R726.144;R971.2
- Received：04 July 2025，
  
  Revised：2025-10-19，
  
  Accepted：19 October 2025，
  
  Published：15 November 2025
- 稿件说明：
移动端阅览
李上莹莹，杨丽，杨飞，等.6~10岁儿童肌间沟臂丛神经阻滞中罗哌卡因的安全有效浓度探索：一项基于序贯法的浓度测定研究［J］.陆军军医大学学报，2025，47（21）：2698-2705.DOI：10.16016/j.2097-0927.202507017.

LI S Y Y，YANG L，YANG F，et al.Safe and effective concentration of ropivacaine in interscalene brachial plexus block for children aged 6 to 10 years： a sequential allocation study［J］.J Army Med Univ，2025，47（21）：2698-2705.DOI：10.16016/j.2097-0927.202507017.
李上莹莹，杨丽，杨飞，等.6~10岁儿童肌间沟臂丛神经阻滞中罗哌卡因的安全有效浓度探索：一项基于序贯法的浓度测定研究［J］.陆军军医大学学报，2025，47（21）：2698-2705.DOI：10.16016/j.2097-0927.202507017. DOI：

LI S Y Y，YANG L，YANG F，et al.Safe and effective concentration of ropivacaine in interscalene brachial plexus block for children aged 6 to 10 years： a sequential allocation study［J］.J Army Med Univ，2025，47（21）：2698-2705.DOI：10.16016/j.2097-0927.202507017. DOI：

摘要

目的

确定容量为0.5 mL/kg的罗哌卡因用于6~10岁儿童超声引导下肌间沟臂丛神经阻滞时的半数有效浓度（median effective concentration， EC

）。

方法

本研究是一项前瞻性浓度探索的观察试验，采用的是Dixon“上下序贯”方法。招募了2022年4—12月在重庆医科大学

附属儿童医院麻醉科接受单侧上肢手术的6~10岁患儿。所有患儿的麻醉方式为全身静脉麻醉联合超声引导下肌间沟臂丛神经阻滞。所有患儿使用的罗哌卡因容量为0.5 mL/kg，第一位患儿罗哌卡因的浓度为0.2%，后续每位患儿使用的浓度都取决于前一位患儿的阻滞效果，增加/减少0.02%；当出现了7个转折点时试验结束。采用等渗回归和Bootstrap算法计算EC

、95%有效浓度（95% effective concentration， EC

）及其95%

。记录患儿一般资料、不良反应及术后疼痛评分等。

结果

本研究共纳入了26名6~10岁的患儿，超声引导下肌间沟臂丛神经阻滞的EC

为0.091%（95%

： 0.077%~0.105%），并估算了EC

为0.117%（95%

： 0.110%~0.118%）。阻滞成功有16例（61.5%），阻滞失败有10例（38.5%），在性别、年龄、体质量、手术部位、手术侧别、手术时间及麻醉时间等方面，阻滞成功与失败病例的差异均无统计学意义。所有患儿未发生气胸、血管损伤、霍纳综合征等不良反应，且术后疼痛评分（改良的东安大略儿童医院疼痛量表）

6分。

结论

在6~10岁儿童中以0.5 mL/kg容量的罗哌卡因用于超声引导下肌间沟臂丛神经阻滞的EC

是0.091%，且低剂量的局麻药可降低全身毒性和直接神经毒性等风险。

Abstract

Objective

To determine the median effective concentration (EC

) of ropivacaine at the volume of 0.5 mL/kg for ultrasound-guided interscalene brachial plexus block in children aged 6 to 10 years.

Methods

A prospective dose-finding trial was conducted based a sequential Dixon up-and-down allocation. We recruited children aged 6 to 10 years who were scheduled for unilateral surgery on upper extremity regions in our hospital from April to December 2022. All of them were subjected to general intravenous anaesthesia combined with ultrasound-guided interscalene brachial plexus block. The ropivacaine volume for each patient was 0.5 mL/kg. The concentration of 0.2% for the first patient

subsequent concentrations were adjusted based on the block effect of previous patient

increase or decrease by 0.02%. The trial was stopped when there were 7 turning points. Isotonic regression and Bootstrap were used to calculate the values of EC

and 95% effective concentration (EC

)

along with their 95% confidence intervals (

). General data

incidence of adverse events

and score of postoperative pain were reco

rded.

Results

A total of 26 children aged 6 to 10 years were included. The EC

of ultrasound-guided interscalene brachial plexus block was determined to be 0.091% (95%

: 0.077%~0.105%)

and the EC

was estimated

to be 0.117% (95%

: 0.110%~0.118%). Successful blockade was achieved in 16 cases (61.5%)

while 10 cases (38.5%) failed. No statistical differences existed between successful and failed cases regarding sex

age

body weight

surgical site

surgical laterality

operative time

or anesthesia duration. None of the patients experienced adverse events such as pneumothorax

vascular injury

or Horner’s syndrome

and the score of postoperative pain were all

6 by modified Children’s Hospital of Eastern Ontario Pain Scale.

Conclusion

In children aged 6 to 10 years

the EC

of ropivacaine is 0.091% at a volume of 0.5 mL/kg for ultrasound-guided interscalene brachial plexus block

and this low dose of regional anesthetic can reduce the risks such as systemic toxicity and direct neurotoxicity.

关键词

Keywords

references

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国家儿童健康与疾病临床医学研究中心，儿童发育疾病研究教育部重点实验室，儿科学重庆市重点实验室3

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