Comparison of anesthetic effect between 0.375% ropivacaine versus 0.5% lidocaine in forearm intravenous regional anesthesia

BACKGROUND AND OBJECTIVES: Ropivacaine was shown to provide superior postblock analgesia to lidocaine in intravenous regional anesthesia (IVRA) in voluntary studies. The objective of this study was to compare the anesthesia efficacy, postblock analgesia, and local anesthetic-related side effects between ropivacaine and lidocaine when forearm IVRA was used. METHODS: Fifty-one patients undergoing outpatient hand surgery were randomized to receive forearm IVRA with either ropivacaine 0.375% or lidocaine 0.5%. The volume was 0.4 mL/kg up to 25 mL. Sensation to pinching by forceps and motor function was assessed at 5-minute intervals up to 15 minutes. After tourniquet deflation, verbal pain rating score (VRPS) at 15-minute intervals for the first 2 hours and time for first analgesic in the first 24 hours were evaluated. RESULTS: Eleven patients were excluded from the study with 20 patients remaining in each group. Onset time of anesthesia (6.5 +/- 2.9 minutes v 8.0 +/- 4.1 minutes for lidocaine and ropivacaine groups, respectively) and motor block were similar. In the postoperative period, VPRS was significantly lower in the ropivacaine group in the first 60 minutes (median, 0; P <.05) with significantly more patients in the ropivacaine group pain free (VPRS, 0) up to the first 90 minutes (P >.05). More patients in lidocaine group requested analgesic in the first 2 hours postblock, and only patients in the lidocaine group required supplemental IV morphine in the recovery room. Twenty-four hour analgesic consumption was the same. No local anesthetic-related side effects were observed. CONCLUSIONS: We conclude that 0.375% ropivacaine provides effective anesthesia and superior postoperative analgesia compared with 0.5% lidocaine when forearm IVRA is used.     

不同局部麻醉药硬膜外阻滞麻醉行隆乳术的效果

目的观察隆乳手术中不同局部麻醉药混合液行硬膜外阻滞的麻醉效果及并发症.方法 120例行乳房假体置入术患者分为4组,以T4～T5棘突间隙为硬膜外穿刺点,分别注入含1 %利多卡因及0.375 %罗哌卡因、0.25 %罗哌卡因、0.25 %布比卡因的混合液及单纯1.3 %利多卡因溶液,初量13 ml,观察麻醉效果及对血流动力学的影响和并发症.结果切皮均无疼痛,脉搏氧饱和度无明显变化,血压及心率轻度降低.1 %利多卡因加0.375 %罗哌卡因、0.25 %罗哌卡因或0.25 %布比卡因混合液组的阻滞麻醉效果较好,单纯1.3 %利多卡因组效果较差.65例(54 %)患者出现鼻塞,39例(33 %)麻醉后发生心动过缓,无组间差异.结论高位硬膜外阻滞麻醉可安全、有效地应用于隆乳房手术麻醉,1 %利多卡因与0.25 %罗哌卡因或布比卡因混合液不仅阻滞麻醉效果较好,对生理功能影响也较小.     

Subjective Outcomes of Carpal Tunnel Release in Patients with Diabetes and Patients without Diabetes

Introduction  This study aims to compare the subjective outcomes of carpal tunnel surgery in the patients with diabetes and patients without diabetes, and it tries to determine the difference between insulin-dependent and noninsulin-dependent patients. Materials and Methods  This retrospective cohort study compares subjective outcomes of 35 patients with type 2 diabetes and 35 patients without diabetes who had a unilateral carpal tunnel release. None of the patients with diabetes had neuropathy. All the patients had surgery by a single surgeon with miniopen incision under local anesthesia. The patients were evaluated before surgery and 6 months after surgery using two Brigham and Women''s Carpal Tunnel Questionnaires Results  Carpal tunnel release was improved based on symptom severity scale (SSS) and functional status scale scores in patients with diabetes and nondiabetic patients. However, the mean SSS scores were higher in patients without diabetes 6 months after the surgery. Comparison between the mean SSS scores of the patients with diabetes showed higher scores in noninsulin-dependent patients. In patients with diabetes, SSS scores were positively correlated with carpal tunnel syndrome and diabetes durations. Conclusion  The outcomes of carpal tunnel release were improved in both patients with diabetes and patients without diabetes suffering from median nerve compression at the wrist. However, the duration of diabetes and its treatment can be related to the severity of the disease symptoms after the carpal tunnel releasing surgeries. In some diabetic patients, the severity of the symptoms was persistent. Level of Evidence  This is a prognostic level IV study.     

Topical anesthesia for cataract surgery with phacoemulsification: lidocaine 2% vs ropivacaine 1%. Preliminary results

BACKGROUND: The safety, tolerability and efficacy of ropivacaine 1% vs lidocaine 2% for phacoemulsification using topical anesthesia during cataract surgery, are compared. METHODS: A prospective, randomized, double-blind study comparing two agents for topical anesthesia is reported. Environment: Operative Unit of Ophthalmology, general Hospital. 1893 consecutively patients were studied (ASA 1-3, 738 males, 1155 females, age 71.8+/-9.7 years, range 35-90 years) undergoing routine phacoemulsification under topical 2% lidocaine (group I) and 1% ropivacaine (group II). The mains outcome measures of the study were: - the total dose of local anesthetic for obtaining a reduction of corneal sensation measured with the Cochet-Bonnet esthesiometer (value>3); - the pain recorded with visual analogic scale and verbal scale at: T1 = the first injection of local anesthetic; T2 = corneal incision; T3 = the end of surgery; T4 = 1h after surgery; T5 = the first postoperative day; - any requirement for additional intraoperative injection anesthesia and systemic sedation when needed; - surgeon assessments of operative conditions and patient cooperation; - patients' subjective level of comfort; - complications. RESULTS: Topical anesthesia using lidocaine 2% was significantly more painful than the ropivacaine 1%. The onset of anesthesia adequate for surgery was similar in all two groups. There were differences between the groups with respect to perioperative analgesia because the VAS was significantly higher in lidocaine group than in ropivacaine group. There were no statistically differences between the two groups at the follow-up. Inadequate anesthesia was seen in 8.05% (74/919 patients) cases of group I vs 0.9% (22/974 patients) of group II. Sedation was needed only in 10 patients and 6 patients of group I and II respectively. The surgeon assessment showed more patient cooperation in the ropivacaine group (83%). Satisfactory comfort (level 1) was reported by 60.4% in the lidocaine group and 86.8% in the ropivacaine group. In both groups there were cases of postoperative epithelial edema (29 patients in group I vs 36 patients in group II) although it decreased after the first postoperative day. No other significant side-effects were observed with the use of either formulations. CONCLUSIONS: Lidocaine 2% and ropivacaine 1% were safe and effective agents in patients having phacoemulsification with IOL implantation. However, ropivacaine provides more good operative conditions than lidocaine for the surgeon and comfortable surgical circumstances for the patient.     

Ropivacaine 0.2% and lidocaine 0.5% for intravenous regional anesthesia in outpatient surgery

BACKGROUND: A longer-acting local anesthetic agent, such as ropivacaine, may offer advantages over lidocaine for intravenous regional anesthesia. The objectives of this study were to evaluate whether the findings of volunteer investigations with intravenous regional anesthesia with ropivacaine (which have shown prolonged analgesia after release of the tourniquet) translates into improved pain control after surgery. METHODS: With Human Investigation Committee approval and a double-blind study design, 20 healthy patients with American Society of Anesthesiologists physical status I or II classification who were scheduled to undergo forearm and hand surgery were randomly assigned to administration of 40 ml of either 0.2% ropivacaine or 0.5% lidocaine for intravenous regional anesthesia. Evidence of central nervous system side effects, such as lightheadedness, tinnitus, and metallic taste, as well as cardiac arrhythmias, were evaluated and treated (if necessary) after local anesthetic administration, before and during surgery, and after release of the tourniquet until discharge from the postanesthesia care unit. Regression of sensory anesthesia in the nerve distributions of the forearm and hand was recorded. Verbal numerical pain scores were monitored and quantified until the patients were discharged to home from the postanesthesia care unit. Patient pain scores, side effect profiles, time to first oral intake, and total amount of oral analgesics were recorded 24 h postoperatively. RESULTS: Intravenous regional anesthesia with 0.2% ropivacaine and 0.5% lidocaine provided equivalent levels of surgical anesthesia. After release of the tourniquet, the first evidence for return of sensation in the distribution of the five peripheral nerves occurred later in the ropivacaine group (median, 20 min; range, 15-40 min) than in the lidocaine group (median, 1 min; range, 1-25 min). Verbal numerical pain scores were significantly lower at the time of admission, whereas during the remainder of the postanesthesia care unit stay and later at home, the difference in verbal numerical pain scores between the two groups was no longer statistically significant. CONCLUSIONS: Ropivacaine 0.2% may be an alternative to 0.5% lidocaine for intravenous regional anesthesia in the outpatient surgical setting. Longer-lasting analgesia in the immediate postoperative period may be due to a more profound and prolonged tissue binding effect of ropivacaine.     

Ropivacaine 0.2% and Lidocaine 0.5% for Intravenous Regional Anesthesia in Outpatient Surgery

Background: A longer-acting local anesthetic agent, such as ropivacaine, may offer advantages over lidocaine for intravenous regional anesthesia. The objectives of this study were to evaluate whether the findings of volunteer investigations with intravenous regional anesthesia with ropivacaine (which have shown prolonged analgesia after release of the tourniquet) translates into improved pain control after surgery.

Methods: With Human Investigation Committee approval and a double-blind study design, 20 healthy patients with American Society of Anesthesiologists physical status I or II classification who were scheduled to undergo forearm and hand surgery were randomly assigned to administration of 40 ml of either 0.2% ropivacaine or 0.5% lidocaine for intravenous regional anesthesia. Evidence of central nervous system side effects, such as lightheadedness, tinnitus, and metallic taste, as well as cardiac arrhythmias, were evaluated and treated (if necessary) after local anesthetic administration, before and during surgery, and after release of the tourniquet until discharge from the postanesthesia care unit. Regression of sensory anesthesia in the nerve distributions of the forearm and hand was recorded. Verbal numerical pain scores were monitored and quantified until the patients were discharged to home from the postanesthesia care unit. Patient pain scores, side effect profiles, time to first oral intake, and total amount of oral analgesics were recorded 24 h postoperatively.

Results: Intravenous regional anesthesia with 0.2% ropivacaine and 0.5% lidocaine provided equivalent levels of surgical anesthesia. After release of the tourniquet, the first evidence for return of sensation in the distribution of the five peripheral nerves occurred later in the ropivacaine group (median, 20 min; range, 15-40 min) than in the lidocaine group (median, 1 min; range, 1-25 min). Verbal numerical pain scores were significantly lower at the time of admission, whereas during the remainder of the postanesthesia care unit stay and later at home, the difference in verbal numerical pain scores between the two groups was no longer statistically significant.     

A double-blind randomized controlled trial showing the analgesic and anesthetic properties of lidocaine E to be equivalent to those of ropivicaine and bupivacaine in carpal tunnel release surgery

In a three-phase trial, the anesthetic properties of lidocaine, bupivacaine and ropivicaine were compared in carpal tunnel release surgery. In phase I, two groups of 25 sequential patients were injected with either lidocaine plain 2% or lidocaine 2% with adrenaline 1:100,000 (E), as the local anesthetic for outpatient carpal tunnel release surgery. Subjective injection pain, postoperative pain at 2 h increments and the number of analgesic pills taken were recorded. During the first postoperative hours, outcome measures were superior in the lidocaine E group.In phase II, a double-blind randomized design compared 42 patients injected with either lidocaine E or a combination of lidocaine E and bupivacaine. Postoperative pain scores and analgesic pills taken were compared using nonparametric statistical tests. During the first 4 h there was a slight benefit in the duration of the anesthetic and fewer pain pills were used in the bupivacaine group.Phase III was a randomized double-blind comparison of ropivicaine and lidocaine E 2% in 72 patients. There was a slight decrease in pain scores and fewer analgesic pills required during the first 6 h in the ropivicaine group.Lidocaine plain 2% provided significantly inferior analgesic and anesthetic properties compared with lidocaine E 2%, bupivacaine or ropivicaine. Sequential randomized comparisons between lidocaine E and bupivacaine and ropivicaine showed clinical equivalence. The present study showed lidocaine E 2% to be a satisfactory and comparatively cost-effective anesthetic for outpatient carpal tunnel surgery.     

Continuous cervical epidural with ropivacaine in carotid surgery. Description of a case

In the light of the recent addition of ropivacaine as a local anesthetic to our pharmacopeia, its effects at the cervical level are examined. A patient undergoing TEAC was given continuous epidural anesthesia with ropivacaine 0.5% (total dose: 167.5 mg in three hours) at C6-C7. No supplementary i.v. anesthetic was administered intraoperatively. The results obtained were compared with those of a similar case as to type of pathology and anesthetic technique, who was anesthetised with bupivacaine 0.375% (total dose: 112.5 mg in three hours-continuous epidural anesthesia) + fentanyl (0.18 mg), supplemented intravenously with ketoprophene (200 mg) + fentanyl (0.15 mg) for analgesic reasons. From this comparison, ropivacaine 0.5% was found to have greater anesthetic potential than bupivacaine 0.375%. However, it did not appear that ropivacaine exerted a protective effect on cardiovascular conditions in the course of carotid surgery. Further anesthesiologic experiences are needed to define the validity of ropivacaine in cervical surgery.     

A comparison of local intraarticular anesthesia versus general anesthesia for ambulatory arthroscopic knee surgery

Various anesthetic techniques including local, regional, and general anesthesia have been utilized for ambulatory arthroscopic knee surgery. The choice of anesthetic technique for this surgical procedure can have a significant impact on postoperative recovery, side effects, and patient satisfaction. The objective of this randomized, prospective study is to evaluate the efficacy of utilizing either intraarticular (IA) local anesthesia or general anesthesia (GA) for patients undergoing outpatient arthroscopic knee surgery. Patients assigned to the local anesthesia group were administered an IA injection of 30 mL of bupivacaine 0.25% approximately 20-30 min before surgery. Intraoperative sedation was provided with the administration of propofol. Patients assigned to the GA group were administered propofol and fentanyl for induction and maintained with sevoflurane combined with nitrous oxide in oxygen by laryngeal mask airway. The surgeon injected 30 mL of bupivacaine 0.25% through the arthroscope at the completion of the surgical procedure. This study demonstrates that IA anesthesia provides for improved pain relief, decreased postoperative opioid use, postoperative nausea and vomiting (PONV), time spent in the recovery room, and improved patient satisfaction with similar operating conditions comparable to general anesthesia in patients undergoing outpatient arthroscopic knee surgery. Although both groups received a similar dose of IA bupivacaine, administering the local anesthetic prior to surgery resulted in more effective analgesia. We currently believe that intraarticular local anesthesia fulfills all the criteria for the optimal anesthetic technique for outpatient arthroscopic knee surgery.     

Lidocaine hydrochloride versus lidocaine bicarbonate for epidural anesthesia in outpatients undergoing arthroscopic surgery

In a randomized, double-blind study, 24 patients undergoing outpatient arthroscopic knee surgery were divided into two groups. Group 1 received 2% lidocaine hydrochloride; group 2 received pH-adjusted 1.73% lidocaine made by adding 1 ml of NaHCO3 44.6 meq/L to 10 ml of 2% lidocaine hydrochloride. Epidural anesthesia was administered in the sitting position. Group 1 consisted of 12 males; group 2 consisted of 6 males and 6 females (p less than 0.01). Statistical analysis using the unpaired Student's t-test and the Mann-Whitney test found no significant differences between the two groups regarding time of onset of analgesia, degree of spread of analgesia, time to maximum motor blockade, degree of motor blockade, length of surgical procedure, total anesthesia time, regression of anesthesia, dosage of lidocaine used, and serum lidocaine levels. Intraoperative conditions were satisfactory in all cases. Postoperatively, all patients reported having experienced a satisfactory anesthetic without any complications. The authors conclude that epidural anesthesia is a satisfactory technique for outpatient arthroscopic surgery. There appears to be no advantage to adding bicarbonate to lidocaine anesthetic solutions for use in epidural anesthesia.     

不同浓度罗哌卡因用于腋路臂丛神经阻滞的研究

目的探讨0.25%、0.3%、0.375%罗哌卡因用于臂丛神经阻滞的有效性和安全性,并与0.25%布比卡因对照.方法选择ASAⅠ-Ⅱ级准备行上肢手术的病人80例,随机分为4组,每组20例,分别用0.25%、0.3%、0.375%罗哌卡因和0.25%布比卡因40ml行臂丛神经阻滞,观察病人有无不适症状,并分别对感觉和运动进行评价.结果随着浓度增加罗哌卡因麻醉强度依次增加,40m10.25%罗哌卡因麻醉强度明显低于0.25%布比卡因,且满意率低,仅为85%;将罗哌卡因浓度提高到0.375%,显示出与0.25%布比卡因相当的麻醉强度,满意率则提高到100%.结论 0.25%罗哌卡因用于臂丛神经阻滞起效慢、满意率低,不是临床使用的适宜浓度;0.3%、0.375%罗哌卡因起效快,作用完善,副作用少,可推荐用于长时间臂丛神经阻滞,而以0.375%罗哌卡因最为适宜.     

Pre- and intraoperative epidural ropivacaine have no early preemptive analgesic effect in major gynecological tumour surgery

PURPOSE: Thoracic epidural analgesia (TEA) is an established technique for postoperative pain relief after major abdominal surgery. However it is still under discussion whether pre-incisional TEA can reduce postoperative pain perception or postoperative analgesic consumption. METHODS: The present prospective, randomized, double-blind study was performed to investigate the effects of intra- and postoperative TEA vs only postoperative TEA using ropivacaine 0.375% in 30 women scheduled for major abdominal tumour surgery. Prior to induction of general anesthesia patients received an epidural bolus of 10 mL saline in Group I (GI) and 10 mL ropivacaine 0.375% in Group II (GII) followed by an infusion of 6 mL x hr(-1) of the respective solution during surgery. Postoperatively all patients received an epidural infusion of 6 mL x hr(-1) ropivacaine 0.375% during 24 hr followed by patient controlled epidural analgesia for the next 72 hr. Operative data, dynamic pain scores, consumption of local anesthetics and standardized supplemental analgesics were analyzed. RESULTS: No difference was seen between groups with respect to the amount of required postoperative local anesthetics and supplemental analgesics, pain scores and side effects during the first 96 hr following surgery except a reduction of intraoperative sufentanil consumption (GI: 143.2 +/- 52.6 vs GII: 73.3 +/- 32.6 microg, P < 0.001). CONCLUSION: Intraoperative TEA with ropivacaine 0.375% did not significantly reduce the amount of analgesics required after major abdominal gynecological tumour surgery.     

不同浓度利多卡因局部浸润麻醉在腹股沟疝修补术中的应用

目的 比较0.25%和0.5%浓度的利多卡因局部浸润麻醉在成人腹股沟疝修补术中的麻醉效果.方法 2012年10月至2012年12月四川大学华西医院收治成人单侧腹股沟疝患者100例,随机分为观察组和对照组各50例,观察组给予0.25%利多卡因,对照组给予0.5%利多卡因行局部浸润麻醉下无张力疝修补术.记录术中使用的利多卡因的体积、剂量、手术时间和麻醉相关并发症,评估患者切皮时、手术开始10 min和手术结束时的视觉模拟评分（visual analogue scale,VAS）及患者对麻醉的满意度.结果 本组患者均无更改麻醉方式.二组术中使用利多卡因的剂量[（153±30）mg vs （287±36）mg]比较差异有统计学意义（F=404.629,P=0.000）,其他各项指标二组之间比较差异均无统计学意义.结论 不同浓度利多卡因局部浸润麻醉用于腹股沟疝无张力修补获得了相同的麻醉效果,但在麻醉药物剂量方面0.25%组明显低于0.5%组.应用低浓度利多卡因可降低局部麻醉药不良反应的危险性,值得推荐.     

定容小剂量利多卡因和罗哌卡因蛛网膜下腔麻醉在输尿管镜技术日间手术中的应用研究

目的 探讨定容小剂量利多卡因和罗哌卡因蛛网膜下腔麻醉(腰麻)应用于输尿管镜技术日间手术的有效性和安全性. 方法 前瞻性纳入输尿管镜技术日间手术患者100例,按随机数字表法分为4组(每组25例):L1组,利多卡因10 mg;L2组,利多卡因15 mg;R1组,罗哌卡因10 mg;R2组,罗哌卡因15 mg.分别将所用麻醉药物稀释于脑脊液至3 ml,给药速度0.2 ml/s.记录麻醉前(T0)及麻醉给药后3 min(T1)、6 min(T2)、20 min(T3)、30 min(T4)、60 min(T5)时患者SBP、DBP、HR等指标变化,监测感觉阻滞起效时间、运动阻滞起效时间、麻醉质量和毒副作用,评估痛觉恢复时间、运动阻滞恢复时间和留院时间. 结果 麻醉后L1组、R1组循环稳定,L2组、R2组在30 min内BP和HR下降(P＜0.05).各组感觉阻滞起效时间差异无统计学意义(p＞0.05),L1组、L2组运动阻滞较R1组、R2组起效时间缓慢且效果轻微.Lovett评分L1组显著高于其他3组(P＜0.05),L1组的留院时间显著低于其他3组(P＜0.05),各组均未发现短暂性神经综合征(transient neurologicalsymptoms,TNS)等毒副作用. 结论 定容小剂量利多卡因腰麻方法循环稳定、感觉阻滞完善、运动阻滞弱、留院时间短、神经毒性极小,可以安全有效地应用于输尿管镜技术日间手术.     

The minimum local anesthetic concentration of ropivacaine for caudal analgesia in children

Ropivacaine is a new long-acting amino-amide local anesthetic. The concentrations of ropivacaine used in caudal analgesia range from 0.1% to 0.5%. The purpose of this study was to determine the minimum local analgesic concentration of ropivacaine to provide caudal analgesia in children. In a prospective, randomized, double-blinded clinical study, we studied 26 ASA grade I patients aged 1 to 5 yr who were scheduled for hypospadias operation under general anesthesia with caudal ropivacaine analgesia. General anesthesia was maintained with an end-tidal enflurane concentration of 0.8% in 100% oxygen (0.5 minimum alveolar anesthetic concentration [MAC]). Each child received 1 mL/kg of ropivacaine solution through a caudal catheter. The first child received ropivacaine 0.2%, and subsequent concentrations were determined by the analgesic response of the previous patient to the initial skin incision by use of Dixon's up-and-down sequential allocation. The testing interval was set at 0.025%. The minimum local analgesic concentration of ropivacaine for caudal analgesia under general anesthesia with 0.5 MAC enflurane was 0.11% (95% confidence interval [CI], 0.09%-0.12%), and the 95% effective concentration was 0.13% (95% CI, 0.12%-0.21%). In conclusion, the minimum local analgesic concentration of ropivacaine to provide effective caudal analgesia in children under general anesthesia with 0.5 MAC enflurane was found to be 0.11% (95% CI, 0.09%-0.12%). IMPLICATIONS: Ropivacaine is a new long-acting amino-amide local anesthetic. The concentrations of ropivacaine used in caudal analgesia ranged from 0.1% to 0.5%. This study determined the minimum local analgesic concentration of ropivacaine to establish effective caudal analgesia under general anesthesia with 0.5 minimum alveolar anesthetic concentration enflurane in children.     

罗哌卡因和利多卡因在腹股沟疝手术中的效果对比

目的探讨罗哌卡因和利多卡因在腹股沟疝手术中局部麻醉的效果差异。方法选择2018年1月至2019年11月在马鞍山中心医院接受腹股沟疝无张力修补手术治疗的患者90例。30例使用利多卡因局部麻醉的患者作为A组,30例使用利多卡因联合0.375%罗哌卡因的患者作为B组,30例使用利多卡因联合0.75%罗哌卡因的患者作为C组。对比3组的血流动力学指标[平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO₂)]、手术情况相关指标(手术耗时、失血量、住院时间)、麻醉效果相关指标[麻醉起效时间、麻醉持续时间、术后患者的视觉模拟评分(VAS)]、术后不良反应。结果3组患者在麻醉前、麻醉后1、5、10 min的MAP、HR、SpO₂数据差异无统计学意义(P>0.05)。3组患者的手术耗时、失血量数据差异无统计学意义(P>0.05)。B组和C组的住院时间短于A组(P<0.05)。B组和C组的麻醉起效时间长于A组(P<0.05)。C组的麻醉持续时间长于B组,B组的麻醉持续时间长于A组(P<0.05)。C组在术后1、3、6、9 h的VAS评分低于B组,B组在术后1、3、6、9 h的VAS评分低于A组(P<0.05)。3组在术后12、24 h的VAS评分差异无统计学意义(P>0.05)。3组的术后不良反应差异无统计学意义(P>0.05)。结论对于接受腹股沟疝无张力修补手术的患者,采用含有利多卡因或者罗哌卡因的局部麻醉方法均可以保证手术过程中的血流动力学稳定以及麻醉效果。利多卡因的起效时间更快,罗哌卡因的镇痛效果维持时间更长,使用浓度为0.75%罗哌卡因与利多卡因联合使用,患者可获得更好的术后镇痛效果,且用药的安全性良好。     

Comparison of ropivacaine 0.2% and 0.25% with lidocaine 0.5% for intravenous regional anesthesia

Study ObjectiveTo compare the anesthetic effects of two different concentrations and doses of ropivacaine (0.2% and 0.25%) with those of a conventional dose of lidocaine 0.5%.DesignProspective, randomized, double-blinded, clinical investigation.SettingLarge metropolitan university hospital.Patients66 adult ASA physical status I and II patients undergoing forearm and hand surgery.InterventionsPatients were randomly allocated to three groups to receive intravenous regional anesthesia (IVRA). Study groups were: ropivacaine 0.2% (Group I, n = 22), ropivacaine 0.25% (Group II, n = 22), and lidocaine 0.5% (Group III, n = 22).MeasurementsTourniquet tolerance times and regression of sensory analgesia were noted. Verbal numerical pain scores (VNS), cumulative analgesic consumption, and side effects were recorded during surgery and postanesthesia care unit (PACU). Time to first pain medication intake and number of patients receiving analgesics in the PACU were recorded.Main ResultsAdditional tolerance times for the distal tourniquet were significantly higher in the ropivacaine 0.25% group than the other two groups. Regression of sensory anesthesia was fastest in the lidocaine group. During the PACU stay, VNSs were significantly lower in the first 20 minutes in the ropivacaine groups than the lidocaine group. Time to first intake of pain medication in the PACU was soonest in the lidocaine group. The number of patients given analgesics in the PACU was highest in the lidocaine group. The number of patients taking > two tablets of tramadol was significantly lowest in the ropivacaine 0.25% group. No serious side effects were observed in any study group.ConclusionLonger tolerance times for the distal tourniquet, prolonged analgesia after tourniquet release, and lower analgesic requirements postoperatively make ropivacaine 0.2% and 0.25% an alternative to lidocaine for IVRA.     

Caudal Block in Children: Ropivacaine Compared with Bupivacaine

Background: Bupivacaine provides reliable, long-lasting anesthesia and analgesia when given via the caudal route. Ropivacaine is a newer, long-acting local anesthetic that (at a concentration providing similar pain relief) has less motor nerve blockade and may have less cardiotoxicity than bupivacaine.

Methods: In a double-blind trial, 81 healthy children, undergoing ambulatory surgical procedures, were randomly allocated to receive caudal analgesia with either bupivacaine or ropivacaine, 0.25%, 1 ml/kg. All blocks were placed by an attending anesthesiologist or an anesthesia fellow after induction of general anesthesia.

Results: Data were available for 75 children. There were no significant differences between the two groups in baseline characteristics or in anesthesia, surgery, recovery room, or day surgery unit durations. The quality and duration of postoperative pain relief did not differ. Motor and sensory effects were similar. Time to first micturition did not differ.     

Infraclavicular brachial plexus block: variation in approach and results in 360 cases.

BACKGROUND AND OBJECTIVES: Brachial plexus block is clinically useful. Although the infraclavicular approach to brachial block is the less commonly used form it may offer advantages. We describe the results with three local anesthetic mixtures used during this observational study. METHODS: Three hundred and sixty patients, ASA physical status I and II, scheduled for upper extremity orthopedic surgery, were anesthetized with an infraclavicular brachial plexus block. They were divided into three groups (120 patients each) by type of 40-mL anesthetic mixture: group I had even parts of 2% plain lidocaine and 0.5% bupivacaine with epinephrine 1:200,000; group II had even parts of 1% plain lidocaine and 0.25% bupivacaine with epinephrine 1:200,000; and group III had even parts of 1.5% plain lidocaine and 0.37% bupivacaine with epinephrine 1:200,000. Plexus identification was made by nerve stimulator. The observational assessments were: adequacy and latency time of the block, tourniquet tolerance, postoperative analgesia, local anesthetics doses, sedative doses, complications, and side effects. RESULTS: In groups I, II, and III, adequacy of the block was 95, 75, and 96%, latency time was 10.4, 12.9, and 10.9 minutes, tourniquet tolerance was 99, 84, and 98%, postoperative analgesia time was 663, 331, and 502 minutes, anesthetic doses of lidocaine/bupivacaine were 5.2/1.3, 2.9/0.7 and 4.1/1.1 mg/kg, respectively. Differences were noted between group II and groups I and III (P range: .01-.0001). Sedatives in adequate blocks were midazolam with/without fentanyl (2-3 mg/50-100 microg) in all groups. There were two complication cases with no consequences: two vascular punctures that did not hold up or delay the anesthetic or surgical procedure. There were no clinical manifestations or side effects. CONCLUSIONS: The infraclavicular approach described is effective. It produced reliable anesthesia and is associated with minimal complications and side effects. The mixture of local anesthetics used in group II is not adequate for producing reliable anesthesia.     

Local anesthetic toxicity in interscalene block: clinical series

We experienced two cases of local anesthetic toxicity by interscalene block. A 62-year-old man received interscalene block with lidocaine 1% 30 mL and bupivacaine 0.25% 20 mL under light sedation followed by general anesthesia. He was not awake at one hour after surgery with his pupils dilated. Three hours after interscalene block, he became awake with no complication. A 73-year-old female received interscalene block with lidocaine 1% 15 mL and ropivacaine 0.75% 15 mL under light sedation. After the injection, a catheter was inserted 5 cm. About 7-8 min after catheter insertion, generalized tonic seizure occurred. Seizure stopped in two min after anesthesia induction. She had no complication after surgery. These two cases showed neurological toxicity by interscalene block with lidocaine and bupivacaine or with ropivacaine without hemodynamic complication.