经尿道前列腺电切术老年患者鞘内注射不同局麻药的药效学

目的 探讨经尿道前列腺电切术老年患者鞘内注射不同局麻药的药效学.方法 择期拟在脊椎-硬膜外联合阻滞下行经尿道前列腺电切术的老年患者90例,ASA分级Ⅰ～Ⅲ级,年龄69～82岁,体重指数＜30 kg/m2,随机分为3组(n=30):左旋布比卡因组(L组)、罗哌卡因组(R组)和布比卡因组(B组)分别于蛛网膜下腔注射0.5%左旋布比卡因、0.5%罗哌卡因、0.5%布比卡因.采用序贯法进行试验,初始剂量分别为7、10、6 mg,相邻剂量比均为0.9.阻滞有效,则下一例采用低一级剂量;阻滞无效,则下一例采用高一级剂量.阻滞有效的标准为:蛛网膜下腔注药后20 min内感觉阻滞平面达T10.计算3种局麻药半数有效剂量(ED50)及其95%可信区间(95%CI).结果 经尿道前列腺电切术老年患者鞘内注射左旋布比卡因、罗哌卡因和布比卡因阻滞的ED50及其95%CI分别为6.781(6.561～7.024)mg、9.135(8.670～9.616)mg和5.170(5.012～5.333)mg.左旋布比卡因、罗哌卡因和布比卡因的效价比为0.76∶0.57∶1.00.结论 经尿道前列腺电切术老年患者鞘内注射左旋布比卡因、罗哌卡因和布比卡因阻滞的效价比为0.76∶0.57∶1.00.     

三种不同局麻药腰麻最大运动阻滞效应的比较

目的 采用序贯试验评估罗哌卡因、左旋布比卡因和布比卡因鞘内注射后达到Bromage 3级的半数有效剂量(ED50),比较三种局麻药腰麻的运动阻滞效应.方法 腰-硬联合麻醉(CSEA)下择期行妇科手术患者99例,随机分为罗哌卡因组、左旋布比卡因组和布比卡因组,分别鞘内注射0.5%等比重罗哌卡因、左旋布比卡因或布比卡因,起始剂量均为7 mg,剂量变化梯度为1mg,鞘内注药后25 min内双下肢改良Bromage达到3级为有效.结果 罗哌卡因组腰麻产生最大运动阻滞的ED50 为9.62 mg,95%可信区间(CI)为9.16～10.09 mg;左旋布比卡因组的ED50为9.55mg,95% CI为9.01～10.11 mg;布比卡因组的ED50为6.08 mg,95% CI为5.39～6.80 mg.罗哌卡因最大运动阻滞相对效价比是布比卡因的0.63倍(95% CI 0.56～O.73).结论 罗哌卡因和左旋布比卡因腰麻的运动阻滞效应明显低于布比卡因,而罗哌卡因与左旋布比卡因无明显差异.     

妇科手术患者蛛网膜下腔注射布比卡因与左旋布比卡因运动阻滞效应的比较

目的 比较妇科手术患者蛛网膜下腔注射布比卡因与左旋布比卡因运动阻滞的的效应.方法 拟在脊椎-硬膜外联合麻醉下行妇科手术的患者60例,ASA Ⅰ或Ⅱ级,年龄20～60岁,身高155～170 cm,体重指数<30 kg/m2,随机分为2组(n=30),布比卡因组(B组):蛛网膜下腔注射等比重0.5%布比卡因;左旋布比卡因组(L组):蛛网膜下腔注射等比重0.5%左旋布比卡因.采用序贯法进行试验,每组第1例患者局麻药剂量均为5 mg,剂量变化梯度为1 mg.运动阻滞有效定义为蛛网膜下腔注药结束后20 min内双下肢改良Bromage评分均达到3分.若上1例有效,则下1例采用低一级剂量;若无效,则下1例采用高一级剂量.采用概率单位回归法计算两药运动阻滞的半数有效剂量(ED50)及其95%可信区间(95%CI).结果 布比卡因运动阻滞的ED50及其95%CI为6.04(5.30～6.93)mg,左旋布比卡因运动阻滞的ED50及其95%CI为9.55(8.62～10.97)mg,布比卡因运动阻滞的ED50低于左旋布比卡因(P<0.01);左旋布比卡因与布比卡因运动阻滞的效价比及其95%CI为0.63(0.52～0.75).结论 左旋布比卡因蛛网膜下腔麻醉时运动阻滞的效应低于布比卡因.     

鞘内注射罗哌卡因、左旋布比卡因和布比卡因后运动阻滞效能的比较

目的测定罗哌卡因、左旋布比卡因和布比卡因鞘内注射后运动阻滞的半数有效量（ED50）及其运动阻滞的相对效能。方法104例在腰麻、硬膜外联合麻醉下行择期剖宫产的产妇随机分为3组，分别鞘内注射0．5％（质量／体积）的罗哌卡因、左旋布比卡因和布比卡因，起始剂量是4mg，试验递增剂量为1mg.有效的定义是：鞘内注药5分钟内任一下肢出现运动阻滞（改良的Bromage评分和臀部运动功能评分）。结果鞘内注射罗哌卡因运动阻滞的ED50值为5．79mg（95％CI：4．62～6．96）；左旋布比卡因的ED50为4．83mg（95％CI：4．35～5．32）；布比卡因的ED50为3．44mg（95％CI：2．55～4．34）（P〈0．0007）。运动阻滞效能的相对比例：罗哌卡因／布比卡因为0．59（95％CI：0．42—0．82）；罗哌卡因／左旋布比卡因为0．83（95％CI：0．64～1．09）；左旋布比卡因／布比卡因为0．71（95％CI：0．51～0．98）。结论3种酰胺类局麻药鞘内注射后运动阻滞效能由低到高分别是：罗哌卡因、左旋布比卡因和布比卡因。     

剖宫产术患者不同比重罗哌卡因腰麻半数有效剂量的比较

目的 比较剖宫产术患者不同比重罗哌卡因腰麻的半数有效剂量(ED50).方法 择期脊椎-硬膜外联合麻醉下行剖宫产术的单胎足月初产妇40例,年龄20～40岁,采用随机数字表法,将其随机分为2组(n=20):重比重罗哌卡因组(HR组)和轻比重罗哌卡因组(LR组).经L2.3间隙行蛛网膜下腔穿刺,2组第1例患者局麻药的初始剂量均为9mg,HR组和LR组分别给予0.5％重比重和0.5％轻比重罗哌卡因,根据腰麻是否有效按照序贯法确定下一例患者的剂量,剂量间隔为1mg.采用概率单位法计算不同比重罗哌卡因腰麻的ED50及其95％可信区间(CI).结果 0.5％重比重和0.5％轻比重罗哌卡因腰麻的ED50分别为9.34 mg(95％CI 8.34～10.46 mg)和9.64 mg(95％CI 8.90～10.44 mg),二者ED50比较差异无统计学意义(P＞0.05).结论 剖宫产术患者0.5％重比重和0.5％轻比重罗哌卡因腰麻的ED50分别为9.34和9.64 mg,比重因素对罗哌卡因腰麻效果无影响.     

高海拔地区高龄全髋关节置换术患者蛛网膜下腔注射布比卡因的药效研究

目的探讨高海拔地区高龄患者全髋关节置换术行蛛网膜下腔注射0.375%布比卡因的半数有效剂量(ED50)及95%有效剂量(ED95)。方法拟在腰-硬联合阻滞下行全髋关节置换术的高海拔高龄患者23例,年龄73~99岁,ASAⅡ或Ⅲ级,采用序贯法进行研究,蛛网膜下腔注射等比重0.375%布比卡因,初始剂量为3.0mg,相邻剂量比值为0.8,计算0.375%等比重布比卡因的ED50、ED95及其95%可信区间(CI)。结果其中20例成功完成测试,得到布比卡因的ED50(95%CI)、ED95(95%CI)分别为4.81(3.98~5.81)mg、7.29(6.03~8.81)mg。结论蛛网膜下腔注射0.375%等比重布比卡因7.5mg能满足高海拔绝大多数高龄患者接受全髋关节置换手术的麻醉需要。     

蛛网膜下腔注射罗哌卡因与布比卡因运动神经阻滞效力的比较

目的 比较蛛网膜下腔注射罗哌卡因与布比卡因的运动神经阻滞效力.方法 择期脊椎.硬膜外麻醉下拟行泌尿外科腔镜手术患者60例,年龄18～64岁,体重46～75 kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将患者随机分为2组(n=30):0.5%罗哌卡因组和0.5%布比卡因组.按照序贯法进行试验,阻滞有效,下一例患者采用低一级剂量,阻滞无效,下一例患者采用高一级剂量,初始剂量均为4 mg,剂量梯度1 mg,阻滞有效的标准:蛛网膜下腔给药后5或10 min时任一下肢的任一种运动神经阻滞评分>0分.采用序贯法计算蛛网膜下腔注射罗哌卡因或布比卡因运动神经阻滞的半数有效剂量(ED50)及其95%置信区间.结果 患者蛛网膜下腔注射罗哌卡因和布比卡因运动神经阻滞的ED50及其95%置信区间分别为6.68(6.27～7.13)mg和4.07(3.56～4.47)mg,效力比为O.61.结论 患者蛛网膜下腔注射罗哌卡因运动神经阻滞效力低于布比卡因.

Abstract：

Objective To determine the median effective doae (ED50) for motor block after intrathecal ropivacaine and bupivacaine. Methods Sixty ASA Ⅰ or Ⅱ patients, aged 18-64, weighing 46-75 kg, undergoing elective urological surgery under combined spinal-epidural anesthesia, were randomized into 2 groups ( n = 30each) receiving intrathecal 0.5% ropivacaine and 0.5% bupivacaine respectively. The ED50 was determined by up-down sequential allocation. The initial dose was 4 mg. Each time the dose increased/decreased by 1 mg. Efficacy was determined by the occurrence of any motor block in either lower extremity (modified Bromage scale > 0)within 5 or 10 min after the spinal injection. Results The intrathecal ED50 for motor block was 6.68 mg for ropivacaine (95% confidence interval 6.27-7.13 mg) and 4.07 mg for bupivacaine (95% confidence interval 3.56-4.47mg) . The relative motor blocking potency ratio was ropivacaine/bupivacaine 0.61. Conclusion The potency of intrathecal ropivacaine is lower than that of bupivacaine for motor block.     

罗哌卡因蛛网膜下腔阻滞用于剖宫产的量效关系

目的 研究罗哌卡因蛛网膜下腔阻滞用于剖宫产的量效关系.方法 择期剖宫产患者100例,随机、双盲分为四组.于L2-3间隙蛛网膜下腔穿刺成功后,分别注射罗哌卡因15 mg(A组)、17.5 mg(B组)、20 mg(C组)、22.5 mg(D组).采用针刺法测定感觉阻滞平面,改良Bromage评分法测定下肢运动神经阻滞程度,VAS评分评估患者疼痛程度,术者评定腹壁松弛度,记录麻醉后不良反应.采用Probit法计算50%和95%患者镇痛有效的罗哌卡因剂量(ED50和ED95)及其95%可信区间(CI).结果 随着剂量加大,运动阻滞起效时间逐渐缩短,Bromage评分逐渐增高,感觉和运动恢复时间逐渐延长.四组镇痛有效率分别为36%、64%、96%、100%,腹壁松弛度"很松"的分别为24%、48%、92%、100%.麻醉后不良反应少.罗哌卡因的ED50为15.95 mg(95%CI 15.31～16.62 mg),ED95为18.76 mg(95%CI 17.67～19.54 mg).结论 国大罗哌卡因用于剖宫产蛛网膜下腔阻滞的ED50为15.95 mg,ED95为18.76 mg.     

剖宫产术患者左旋布比卡因蛛网膜下腔阻滞的量效关系

目的 确定剖宫产术患者左旋布比卡因蛛网膜下腔阻滞的量效关系.方法 择期剖宫产术患者印例,年龄25～35岁,体重60～90 kg,ASA Ⅰ或Ⅱ级,随机分为4组(n=15),于L3,4蛛网膜下腔穿刺成功后,分别注射左旋布比卡因7.5 mg(L1组)、10 mg(L2组)、12.5 mg(L3组)和15 mg(L4组),均用5%葡萄糖稀释至3 ml,注药时间30 s.采用视觉模拟评分法(VAS)评价切皮即刻患者疼痛程度,0分为无痛,10分为剧痛.VAS评分=0分为镇痛有效;VAS评分≥1分为镇痛无效,硬膜外追加1%利多卡因5～10 ml.采用Probit法计算50%和95%患者镇痛有效的左旋布比卡因剂量(ED50和ED95)及其95%可信区间.结果 左旋布比卡因的ED50及其95%可信区间为9.0(7.8～9.9)mg,ED95及其95%可信区间为13.2(11.6～17.6)mg.结论 剖宫产术患者左旋布比卡因蛛网膜下腔阻滞的ED50和ED95分别为9.0、13.2 mg.     

重比重甲磺酸罗哌卡因复合舒芬太尼蛛网膜下腔注射用于剖宫产的最佳剂量

目的探讨重比重甲磺酸罗哌卡因复合舒芬太尼蛛网膜下腔注射用于剖宫产的最佳剂量。方法 31例ASAⅠ或Ⅱ级在腰-硬联合麻醉下行择期剖宫产的产妇,首先选择L1~2间隙进行硬膜外置管,然后在L3~4间隙进行蛛网膜下腔穿刺,在30 s内注入混合的重比重甲磺酸罗哌卡因溶液。注药后立即头低脚高位调节平面,到达T7平面时,将床摇平,并略向左侧倾斜。罗哌卡因起始剂量为13.410 mg,腰麻成功的定义为10 min内到达T7平面和术中手术条件满意,硬膜外不需要追加利多卡因完成手术。根据罗哌卡因腰麻成功或不成功的反应,采用改良Dixon序贯法,减少或者增加0.894 mg来确定下一个产妇的腰麻剂量。结果 Probit分析表明,复合5μg舒芬太尼时,重比重甲磺酸罗哌卡因半数有效剂量(ED50)为10.713 mg(95%的可信区间为10.126~11.236 mg),95%有效剂量(ED95)为12.002 mg(95%的可信区间11.405~14.547 mg)。结论复合5μg舒芬太尼时,重比重甲磺酸罗哌卡因使50%产妇行剖宫产时获得满意麻醉的最佳剂量为10.713mg。甲磺酸罗哌卡因适合用于剖宫产腰麻。     

Minimum local analgesic doses of ropivacaine, levobupivacaine, and bupivacaine for intrathecal labor analgesia

BACKGROUND: Doses for intrathecal opioid-local anesthetic mixtures have been arbitrarily chosen. The aim of this study was to compare the analgesic efficacies of intrathecal ropivacaine, levobupivacaine, and bupivacaine for labor analgesia and to determine the analgesic potency ratios for these three drugs. For this purpose, the authors used the up-down sequential allocation model, which estimates the minimum local analgesic dose for intrathecal local anesthetic. METHODS: Ninety-seven nulliparous term parturients in spontaneous labor, requesting combined spinal-epidural analgesia, were randomly allocated to one of three groups to receive 0.25% spinal ropivacaine, levobupivacaine, or bupivacaine. The initial dose of the local anesthetic drug was chosen to be 2.5 mg, and the testing interval was set at 0.25 mg. The subsequent doses were determined by the response of the previous parturient. Efficacy was accepted if the visual analog pain score decreased to 10 mm or less on a 100-mm scale within 30 min. The minimum local analgesic dose was calculated using the method of Dixon and Massey. RESULTS: The intrathecal minimum local analgesic dose was 3.64 mg (95% confidence interval, 3.33-3.96 mg) for ropivacaine, 2.94 (2.73-3.16) mg for levobupivacaine, and 2.37 (2.17-2.58) mg for bupivacaine. The relative analgesic potency ratios were 0.65 (0.56-0.76) for ropivacaine:bupivacaine, 0.80 (0.70-0.92) for ropivacaine:levobupivacaine, and 0.81 (0.69-0.94) for levobupivacaine:bupivacaine. There were significant trends (P levobupivacaine > ropivacaine.     

Determination of the full dose-response relation of intrathecal bupivacaine, levobupivacaine, and ropivacaine, combined with sufentanil, for labor analgesia

BACKGROUND: Ropivacaine and levobupivacaine are local anesthetics that produce less motor block and greater sensory-motor separation when compared with equal milligram doses of bupivacaine. Although minimum local analgesic concentration studies suggested that they are less potent than bupivacaine, full dose-response studies have not been performed. The current trial describes the dose-response relation of levobupivacaine, ropivacaine, and bupivacaine, combined with sufentanil, when used for intrathecal labor analgesia. METHODS: Four hundred fifty term parturients in active labor were included in this double-blind, randomized trial. Combined spinal-epidural anesthesia was performed, and ropivacaine, levobupivacaine, or bupivacaine was intrathecally administered in a dose of 1.0, 1.5, 2.0, 2.5, 3.0, or 3.5 mg, always combined with 1.5 microg sufentanil. Patients were considered responders to spinal analgesia if the visual analog scale score for pain was less than 25 mm within 15 min and the visual analog scale score remained less than 25 mm for 45 min. Patient demographics, obstetric data, maternal side effects, and fetal and neonatal well-being were noted. Group-specific dose-response curves were constructed using a probit regression model. RESULTS: The ED95 of bupivacaine was 3.3 mg (95% confidence interval, 2.9-4.1). The ED95s of ropivacaine and levobupivacaine were 4.8 mg (95% confidence interval, 4.0-6.7) and 5.0 mg (95% confidence interval, 4.1-7.0), respectively. Racemic bupivacaine was significantly more potent than ropivacaine (P=0.0027) and levobupivacaine (P=0.0006). Ropivacaine and levobupivacaine were of similar potency (P=0.91). CONCLUSIONS: This full dose-response study suggests that ropivacaine and levobupivacaine are of similar potency, whereas bupivacaine is more potent than both other drugs.     

Determination of the Full Dose-Response Relation of Intrathecal Bupivacaine, Levobupivacaine, and Ropivacaine, Combined with Sufentanil, for Labor Analgesia

Background: Ropivacaine and levobupivacaine are local anesthetics that produce less motor block and greater sensory-motor separation when compared with equal milligram doses of bupivacaine. Although minimum local analgesic concentration studies suggested that they are less potent than bupivacaine, full dose-response studies have not been performed. The current trial describes the dose-response relation of levobupivacaine, ropivacaine, and bupivacaine, combined with sufentanil, when used for intrathecal labor analgesia.

Methods: Four hundred fifty term parturients in active labor were included in this double-blind, randomized trial. Combined spinal-epidural anesthesia was performed, and ropivacaine, levobupivacaine, or bupivacaine was intrathecally administered in a dose of 1.0, 1.5, 2.0, 2.5, 3.0, or 3.5 mg, always combined with 1.5 [mu]g sufentanil. Patients were considered responders to spinal analgesia if the visual analog scale score for pain was less than 25 mm within 15 min and the visual analog scale score remained less than 25 mm for 45 min. Patient demographics, obstetric data, maternal side effects, and fetal and neonatal well-being were noted. Group-specific dose-response curves were constructed using a probit regression model.

Results: The ED95 of bupivacaine was 3.3 mg (95% confidence interval, 2.9-4.1). The ED95s of ropivacaine and levobupivacaine were 4.8 mg (95% confidence interval, 4.0-6.7) and 5.0 mg (95% confidence interval, 4.1-7.0), respectively. Racemic bupivacaine was significantly more potent than ropivacaine (P = 0.0027) and levobupivacaine (P = 0.0006). Ropivacaine and levobupivacaine were of similar potency (P = 0.91).     

Minimum Local Analgesic Doses of Ropivacaine, Levobupivacaine, and Bupivacaine for Intrathecal Labor Analgesia

Background: Doses for intrathecal opioid-local anesthetic mixtures have been arbitrarily chosen. The aim of this study was to compare the analgesic efficacies of intrathecal ropivacaine, levobupivacaine, and bupivacaine for labor analgesia and to determine the analgesic potency ratios for these three drugs. For this purpose, the authors used the up-down sequential allocation model, which estimates the minimum local analgesic dose for intrathecal local anesthetic.

Methods: Ninety-seven nulliparous term parturients in spontaneous labor, requesting combined spinal-epidural analgesia, were randomly allocated to one of three groups to receive 0.25% spinal ropivacaine, levobupivacaine, or bupivacaine. The initial dose of the local anesthetic drug was chosen to be 2.5 mg, and the testing interval was set at 0.25 mg. The subsequent doses were determined by the response of the previous parturient. Efficacy was accepted if the visual analog pain score decreased to 10 mm or less on a 100-mm scale within 30 min. The minimum local analgesic dose was calculated using the method of Dixon and Massey.

Results: The intrathecal minimum local analgesic dose was 3.64 mg (95% confidence interval, 3.33-3.96 mg) for ropivacaine, 2.94 (2.73-3.16) mg for levobupivacaine, and 2.37 (2.17-2.58) mg for bupivacaine. The relative analgesic potency ratios were 0.65 (0.56-0.76) for ropivacaine:bupivacaine, 0.80 (0.70-0.92) for ropivacaine:levobupivacaine, and 0.81 (0.69-0.94) for levobupivacaine:bupivacaine. There were significant trends (P <= 0.021) for greater motor block with bupivacaine and levobupivacaine.     

罗哌卡因混合舒芬太尼用于剖宫产术患者腰麻的半数有效剂量

目的 确定剖宫产术患者混合舒芬太尼时罗哌卡因腰麻的半数有效剂量(ED50).方法 择期行剖宫产术患者28例,ASA分级Ⅰ或Ⅱ级,经L2,3间隙行脊椎.硬膜外联合穿刺.蛛网膜下腔注射罗哌卡因混合舒芬太尼5 μg,注射时间30 s.第1例患者罗哌卡因剂量为11 mg,采用序贯法,根据腰麻是否成功确定下一例患者的罗哌卡因剂量,相邻剂量梯度为1 mg.采用序贯法计算罗哌卡因腰麻的ED50(95%可信区间).结果 罗哌卡因腰麻的ED50为7.780 mg(95%可信区间为6.850～8.836 mg).结论 罗哌卡因混合舒芬太尼5 μg用于剖宫产术腰麻的ED50为7.780 mg.

Abstract：

Objective To determine the median effective dose (ED50 ) of ropivacaine for spinal anesthesia when combined with sufentanil in patients undergoing caesarean section. Methods Twenty-eight ASA Ⅰ or Ⅱ parturients, aged 18-40 yr, weighing 50-110 kg, undergoing cesarean section under combined spinal-epidural anesthesia, were enrolled in this study. Combined spinal-epidural anesthesia was performed at L2,3 interspace. The mixture of ropivacaine and 5 fig sufentanil was injected into the subarachnoid space over 30 s. The initial dose of ropivacaine was 11 mg. The dose was increased/decreased by 1 mg in the next patient. The ED50 and 95% confidence interval were calculated by up-and-down method. Results The ED50 of ropivacaine was 7.780 mg (95% confidence interval 6.850-8.836 mg). Conclusion When combined with sufentanil 5 μg, the ED50 of ropivacaine for spinal anesthesia is 7.780 mg in patients undergoing caesarean section.