右美托咪定复合罗哌卡因骶管阻滞在小儿腹腔镜疝手术中的应用

目的 探讨右美托咪定(dexmedetomidine,Dex)复合罗哌卡因骶管阻滞在腹腔镜下小儿腹股沟疝手术中的作用. 方法采 用随机数字表法将52例斜疝患儿分为两组(每组26例):A组,Dex 1 μg/kg复合0.25％罗哌卡因1 ml/kg骶管阻滞;B组,0.25％罗哌卡因骶管阻滞组.记录两组患儿麻醉前(T0)、骶管阻滞后5 min(T1)、切皮时(T2)、手术结束时(T3)、拔气管导管时(T4)、苏醒后10 min时(T5)的MAP和HR,观察术后苏醒时间、苏醒时躁动发生率、躁动评分、术后镇痛评分、术后追加镇痛药的发生率及副作用. 结果 A组HR在T4时显著低于B组[(106±12)次/min比(117±12)次/min] (P＜0.05).与B组比较,A组苏醒期躁动发生率[3.8％比23.1％]、躁动评分[(1.9±0.6)分比(3.1±0.7)分]和术后4、8、12、16 h FLACC疼痛评分[(1.1±0.6)分比(2.2±0.7)分、(1.2±0.6)分比(3.8±0.9)分、(2.3±0.6)分比(4.2±0.7)分、(2.6±0.9)分比(3.8±0.8)分]均降低(P＜0.05);两组苏醒时及术后2、24 h的FLACC疼痛评分差异无统计学意义(P＞0.05).B组术后使用镇痛药曲马多为4例,A组无使用曲马多者(P＜0.05).两组均未发生明显的副作用. 结论 与单独使用罗哌卡因相比,Dex复合罗哌卡因骶管阻滞用于腹腔镜下小儿腹股沟疝手术能降低拔管时的应激反应,减少小儿苏醒期躁动,明显延长罗哌卡因骶管阻滞的术后镇痛时间.     

罗哌卡因股神经导管不同给药方式对术后镇痛的影响

目的 探讨罗哌卡因股神经导管不同给药方式用于全膝关节置换术后镇痛的效果.方法 拟行全膝关节置换术患者40例,随机均分为持续给药组(A组,0.20％罗哌卡因)和间断给药组(B组,0.33％罗哌卡因).观察患者术后48 h内VAS评分及拔管后24 h股神经感觉功能和改良Bromage评分.结果 术后24hB组静息和运动时VAS评分均明显低于A组(P＜0.05或P＜0.01).术后48 hB组运动时VAS评分明显低于A组(P＜0.05).B组罗哌卡因用量明显低于A组(P＜0.01).B组芬太尼用量明显低于A组(P＜0.05).所有患者神经功能恢复均未出现延迟.结论 经股神经导管持续或间断给予罗哌卡因均能提供较好的镇痛效果,对股神经功能均没有明显影响;0.33％罗哌卡因间断给药可减少镇痛药用量.     

罗哌卡因复合芬太尼用于胸科患者术后硬膜外镇痛

目的 评估罗哌卡因复合不同浓度芬太尼用于胸科手术后硬膜外镇痛(PCEA)效果及不良反应.方法 选取择期胸科食管及贲门手术男性患昔72例,年龄18～65岁,随机分成三组,每组24例.术前T7～8行硬膜外穿刺留置导管,术后接硬膜外镇痛泵.分别用罗哌卡因复合芬太尼1μg/ml(A组)、2μg/ml(B组)或3μg/ml(C组),观察术后2、4、8、12、24、36、48 h的安静/咳嗽疼痛VAS评分、不良反应和追加使用吗啡剂量和PCEA按压情况.结果 术后2、4、8 h,B、C组安静和咳嗽时VAS评分均明显低于A组(P＜0.05);术后16 h,B、C组咳嗽时VAS评分仍低于A组(P＜0.05).B、C组PCEA按压次数显著少于A组(P＜0.01),追加吗啡量也明显低于A组(P＜0.01).结论 0.15%罗哌卡因合用1、2、3μg/ml芬太尼用于PCEA均可获得满意镇痛效果;但推荐以0.15%罗哌卡因合用2μg/ml为首选,镇痛效果好,不良反应低.     

超前多模式镇痛在腹腔镜结肠肿瘤手术中的应用

目的探讨联合应用罗哌卡因局部区域阻滞和帕瑞昔布钠的超前多模式镇痛治疗在腹腔镜结肠肿瘤手术中的应用。方法 60例行腹腔镜结肠肿瘤手术的患者,随机分入对照组(A组,n=20)、罗哌卡因阻滞组(B组,n=20)及罗哌卡因阻滞+帕瑞昔布钠组(C组,n=20)。记录各组患者术后各时间点视觉模拟评分(VAS);拔管即刻和拔管后5 min躁动及镇静评分;术后镇痛舒芬太尼剂量、PCA有效按压次数;术后不良反应及切口愈合情况。测定各组患者麻醉诱导前(T1)、手术结束即刻(T2)、术后4 h(T3)及24 h(T4)的PGE2和Cor浓度。应用SPSS17.0软件处理数据。以上资料用(x珋±s)表示,组内比较采用重复测量的方差分析,组内两两比较采用S-N-K法,P0.05差异有显著意义。结果术后各时点VAS评分B、C组低于A组,C组低于B组,P0.05。C组拔管即刻、拔管后5 min躁动评分低于A组,镇静评分高于A组,P0.05。术后镇痛舒芬太尼剂量C组少于A组,PCA有效按压次数B、C组少于A组,C组少于B组,P0.05。血浆PGE2值:三组患者T1比较无显著差异P0.05,T2~T4时与T1比较升高,P0.05;C组T2~T4时低于A、B组同时点,P0.05。血清Cor值:A、B组T2-T4及C组T2、T3与T1比较升高,P0.05;C组T4与T1比较无显著差异,P0.05;T2~T4时点B、C组低于A组,C组低于B组,P0.05。各组患者术后不良反应发生率及切口愈合情况无显著差异,P0.05。结论联合应用罗哌卡因局部区域阻滞及帕瑞昔布钠的超前多模式镇痛能有效缓解腹腔镜结肠肿瘤手术后疼痛,减轻伤害性刺激对机体造成的应激及炎性反应。     

不同浓度罗哌卡因用于臂丛神经感觉与运动分离阻滞的效果

目的 探讨不同浓度罗哌卡因用于臂丛神经感觉与运动分离阻滞的效果.方法 择期上肢手术患者90例,ASA分级Ⅰ～Ⅲ级,年龄16～75岁,体重40～85 kg.均在超声引导联合神经刺激器辅助定位下行腋路臂丛神经阻滞,根据不同罗哌卡因浓度分为3组(n=30):0.15%罗哌卡因组(A组),0.10%罗哌卡因组(B组),0.05%罗哌卡因组(C组).于注射局麻药后10、30、60、240 min(T1～4)时记录感觉与运动分离阻滞情况、感觉阻滞完善情况和臂丛神经阻滞成功情况,术毕时评定麻醉效果.记录手术时间、镇痛时间.结果 与A组比较,B组T1.2时感觉阻滞完善率较低(P＜0.05),T3.4时感觉阻滞完善率差异无统计学意义(P＞0.05),感觉与运动分离阻滞率较高(P＜0.01),C组T1.2时感觉与运动分离阻滞率较低(P＜0.01),T3.4时感觉与运动分离阻滞率差异无统计学意义(P＞0.05),各时点感觉阻滞完善率较低(P＜0.01).与B组比较,C组各时点感觉阻滞完善率、感觉与运动分离阻滞率均较低(P＜0.01).A组麻醉效果优于B组,B组麻醉效果优于C组(P＜0.01),与A组和B组比较,C组臂丛神经阻滞成功率较低(P＜0.01),A组与B组差异无统计学意义(P＞0.05).结论 0.10%罗哌卡因用于臂丛神经阻滞可产生感觉与运动分离阻滞效果.     

神经刺激仪引导下连续外周神经阻滞用于下肢术后镇痛的效果

目的观察神经刺激仪引导下连续外周神经阻滞用于下肢术后镇痛的效果。方法 90例择期行单侧下肢手术的患者,随机均分为:神经刺激仪引导下连续外周神经阻滞镇痛组(N组),连续硬膜外镇痛组(E组),连续静脉给药镇痛组(I组)。N组麻醉前根据手术情况选择适当的下肢神经在刺激仪的引导下定位、穿刺留置导管;E组麻醉前行腰段(L3~4)硬膜外穿刺留置导管。三组患者麻醉方法及用药相同,手术结束前10min,N组经留置导管推注0.2%罗哌卡因15ml;E组经留置导管推注0.2%罗哌卡因10ml,I组静脉推注地佐辛5mg后接镇痛泵,配方分别为:N组0.2%罗哌卡因;E组0.2%罗哌卡因与0.5μg/ml舒芬太尼混合液;I组1.0μg/ml舒芬太尼。记录麻醉前(T0)、术后1h(T1)、4h(T2)、12h(T3)、24h(T4)、48h(T5)的SBP、DBP、HR、SpO2、VAS评分和Ramsay镇静评分及不良反应发生情况。结果与I组比较,N组和E组术后T1~T5时VAS评分明显降低(P0.05);T1~T3时Ramsay镇静评分明显升高(P0.05)。与T0和N组比较,T1~T3时E组SBP、DBP明显下降(P0.05)。与N组比较,E组和I组恶心呕吐、瘙痒发生率也明显升高(P0.05);E组的尿潴留发生率也明显升高(P0.05)。三组头晕、运动阻滞发生率差异无统计学意义。结论神经刺激仪引导下连续外周神经阻滞用于下肢手术后镇痛简便、安全、镇痛完善且不良反应少,值得临床推广。     

微创经椎间孔腰椎椎体间融合术后切口注射罗哌卡因的镇痛效果

目的观察罗哌卡因用于微创经椎间孔腰椎椎体间融合术(MI-TLIF)术后镇痛的临床效果。方法 2013年1月—2014年6月,在本院采用MI-TLIF治疗的单节段腰椎椎间盘突出症患者90例,随机分为罗哌卡因组(A组)和患者自控镇痛组(B组),研究过程遵循双盲对照原则。A组患者术后在切口周围环形全层给予1%罗哌卡因注射100.00 mg(生理盐水稀释至20.00 m L)。B组患者术后给予舒芬太尼患者自控镇痛(PCA)。术后(2 h、6 h、12 h、24 h)对患者进行疼痛视觉模拟量表(VAS)评分、镇痛满意度、镇痛补救情况及不良反应发生情况评价。结果 2组患者一般资料比较差异无统计学意义(P0.05)。A组术后2 h、6 h VAS评分低于B组,差异具有统计学意义(P0.05);术后12 h、24 h 2组间差异无统计学意义(P0.05)。A组术后有1例患者进行了镇痛补救,B组术后有4例患者进行了镇痛补救。A组(77.8%)术后镇痛满意率明显优于B组(60.0%),差异有统计学意义(P0.05)。A组和B组不良反应发生率分别为17.8%和44.4%,差异有统计学意义(P0.05)。结论 MI-TLIF术后切口周围局部注射罗哌卡因较PCA效果更确切,可明显减轻患者术后急性疼痛,增加患者术后镇痛满意度。     

老年患者胸腔镜肺叶切除术前行胸椎旁神经阻滞所需罗哌卡因的最佳药物浓度观察

目的研究老年患者胸腔镜肺叶切除术(video-assisted thoracic surgery,VATS)前行胸椎旁神经阻滞(paravertebral nerve block,PVB)所需罗哌卡因的最佳药物浓度。方法选取南京医科大学附属淮安第一医院2019年1月至2019年12月于全身麻醉下行VATS的老年患者80例,采用随机数字表法将患者分为4组(每组20例):0.25%罗哌卡因PVB复合全身麻醉组(A组)、0.33%罗哌卡因PVB复合全身麻醉组(B组)、0.50%罗哌卡因PVB复合全身麻醉组(C组)、单纯全身麻醉组(D组)。记录各组患者拔管后5 min(T1)、拔管后2 h(T2)、拔管后4 h(T3)、拔管后24 h(T4)静息及咳嗽时的VAS疼痛评分,术中舒芬太尼和间羟胺的用量,苏醒时间和拔管时间,PACU补救镇痛的例数,苏醒期躁动以及术后恶心、呕吐的例数。结果与A组和D组比较:B组与C组患者静息与咳嗽时VAS疼痛评分明显下降,PACU补救镇痛的例数明显减少,苏醒期躁动例数减少(P<0.05);C组术中舒芬太尼和间羟胺用量减少,苏醒时间、拔管时间缩短(P<0.05)。与B组比较,C组术中舒芬太尼和间羟胺用量减少,苏醒时间、拔管时间缩短(P<0.05)。4组患者术后恶心、呕吐发生例数比较,差异无统计学意义(P>0.05)。结论0.33%罗哌卡因与0.50%罗哌卡因行PVB均能减轻老年患者VATS术后疼痛。0.50%罗哌卡因更有利于减少围手术期镇痛药使用,维持血流动力学稳定,促进患者术后快速苏醒及拔管,推荐其为老年患者VATS的最佳药物浓度。     

不同浓度罗哌卡因复合舒芬太尼用于产妇分娩镇痛的临床研究

目的 观察不同浓度的罗哌卡因复合舒芬太尼用于产妇分娩硬膜外自控镇痛的临床效果.方法 150例拟行硬膜外分娩镇痛的初产妇随机分为五组,每组30例,分别予以0.05%(A组)、0.075%(B组)、0.1%(C组)、0.125%(D组)、0.15%(E组)的罗哌卡因+0.5 μg/ml舒芬太尼进行硬膜外镇痛,VAS评分≤3分认为镇痛有效.记录各组产妇的镇痛有效率,第一、第二产程时间、运动阻滞评分、新生儿Apgar评分以及小良反应等指标.结果 A、B、C、D、E组产妇镇痛有效率分别为47%、70%、83%、87%,D,E组明显高于A、B、C组(P＜0.05),E组有1例发生运动阻滞(Bromage评分为1分).结论 0.1%和0.125%罗哌卡因复合0.5 μg/ml舒芬太尼能够为产妇提供安全可靠的镇痛.     

可乐定用于原发性高血压病人术后自控硬膜外镇痛的效应

目的观察可乐定用于原发性高血压病人术后自控硬膜外镇痛(PCEA)的效果、对血液动力学和血浆内皮素-1(ET-1)、降钙素基因相关肽(CGRP)浓度的影响.方法 60例ASAⅠ～Ⅱ级择期行盆腔手术的原发性高血压病人,均采用全麻复合硬膜外阻滞.术后随机分为三组(n=20),均行PCEA.镇痛药液A组吗啡2 mg和罗哌卡因75 mg;B组可乐定150μg、吗啡2 mg和罗哌卡因75 mg;C组可乐定300μg、吗啡2 mg和罗哌卡因75 mg.监测术前、后血压(BP)、心率(HR)及进行VAS评分、Remesay镇静评分,记录24 h总按压次数、实进次数、镇痛药总用量,并测定麻醉诱导前、术后6、24h血浆ET-1和CGRP浓度.结果术后24 h VAS评分A组高于B组(P＜0.01),B组高于C组(P＜0.05).B、C组24 h总按压次数、实进次数、镇痛药总用量显著性低于A组(P＜0.01),且C组低于B组(P＜0.01).A、B、C组镇静评分分别为2.5±0.4、2.9±0.7、(3.9±0.7)分,A组低于B组,B组低于C组(P＜0.05或0.01).与术前相比,A、B两组术后BP、HR、血浆ET-1和CGRP浓度差异无统计学意义(P＞0.05),而C组术后BP、HR和血浆ET-1浓度均显著性降低,CGRP浓度显著性升高(P＜0.01).结论可乐定用于原发性高血压病人术后PCEA不仅能发挥良好镇痛作用,而且降低动脉BP,使血浆缩血管/舒血管神经肽比例平衡,可防止术后高血压恶化.     

罗哌卡因复合舒芬太尼或地佐辛连续股神经阻滞在全膝关节置换术后镇痛中的应用

目的观察罗哌卡因与罗哌卡因复合舒芬太尼或地佐辛连续股神经阻滞(FNB)在全膝关节置换术(TKA)术后镇痛中的效果。方法择期行单侧TKA患者60例,采用统一麻醉和手术方案,术后FNB自控镇痛48h,持续剂量2ml/h,总量100ml。随机将患者均分为三组:罗哌卡因组(R组):0.225%罗哌卡因;罗哌卡因复合地佐辛组(D组):0.15%罗哌卡因含地佐辛10 mg;罗哌卡因复合舒芬太尼组(S组):0.15%罗哌卡因含舒芬太尼1μg/kg。记录三组患者术后1、3及7d静息状态下VAS(RVAS)评分、主动功能锻炼时VAS(AVAS)评分和被动功能锻炼时VAS(PVAS)评分;记录其他镇痛药物用量、不良事件发生情况。结果术后1、3、7d三组患者RVAS评分,术后1、7d的AVAS评分和术后1d的PVAS评分明显低于术前(P0.05);术后3d,S组与D组RVAS评分明显高于R组(P0.05)。三组术后恶心呕吐及谵妄发生率差异无统计学意义。结论罗哌卡因复合舒芬太尼或地佐辛用于FNB,可提供良好的TKA术后镇痛效果,且不增加不良反应;但0.15%罗哌卡因复合舒芬太尼或地佐辛不及0.225%罗哌卡因镇痛维持时间长,复合地佐辛这一现象更明显。     

Postoperative analgesia by femoral nerve block with ropivacaine 0.2% after major knee surgery: continuous versus patient-controlled techniques

BACKGROUND AND OBJECTIVES: This prospective study compared the efficacy and adverse effects after knee surgery of ropivacaine 0.2% administered as patient-controlled femoral analgesia (PCFA), as a continuous femoral infusion (Inf), or as both (PCFA+Inf). METHODS: Before general anesthesia, 140 adults scheduled to undergo major knee surgery received a sciatic/fascia iliaca nerve block with 0.75% ropivacaine (40 mL). After surgery, they were randomly assigned to receive, through the femoral catheter, an infusion of 0.2% ropivacaine administered as PCFA (boluses of 10 mL with a lockout time of 60 minutes), Inf (10 mL/h), or PCFA + Inf (5 mL/h plus boluses of 5 mL with a lockout time of 60 minutes). Pain was assessed at rest, on mobilization, and during physiotherapy using a visual analog scale (VAS). Additional use of intravenous (IV) analgesics was noted. RESULTS: Patients in all 3 groups experienced similar pain relief at rest, on mobilization, and after physiotherapy (P >.05). Additional use of analgesics and overall patient satisfaction (excellent or good in 80% of cases) were also similar in all groups. However, total postoperative ropivacaine consumption was lower in the PCFA group, 150 mL/48 h (90.5 to 210); than in the Inf group, 480 mL/48 h (478 to 480); and the PCFA + Inf group, 310 mL/48 h (280 to 340) (P <.05). Adverse events were similar in all 3 groups (hypotension, vomiting, insomnia). No paresthesia or motor block were observed. CONCLUSION: All 3 strategies provided effective pain relief. PCFA resulted in a lower consumption of ropivacaine (toxic and financial impact). PCFA + Inf does not improve postoperative analgesia.     

Ropivacaine or 2% mepivacaine for lower limb peripheral nerve blocks. Study Group on Orthopedic Anesthesia of the Italian Society of Anesthesia, Analgesia, and Intensive Care

BACKGROUND: Intra- and postoperative clinical properties of sciatic-femoral nerve block performed with either ropivacaine at different concentrations or mepivacaine have been evaluated in a multicenter, randomized, blinded study. METHODS: Adult patients scheduled for foot and ankle surgery were randomized to receive combined sciatic-femoral nerve block with 225 mg of either 0.5% (n = 83), 0.75% (n = 87), or 1% (n = 86) ropivacaine, or with 500 mg of 2% mepivacaine (n = 84). A thigh tourniquet was used in all patients. Onset time, adequacy of surgical anesthesia, time to offset of nerve block, and time until first postoperative requirement for pain medication were evaluated by a blinded observer. RESULTS: The adequacy of nerve block was similar in the four treatment groups (the ratios between adequate:inadequate: failed blocks were 74:9:0 with 0.5% ropivacaine, 74:13:0 with 0.75% ropivacaine, 78:8:0 with 1% ropivacaine, and 72:12:0 with 2% mepivacaine). The onset of the block was slower with 0.5% ropivacaine than with other anesthetic solutions (P < 0.001). Regardless of the concentration, ropivacaine produced a longer motor blockade (10.5+/-3.8 h, 10.3+/-4.3 h, and 10.2+/-5.1 h with 0.5%, 0.75%, and 1% ropivacaine, respectively) than with mepivacaine (4.3+/-2.6 h; P < 0.001). The duration of postoperative analgesia was shorter after mepivacaine (5.1+/-2.7 h) than after ropivacaine (12.2+/-4.1 h, 14.3+/-5 h, and 14.5+/-3.4 h, with 0.5%, 0.75%, or 1% ropivacaine, respectively; P < 0.001). Pain relief after 0.5% ropivacaine was 14% shorter than 0.75% or 1% ropivacaine (P < 0.05). During the first 24 h after surgery, 30-37% of patients receiving ropivacaine required no analgesics compared with 10% of those receiving mepivacaine (P < 0.001). CONCLUSIONS: This study suggests that 0.75% ropivacaine is the most suitable choice of local anesthetic for combined sciatic-femoral nerve block, providing an onset similar to mepivacaine and prolonged postoperative analgesia.     

Combined sciatic-femoral nerve block with 0.75% ropivacaine: effects of adding a systemically inactive dose of fentanyl

To evaluate the effects of adding low-dose fentanyl to 0.75% ropivacaine during peripheral nerve blocks, 30 ASA physical status I-II patients undergoing hallux valgus repair under combined sciatic-femoral nerve block were randomly allocated in a double-blind fashion to receive nerve block placement with 30 mL of either 0.75% ropivacaine alone (group: ropivacaine, n = 15) or 0.75% ropivacaine plus fentanyl 1 microg kg(-1) (group: ropivacaine-fentanyl, n = 15). A blinded observer recorded haemodynamic variables and sedation, as well as the time required to achieve surgical block and the first request for analgesia. Readiness to surgery required 10 min (5-20 min) with 0.75% ropivacaine and 10 min (3-20 min) with the ropivacaine-fentanyl mixture. No differences in the degree of sedation, peripheral oxygen saturation, and haemodynamic variables were observed between the two groups. The degree of pain measured at first analgesic request, and the consumption of postoperative analgesics, was similar in the two groups, while the mean time from block placement to the first request for pain medication was 13.7 h (25-75th percentiles: 11.8-14.5 h) in the ropivacaine group and 13.9 h (25-75th percentiles: 10.5-14.5 h) in the ropivacaine-fentanyl group (P = not significant). We conclude that adding fentanyl 1 microg kg(-1) to 0.75% ropivacaine did not provide clinically relevant advantages in terms of onset time, quality and duration of combined sciatic-femoral nerve block in patients undergoing elective hallux valgus repair.     

Ropivacaine 0.25% is as effective as bupivacaine 0.25% in providing surgical anaesthesia for lumbar plexus and sciatic nerve block in high-risk patients: preliminary report

Ropivacaine is potentially less cardiotoxic and neurotoxic than bupivacaine. The aim of this study was to compare the effectiveness of ropivacaine 0.25% and bupivacaine 0.25% for surgical anaesthesia and postoperative analgesia during lumbar plexus and sciatic nerve block in high-risk patients. We performed combined lumbar plexus and sciatic nerve blockade on 62 consecutive ASA III or IV patients undergoing unilateral hip or femur surgery. The first 30 patients received bupivacaine (Group 1) and the remaining 32 patients received ropivacaine (Group 2). Perioperative management was otherwise similar The groups were compared for the time of onset of the block, additional analgesics and sedatives required, time from end of surgery to the first analgesic requirement and the need for rescue analgesia. Ninety percent (29/32) of the patients in the ropivacaine group and 86% (26/30) of the patients in the bupivacaine group reached surgical anaesthesia. The time from the end of the surgery to the first analgesic requirement was similar between the two groups (10.3 +/- 5.2 hours for ropivacaine, 11.2 +/- 4.6 hours for bupivacaine). There was no statistically significant difference between the two groups in any of the measured variables (P > 0.05). The results of this preliminary study suggest that ropivacaine 0.25% is as effective as bupivacaine 0.25% when used for blocking lumbar plexus and sciatic nerve in high-risk patients undergoing hip or femur surgery.     

A double-blinded, randomized comparison of either 0.5% levobupivacaine or 0.5% ropivacaine for sciatic nerve block

To compare intraoperative and postoperative clinical properties of levobupivacaine and ropivacaine for sciatic nerve block, 50 ASA physical status I and II patients undergoing hallux valgus repair received a femoral nerve block with 15 mL of 2% mepivacaine. They were then randomly allocated in a double-blinded fashion to receive a sciatic nerve block with either 0.5% levobupivacaine (n = 25) or 0.5% ropivacaine (n = 25). An independent blinded observer evaluated the onset time of surgical anesthesia as well as the quality of the surgical block and postoperative analgesia. The median (range) onset time of surgical block at the sciatic nerve distribution was 30 min (5-60 min) with levobupivacaine and 15 min (5-60 min) with ropivacaine (P = 0.63). Four patients (two patients in each group) received a supplementary ankle block by the surgeon just before the beginning of surgery. All four patients also received IV fentanyl supplementation, but in three of them, propofol infusion was required to complete surgery (two in the Levobupivacaine group [8%] and one in the Ropivacaine group [4%]; P = 0.99). In six patients of the Levobupivacaine group (24%) and five patients of the Ropivacaine group (20%), IV fentanyl supplementation was required to complete surgery (P = 0.99). No differences in the time to recovery of sensory and motor function were observed between the two groups, whereas median (range) duration of postoperative analgesia was 16 h (8-24 h) with levobupivacaine and 16 h (8-24 h) with ropivacaine (P = 0.83). We conclude that 0.5% levobupivacaine and 0.5% ropivacaine provide comparable surgical anesthesia and postoperative analgesia. IMPLICATIONS: No studies have compared the clinical properties of levobupivacaine with those of ropivacaine when providing sciatic nerve block for hallux valgus repair. Results from this prospective, randomized, double-blinded study demonstrate that 20 mL of either 0.5% levobupivacaine or 0.5% ropivacaine provide comparable surgical block with prolonged postoperative analgesia.     

罗哌卡因联合地塞米松竖脊肌平面阻滞对腰椎手术患者围手术期镇痛效果的影响

目的观察罗哌卡因联合地塞米松竖脊肌平面阻滞(erector spinae plane block,ESPB)对腰椎手术患者围手术期镇痛效果的影响。方法选择全身麻醉下行腰椎手术患者105例,按照随机数字表法分为3组(每组35例):罗哌卡因+地塞米松组(RD组)、罗哌卡因+生理盐水组(R组)和对照组(C组)。RD组、R组在麻醉诱导前分别以0.5%罗哌卡因20 ml+地塞米松2 ml(10 mg)、0.5%罗哌卡因20 ml+生理盐水2 ml行双侧ESPB,C组不行阻滞。记录患者术中全身麻醉药用量、术后VAS疼痛评分、首次按压镇痛泵时间、术后48 h舒芬太尼用量、镇痛泵有效按压次数与实际按压次数比(D₁/D₂)、补救镇痛率及不良反应发生情况。结果RD组和R组术中全身麻醉药用量少于C组(P<0.05);RD组和R组术后2、4、8、12、24 h静息和翻身VAS疼痛评分低于C组(P<0.05),RD组24、48 h静息和翻身VAS疼痛评分低于R组和C组(P<0.05);RD组首次按压镇痛泵时间长于R组和C组(P<0.05),术后48 h舒芬太尼用量低于R组和C组(P<0.05),D₁/D₂高于R组和C组(P<0.05),补救镇痛率及恶心呕吐发生率低于R组和C组(P<0.05)。结论罗哌卡因联合地塞米松ESPB可为腰椎手术患者提供良好的围手术期镇痛。     

连续股神经阻滞联合口服镇痛药用于全膝关节置换术术后镇痛的效果

目的观察连续股神经阻滞联合口服镇痛药用于全膝关节置换术患者术后镇痛的效果及其对膝关节早期康复的影响。方法选择择期行单侧全膝关节置换的患者60例,随机分为多模式镇痛组(M组)和静脉自控镇痛组(I组),每组30例。M组术前2d口服塞来昔布200mg/次、每天2次,羟考酮10mg/次、每天2次、持续2d,术后连续股神经阻滞镇痛并加服对乙酰氨基酚100mg/次、每天3次,羟考酮20mg/次、每天2次、持续3d;I组仅采用静脉自控镇痛。记录患者术后6、12、24、48h的静息状态、主动/持续被动功能训练时的VAS评分、主动/持续被动功能训练时患侧膝关节活动度、首次下床活动时间、住院时间、出院时患侧膝关节活动度及术后镇痛不良反应发生率。当VAS≥5分时,静脉注射地佐辛5mg,并予以记录。结果术后6、12、24、48h静息状态及主动/持续被动功能训练时M组VAS评分明显低于I组(P0.05);术后24、48、72h主动/持续被动功能训练时M组患侧膝关节活动度明显大于I组(P0.05);M组首次下床活动时间[(2.5±0.8)d]明显短于I组[(3.3±0.7)d](P0.05);M组住院时间[(9.1±2.3)d]明显短于I组[(10.8±2.0)d](P0.05);出院时M组患侧膝关节活动度[(95.6±17.2)°]明显大于I组[(82.5±15.2)°](P0.05);M组恶心呕吐1例(3.3%)及尿潴留2例(6.7%)明显低于I组恶心呕吐9例(30.0%)及尿潴留8例(26.7%)(P0.05);M组追加地佐辛1例(3.3%)明显低于I组12例(40.0%)(P0.05)。结论与静脉自控镇痛比较,连续股神经阻滞联合口服镇痛药的多模式镇痛方案能有效减轻全膝关节置换术患者术后疼痛,有利于膝关节功能的早期康复。