Dexamethasone as an adjuvant for peripheral nerve blockade: a randomised,triple-blinded crossover study in volunteers

Background

The efficacy of dexamethasone in extending the duration of local anaesthetic block is uncertain. In a randomised controlled triple blind crossover study in volunteers, we tested the hypothesis that neither i.v. nor perineurally administered dexamethasone prolongs the sensory block achieved with ropivacaine.

甲磺酸罗比卡因与盐酸罗比卡因用于硬膜外阻滞的效应比较

目的 评价甲磺酸罗比卡因用于硬膜外阻滞的效应和安全性。方法 45例择期行下腹或下肢手术病人,随机分别接受用甲磺酸罗比卡因(8.94 mg/ml,观察组)或盐酸罗比卡因(7.5mg/ml,对照组)施行的硬膜外阻滞。观察两组在感觉阻滞、运动阻滞、镇痛和肌肉松弛方面的效果,同时观察用药前后肝肾功能变化。结果 观察组和对照组感觉阻滞平面达到T6以上的病例分别为84.3％和76％(P>0.05),Bromage≥3级的病例分别90％和92％(P>0.05)。两组感觉阻滞平面固定时间、Bromage达到最大级别时间、最大级别维持时间和运动阻滞维持时间均无显著性差异(P>0.05)。两组镇痛及肌松满意率无显著性差异。观察组术中2例发生低血压,2例发生心动过缓,而对照组仅1例发生低血压。两组术后24 h天冬氨酸氨基转移酶(AST)、天冬氨酸转氨酶(ALT)、尿素氮(BUN)和肌酐(Cr)均在正常范围。结论 甲磺酸罗比卡因与盐酸罗比卡因行硬膜外阻滞的效应基本相同,且无明显毒性。     

Local analgesic and vascular effects of intradermal ropivacaine and bupivacaine in various concentrations with and without addition of adrenaline in man

Ropivacaine, a new long–acting amino–amide local anaesthetic agent, and bupivacaine, in various concentrations with or without addition of adrenaline, were tested in a randomized, double–blind study using intradermal wheals. Ten non–smoking, healthy, young male volunteers participated. In series I plain solutions of ropivacaine (0.25%, 0.5%, 0.75% and 1%) and bupivacaine (0.25%, 0.5% and 0.75%) were injected intradermally and in series II the same concentrations, with the addition of adrenaline 5 ug ml^-1 ( 1 :200 000), were used. The same volunteers took part in both series, with an interval of at least three weeks between the experiments. Saline was included as control in both series. Pin–pricking was used to assess the dermal analgesia. Plain solutions of ropivacaine produced significantly longer durations of dermal analgesia than did plain solutions of bupivacaine, in all tested concentrations. A significant increase in duration was seen for both local anaesthetics when adding adrenaline. Local vascular effects at the injected areas were determined by visual inspection (nil, pink, pale). Local blanching (pale) was significantly more frequent for plain solutions of ropivacaine, in all tested concentrations. Local redness (pink) was significantly more frequent with plain bupivacaine, in a dose–dependent relation. An initial redness was frequently observed for both local anaesthetics containing adrenaline, followed by blanching at most sites.     

两种局麻药术后镇痛效果及副作用比较

目的：观察比较0．2％罗哌卡因和0．15％布比卡因两种同麻药在硬膜外自控镇痛(PCEA)中的镇痛效果及副作用。方法：选用0．2％罗哌卡因和0．15％布比卡因两种同麻药用于PCEA中．对其效果进行对比分析。结果：0．2％罗哌卡因、0．15％布比卡因分别与0．1mg芬太尼联合用于PCEA中，镇痛效果确切．毒副作用轻微，并发症少。结论：将0．2％罗哌卡因替代0．15％布比卡因与0．1mg芬太尼合用后．病人术后行走能力的早期恢复可得到改善。     

Wide Awake Open Carpal Tunnel Release: The Effect of Local Anesthetics in the Postoperative Outcome

Introduction  Wide awake open carpal tunnel decompression is a procedure performed under local anesthesia. This study aimed to present the effect of various local anesthetics in peri and postoperative analgesia in patients undergoing this procedure. Materials and Methods  A total of 140 patients, with 150 hands involved, underwent carpal tunnel release under local anesthesia. Patients were divided in five groups according to local anesthetic administered: lidocaine 2%, ropivacaine 0.75%, ropivacaine 0.375%, chirocaine 0.5%, and chirocaine 0.25%. Total 400 mg of gabapentin were administered to a subgroup of 10 cases from each group (50 cases totally), 12 hours before surgery. Patients were evaluated immediately, 2 weeks and 2 months after surgery according to VAS pain score, grip strength, and two-point discrimination. Results  In all patients, pain and paresthesia improved significantly postoperatively, while the use of gabapentin did not affect outcomes. Grip strength recovered and exceeded the preoperative value 2 months after surgery, without any difference between the groups. No case of infection, hematoma, or revision surgery was reported. Conclusion  Recovery after open carpal tunnel release appears to be irrelevant of the type of local anesthetic used during the procedure. Solutions of low local anesthetic concentration (lidocaine 2%, ropivacaine 0.375%, and chirocaine 0.25%) provide adequate intraoperative analgesia without affecting the postoperative course.     

罗哌卡因与布比卡因用于硬膜外阻滞的临床对比观察

目的：将新型酰胺类局麻药罗哌卡因药效学与布比卡因进行比较。方法：选择行择期下肢手术病人40例,随机分成四组进行硬膜外麻醉,分别在硬膜外注入0．75％罗哌卡因（n=10例）,0．5％罗哌卡因（n=10例）和0．75％布比卡因（n=10例）,0．5％布比卡因（n=10例）15－18ml。分别观察感觉阻滞起效,最大运动阻滞,感觉、运动恢复时间及最高阻滞平面,最大Bromage评分及术中不良反应的情况。结果：罗哌卡因起效快,产生的麻醉平面广,镇痛、运动阻滞效果好。术中有低血压、心率减慢等副作用发生。结论：罗哌卡因应用于临床麻醉有可靠的麻醉性能及安全性,利用其感觉运动神经分离作用,利于病人术后早期活动,具有良好的临床应用前景。     

多区域浸润麻醉减轻腹腔镜胆囊切除术后早期症状

目的探讨躯体、内脏局部浸润麻醉对择期腹腔镜胆囊切除术后疼痛、恶心症状的影响.方法随机将50例病人分为对照组和实验组,在门静脉周围和腹膜内分别浸润生理盐水66ml和罗吡卡因66ml;术后3h记录疼痛和恶心的程度、部位及所补充的哌替啶用量.结果罗吡卡因局部浸润可减轻术后3h的切口疼痛和恶心症状,但对腹内和肩部疼痛无明显效果;且术后3h所补充的哌替啶的用量显著减少.结论躯体、内脏局部浸润麻醉可减轻术后3h的切口疼痛、恶心及哌替啶用量.     

局麻药心脏毒性研究进展

自从首例局麻药引发心脏毒性的病例报道以来,20多年来对局麻药的心脏毒性机理及治疗的研究从来没有终止过,本文旨在对局麻药心脏毒性的机理、比较及治疗进展作综述。     

The effect of the addition of ropivacaine or bupivacaine upon pruritus induced by intrathecal fentanyl in labour

Sixty patients in early labour were randomly allocated to one of three groups. The control group received intrathecal fentanyl 25 microg, the ropivacaine group received intrathecal fentanyl 25 microg and ropivacaine 2.5 mg while the bupivacaine group received intrathecal fentanyl 25 microg and bupivacaine 2.5 mg. The incidence of pruritus was 100% in controls, compared with 85% in the ropivacaine group (not significant) and 75% in the bupivacaine group (p = 0.003). The severity of pruritus was significantly less in the ropivacaine (p = 0.006) and bupivacaine (p = 0.001) groups. Most patients developed pruritus by 30 min. Pruritus above the abdomen was not reduced in patients receiving local anaesthetics. There were no significant differences in the mean pain visual analogue score, systolic blood pressure, maternal heart rate and upper level of reduced pin-prick sensation in the first 30 min. Intrathecal ropivacaine and, more so, intrathecal bupivacaine reduce the incidence and severity of pruritus from intrathecal fentanyl for labour analgesia.