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目的探讨一种镇痛、肌松效果好,不良反应少,适用于腰椎间盘摘除、腰椎管减压术,椎管内麻醉用药的最佳浓度。方法选择腰椎间盘突出、腰椎管狭窄患者60例,ASA Ⅰ~Ⅱ级,随机分成3组,每组20例,均选择硬膜外麻醉。A组:硬膜外用0.4%罗哌卡因;B组:硬膜外用0.5%罗哌卡因;C组:硬膜外用0.75%罗哌卡因。对麻醉效果欠佳者,静脉滴注芬太尼0.05mg。结果A组患者镇痛效果欠佳,应用芬太尼例数较多;B组患者镇痛效果好,肌松效果满意,不良反应少;C组患者镇痛、肌松效果较强,不良反应多。结论B组药物浓度是腰椎间盘摘除、腰椎管减压术最佳浓度。  相似文献   
2.
Aim of investigation: We examined whether a pre-emptive analgesic effect could be achieved with ropivacaine, which has less cardiovascular and central nervous system toxicity than bupivacaine, in adults undergoing tonsillectomy. Methods: The study was carried out in 80 patients in a randomised, double-blind fashion. The patients were randomly assigned to one of four groups. In group I, 3 ml ropivacaine 7,5 mg/ml were injected pre-operatively 5 minutes before the start of OR into each tonsil bed. In group II, 3 ml ropivacaine 7,5 mg/ml were injected post-operatively into each tonsil bed. In group III, 3 ml NaCl were injected pre-operatively 5 minutes before the start of OR into each tonsil bed. In group IV, 3 ml NaCl were injected post-operatively into each tonsil bed. The analgesic effectiveness was measured post-operatively by the use of a visual analogue scale, a numeric rating scale (at rest and during activity) and by measuring the total analgesic comsumption (mefenamic acid) in the first 192 hours. In addition the time of first analgesic request was noted. Vital parameters and side-effects were documented. Results: There was no significant difference between the groups in the time of first analgesic request. Likewise, there was no significant difference in the post-operative cumulative analgesic consumption between the four groups. The post-operative administration of ropivacaine resulted in significantly lower pain scores at certain time points compared with the other groups as measured both with the visual analogue scale and the numeric rating scale (at rest). It must be emphasized, that the pain scores both at rest and with exertion remain high and that the net analgesic consumption (per day) remains constant for the first 8 post-operative days. Conclusions: We could demonstrate no significant pre-emptive analgesic effect with ropivacaine in adults undergoing tonsillectomy in our study. One can, however, recommend the administration of ropivacaine post-operatively after tonsillectomy, since a reduction of pain scores can thereby be achieved. For post-operative analgesia we recommend the combination of a non-opioid analgesic with a weak opioid.  相似文献   
3.
庚俊雄 《海南医学》2003,14(1):31-32
目的:比较不同浓度罗哌卡因在术后硬膜镇痛(PCEA)的临床效果。方法:术后病人90例,随机分为三组:A组0.25%罗哌卡因(n=30);B组0.15%罗哌卡因(n=30);C组0.075%罗哌卡因(n=30),三组均加入芬太尼和氟哌利多。首剂负荷量8ml,采用镇痛泵持续量2ml/h,单次按压量每次0.5ml,锁定时间15min。结果:A、B两组间VAS疼痛评分无显著差异(P>0.05),有较好的镇痛效果。两组病人恶区,呕吐、皮肤瘙痒,呼吸抑制发生率无显著差异(P>0.05)。B组尿潴留发生率明显低于A组(P<0.05)。C组镇痛效果不满意,结论:0.15%罗哌卡因复合芬太尼,氟哌利多在PCEA术后镇痛是安全有效的。  相似文献   
4.
目的 观察罗哌卡因复合地塞米松双侧眶下神经阻滞对小儿唇裂修复术后疼痛与应激水平的影响. 方法 择期行先天性唇裂修复术患儿60例,按随机数字表法分为2组(每组30例):A组,0.25%罗哌卡因1 ml复合地塞米松1 mg配成2ml,于术前行双侧眶下神经阻滞;B组,手术结束后静脉给予地佐辛0.1 mg/kg.观察并记录苏醒期躁动发生率及躁动评分,记录术后2 h(T3)、4 h(T4)、6 h(T5)、8 h(T6)、12 h(T7)、24 h(T8) CRIES(crying,required O2 for SP02>95%,increased vital signs, expression,sleeplessness)评分.评分≥4分时给予地佐辛0.1 mg/kg肌内注射,记录术后镇痛持续时间与24 h内注射地佐辛总剂量,记录术后副作用.于麻醉前(T1)、手术结束即刻(T2)、T6、T8时采集静脉血测定皮质醇(cortisol,COR)、去甲肾上腺素(norepinephrine,NE)、肾上腺素(epinephrine,E)水平.用放射免疫法测定血清COR浓度,用ELISA法测定血清E和NE的浓度. 结果 A组苏醒期躁动发生率、躁动评分明显低于B组,差异有统计学意义(P<0.05).A组T4、T5、T6时CRIES评分低于B组,差异有统计学意义(P<0.05),两组T7、T8时CRIES评分差异无统计学意义(P>0.05).额外镇痛药需求总量、术后恶心呕吐发生率比较,A组明显低于B组,差异有统计学意义(P<0.05).平均镇痛时间A组明显长于B组(P<0.05).T6时A组血清NE、E、COR浓度均低于B组,差异有统计学意义(P<0.05).T8时血清NE、E、COR浓度接近麻醉前水平. 结论 罗哌卡因复合地塞米松双侧眶下神经阻滞可为唇裂修复术患儿提供有效的术后镇痛,镇痛持续时间明显延长,抑制由于疼痛导致的应激水平的增强.  相似文献   
5.
目的:比较0.125%及0.2%罗比卡因与0.125%布比卡因在病人自控硬膜外镇痛(PCEA)分娩镇痛中应用的临床效果。方法:90例ASAⅠ~Ⅱ级足月初产妇,随机分为三组。A组采用0.125%罗比卡因(n=30);B组采用0.2%罗比卡因(n=30);C组采用0.125%布比卡因(n=30)。三组均加入芬在μg/ml。首剂负荷量给予10ml。采用电子镇痛泵调节持续量为5ml/h,单次按压量每次2ml,锁定时间为15分钟。于宫口开至8~9cm时再给药10ml,宫口开全后停用麻醉药。结果:三组均能提供安全有效的分娩镇痛,产程时间无延长,阴道助产率无增加,剖宫产率显著下降,对胎儿、新生儿无不良影响。两组罗比卡因与布比卡因组比较,缩短产程时间明显,催产素使用率及阴道器械助产率无增加,对产妇下肢活动影响小。结论:与0.1  相似文献   
6.
罗哌卡因复合咪达唑仑对臂丛阻滞效果的影响   总被引:1,自引:0,他引:1  
目的评价局麻药罗哌卡因复合咪达唑仑对肌间沟臂丛阻滞效果的影响。方法需行上肢手术的成年病人40例,ASAⅠ-Ⅱ级,按单双号随机分为两组,均行肌间沟臂丛阻滞。A组20例,局麻药用0.25%罗哌卡因。B组20例用0.25%罗哌卡因加50μg/kg咪达唑仑,记录麻醉起效时间、持续时间及术后24 h止痛药的需要量。结果感觉和运动神经阻滞起效时间B组比A组明显加快,镇痛时间B组比A组显著延长(P〈0.05);B组术后24 h对疼痛药的需要量明显减少(P〈0.05)。血流动力学及血氧饱和度术后两组无明显差别。结论0.25%罗哌卡因复合咪达唑仑臂丛阻滞使感觉和运动神经阻滞起效时间缩短,镇痛时间明显延长,术后24 h止痛药用量明显减少,改善了术后镇痛质量,但并不延长运动阻滞时间。  相似文献   
7.
Zusammenfassung Levobupivacain [S(-)Bupivacain] ist heute in den meisten Ländern der EU sowie in den USA zugelassen und erhältlich. In einer systematischen Literaturrecherche in der Datenbank MEDLINE wurden 88 klinische Studien identifiziert, in denen insgesamt 3265 Patienten den Gruppen mit Levobupivacain zugeteilt waren. Die klinische Anwendung von Levobupivacain ist für alle wesentlichen Verfahren der Regionalanästhesie und für alle gängigen Indikationen, teilweise kombiniert mit Adjuvanzien, beschrieben. Levobupivacain kann somit epidural (einschließlich kaudal), spinal, bei peripheren Nervenblockaden (einschließlich Plexusblockaden), bei der Paravertebralblockade, bei peribulbären Blockaden, beim Penisblock, in der i.v.-Regionalanästhesie, in der Infiltrationsanästhesie und in der Zahn-Mund-Kiefer- (ZMK-)Anästhesie für die in den Tabellen genannten Indikationen eingesetzt werden. Als kombinierbare Adjuvanzien können epidural Fentanyl, Morphin, Sufentanil, Adrenalin und Clonidin angewendet werden, bei der Spinalanästhesie Sufentanil, Fentanyl und Adrenalin. Als Vergleichssubstanzen wurde in den vorliegenden Studien meist Bupivacain und/oder Ropivacain herangezogen.  相似文献   
8.

Background and purpose

Effective analgesia is essential for postoperative recovery and rehabilitation in TKA. The challenge of analgesic regimes is to obtain adequate pain relief and maximum muscle control to mobilize and rehabilitate patients early. However, the optimal dose and best composition are not known. We hypothesized that there would be no differences in reported postoperative pain on the day of the TKA surgery as well as the first day after surgery when different combinations of ropivacain for LIA and gabapentin are given.

Methods

This prospective randomized trial examined 128 TKA patients treated with LIA and gabapentin in four groups. Group A: 300-mg ropivacain/600-300-300-mg gabapentin. Group B: 150-mg ropivacain/600-300-300-mg gabapentin. Group C: 300-mg ropivacain/300-100-100-mg gabapentin. Group D: 150-mg ropivacain/300-100-100-mg gabapentin.Primary endpoint was pain (NRS) at multiple moments. Secondary endpoints were number of adverse effects, length of hospital stay (LOS), the amount of consumption of pain medication, and wound leakage. Generalized estimating equation (GEE) was used to detect differences between the four groups regarding the course of pain.

Results

No differences regarding adverse effects, LOS, and wound leakage were found. GEE revealed a significant difference in course of pain between group A and B, with group B experiencing higher NRS scores postoperatively than group A (p = 0.021). No differences between the other groups were found.

Interpretation

The results of the current study suggest that LIA with 300-mg (150 ml) ropivacain might be more effective than 150-mg (75 ml) ropivacain. Alteration in dose of gabapentin appears not to have influence on the course of pain.  相似文献   
9.
尚书军  林生  邵伟 《临床医学》2009,29(6):32-33
目的探讨不同容量罗哌卡因对剖宫产手术术后镇痛的效果。方法剖宫产手术患者120例,ASAⅠ-Ⅱ级。随机分为A、B、C、D四组。所有患者均采用腰麻联合硬膜外阻滞,手术结束前10min经硬膜外导管注入负荷量。术毕分别接不同输药速度镇痛泵2ml(A组)、3ml(B组)、4ml(C组)、5ml(D组)。四组患者镇痛泵罗哌卡因浓度均为0.15%,其余药物均相同,镇痛泵总容量分别为100ml、155ml、215ml、275ml。结果四组患者在性别比、年龄、体重、手术时间等方面差异无统计学意义(P〉0.05)。与A组比较,C、D组静息、运动VAS评分均明显降低(P〈0.05),Bromage评分随着注药速度的增加有增高的趋势,但差异无统计学意义(P〉0.05)。肛门排气时间随着注药速度的增加逐渐提前,D组较A组明显缩短,满意率增加(P〈0.05),但尿潴留四组间差异无统计学意义(P〉0.05)。结论5ml/h PCEA泵能够提供满意的镇痛效果,增加胃肠蠕动,肛门排气时间提前,患者满意率增加。  相似文献   
10.
目的 :探讨罗哌卡因与布比卡因在腰—硬联合阻滞中的差别。方法 :下腹部以下手术 ,随机采用罗哌卡因与布比卡因做腰—硬联合阻滞。结果 :罗哌卡因对运动神经阻滞较布比卡因起效慢 ,而且运动神经阻滞时间短。结论 :罗哌卡因在腰—硬联合麻醉用于下腹部以下手术 ,安全、可靠、有利于术后恢复。减少并发症  相似文献   
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