20%脂肪乳剂对大鼠血浆和心肌罗哌卡因水平的影响

目的 评价20%脂肪乳剂对大鼠血浆罗哌卡因浓度和心肌罗哌卡因含量的影响.方法 雄性SD大鼠60只,体重220～270 g,随机分为2组(n=30):生理盐水组和脂肪乳剂组.股静脉注射l%罗哌卡因5 mg/kg后,脂肪乳剂组股静脉注射20%脂肪乳剂注射液5 ml/kg;生理盐水组股静脉注射等容量生理盐水.分别于给予罗哌卡因后5、10、20、40、60和120 min时取5只大鼠,心尖取血样后取心肌组织,采用高效液相色谱法测定血浆罗哌卡因浓度和心肌罗哌卡因含量.结果 与生理盐水组比较,脂肪乳剂组给予罗哌卡因后20 min时血浆罗哌卡因浓度升高,给予罗哌卡因后5、10 min时心肌罗哌卡因含量降低(P＜0.01).结论 20%脂肪乳剂可在短时间内与大鼠血液中的罗哌卡因结合,减少在心肌组织中的分布,有助于降低其心脏毒性.     

等剂量不同浓度罗哌卡因用于臂丛神经阻滞效果及血药浓度观察

目的探讨罗哌卡因用于肌间沟臂丛神经阻滞效果与血药浓度的关系。方法择期行上肢骨科手术患者60例,随机均分为三组,罗哌卡因150 mg分别配成20 ml(0.75%,A组)、30 ml(0.5%,B组)和40 ml(0.375%,C组),神经刺激仪定位行肌间沟臂丛神经阻滞。观察感觉、运动阻滞情况;高效液相法测定注药后10、15、20、30、60、90、120 min静脉血罗哌卡因浓度。结果感觉和运动阻滞起效时间均为A组相似文献   

甲磺酸罗哌卡因和盐酸罗哌卡因肌间沟臂丛神经阻滞的比较

目的 观察0.596%甲磺酸罗哌卡因和0.5%盐酸罗哌卡因在超声引导下行肌间沟臂丛神经阻滞的效果.方法 60例上肢手术行肌间沟臂丛麻醉的患者,随机均分成两组:A组给予0.596%甲磺酸罗哌卡因30 ml;B组给予0.5%盐酸罗哌卡因30 ml.比较两组感觉及运动阻滞起效时间、阻滞程度、运动恢复时间、镇痛持续时间和不良反应.结果 A组尺神经感觉阻滞起效时间显著快于B组[(38.30±14.65)min vs.(48.03±22.34)min](P<0.05).注药60 min A组尺神经感觉完全阻滞29例(96.7%),显著多于B组的20例(66.7%)(P<0.05).结论 0.596%甲磺酸罗哌卡因的尺神经感觉阻滞优于0.5%盐酸罗哌卡因.     

0.75%和0.5%罗哌卡因与0.5%布比卡因应用于臂丛神经阻滞的临床比较

目的 观察罗哌卡因应用于臂丛神经阻滞的临床效果。方法 选择ASA Ⅰ～Ⅱ级上肢手术病人30例,随机分为三组,每组10例。分别以0.75％罗哌卡因、0.5％罗哌卡因和0.5％布比卡因采用肌间沟法进行臂丛神经阻滞,注入量20ml。分别记录病人感觉阻滞和运用阻滞的起效时间,峰值时间(达到完全阻滞可以开始手术的时间),追加阻滞药物的比率,术中病人对阿片类药物的需要,病人的满意程度等指标。对比各组间的各项指标。结果 两组罗哌卡因与0.5％布比卡因比较在注射10、15、20 min后达到完全的感觉和运动阻滞的比率较高(P<0.01)。罗哌卡因组的平均峰值时间明显短于布比卡因组(R50=16.3±3.16min,R75=14.6±3.33min,B=22.4±4.17 min,P<0.05)。根据病人术中对阿片类药的需要和全部病人的满意程度,认为罗哌卡因有较高的麻醉质量(P<0.05)。其他各项指标无显著差异。结论 罗哌卡因在臂丛神经阻滞中出现了较布比卡因平均峰值时间短、阻滞完善的优越性。在肌间沟臂丛神经阻滞中应该使用0.5％的罗哌卡因。     

不同脂肪乳剂预先给药对罗哌卡因致老龄大鼠心血管毒性的影响

目的 评价不同脂肪乳剂预先给药对罗哌卡因致老龄大鼠心血管毒性的影响.方法 健康雄性SD大鼠24只,月龄18月,体重400～550 g,随机分为3组(n=8):生理盐水组(NS组)、长链脂肪乳剂组(LLE组)和中/长链脂肪乳剂组(MLE组).腹腔注射氯胺酮100 mg/ks麻醉,监测ECG、BP和HR,气管插管后行机械通气,潮气量2 ml/100 g,通气频率60次/min.静脉注射维库溴铵0.5 mg维持肌松.NS组、LLE组和MLE组分别经颈静脉输注0.9%氯化钠注射液、20%长链脂肪乳剂注射液和20%中/长链脂肪乳剂注射液,输注速率均为3 ml·ks~(-1)·min~(-1);5 min后均静脉输注0.75%盐酸罗哌卡因注射液10 mg·ks~(-1)·min~(-1),直至出现心跳停止.记录出现心律失常时、BP较基础值下降20%时和心跳停止时罗哌卡因的用量.结果 与NS组比较,LLE组和MLE组出现心律失常时、血压较基础值下降20%时和心跳停止时罗哌卡因的用量增加(P＜0.05);LLE组和MLE组出现心律失常时、BP较基础值下降20%时和心跳停止时罗哌卡因的用量比较差异无统计学意义(P＞0.05).结论 长链脂肪乳剂和中/长链脂肪乳剂预先给药可减轻罗哌卡因致老龄大鼠心血管毒性.     

咪唑安定拮抗罗哌卡因致惊厥实验研究

目的 了解罗哌卡因引起惊厥时的剂量,对机体的影响及咪唑安定对罗哌卡因致惊厥的拮抗作用。方法 家兔20只,分成罗哌卡因组（R）和咪唑安定 罗哌卡因组（MR）,均在未麻醉下行耳正中动脉、耳缘静脉穿刺置管,超级大国动脉监测MAP、HR,取样测全血乳酸浓度,血气及血浆罗哌卡因浓度,MR组预先经静脉推注咪唑安定0.8mg/kg,两组均以0.5ml/min输注0.7%罗哌卡因至惊厥发作停药,记录抽搐起止时间为惊厥持续时间。结果 R组和MR组罗哌卡因惊厥阈量分别为4.86mg/kg和12.26mg/kg,惊厥持续时间分别为7.25min和8.59min,惊厥时动脉血药浓度分别为11.52ugml和16.77ug/ml,罗哌卡因486mg/kg对血压、心率影响很小,罗哌卡因12.26mg/kg使血压下降31%,心率减慢35%,停药后逐渐恢复正常,两组动物均无特殊处理全部存活,MR组在惊厥过程中能维持动脉血pH正常,血乳酸水平不升高,结论 罗哌卡因对心血管毒性作用较轻,0.8mg/kg咪唑安定可有效预防和治疗罗哌卡因在全身毒性反应,能提高罗哌卡因惊厥阈量2.5倍。     

地塞米松对0·5%罗哌卡因腰丛-坐骨神经联合阻滞作用的影响

目的评价地塞米松给药方式对0.5%罗哌卡因腰丛-坐骨神经联合阻滞(CLPSNB)作用时效的影响。方法60例神经刺激器定位CLPSNB患者随机分为三组,每组20例。A组,0.5%罗哌卡因45ml加地塞米松10mg行神经阻滞,同时静脉注射生理盐水(NS);B组,0.5%罗哌卡因45ml加NS2ml行神经阻滞,同时静脉注射地塞米松10mg;C组,0.5%罗哌卡因45ml加NS2ml神经阻滞,同时静脉注射NS2ml。结果感觉、运动阻滞持续时间A组[(15.2±3.3)h、(12.6±2.8)h]显著长于B组[(10.1±2.1)h、(7.9±1.6)h]和C组[(10.4±2.5)h、(7.6±2.3)h](P0.05)。结论地塞米松可以通过局部作用机制延长0.5%罗哌卡因CLPSNB持续时间。     

同一剂量不同容量罗哌卡因超声引导肌间沟臂丛神经阻滞对膈肌移动度的影响

目的探讨在超声引导下同一剂量不同容量罗哌卡因肌间沟臂丛神经阻滞(interscalene brachial plexus block,ISBPB)对膈肌移动度的影响。方法拟行右侧前臂骨折术后取内固定装置患者60例,在超声引导下进行ISBPB,随机分为A组(0.5%罗哌卡因20ml)和B组(0.75%罗哌卡因13.3ml),每组30例。应用M型超声对注药前、注药后15及30min的膈肌移动度进行测量并记录,观察并评价注药后15及30min臂丛各主要神经的痛觉阻滞效应、运动阻滞程度,记录麻醉效果、麻醉维持时间、运动阻滞恢复时间。结果两组患者麻醉阻滞效果及维持时间差异无统计学意义。与A组比较,B组注药后30min膈肌麻痹的发生率明显降低(P0.05)。两组在注药30min后分别有28例(93%)和22例(73%)患者的膈肌移动度下降幅度超过50%(P0.05)。结论 0.5%罗哌卡因20ml与0.75%罗哌卡因13.3ml在超声引导下行肌间沟臂丛阻滞时均可以达到理想的臂丛阻滞效果。与0.75%罗哌卡因13.3ml相比,0.5%罗哌卡因20ml更易引起膈肌麻痹。     

老年患者硬膜外注射罗哌卡因的药效动力学和药代动力学

目的 评价老年患者硬膜外注射罗哌卡因的药效动力学和药代动力学.方法 20例择期行疝修补术的老年患者为老年组,年龄65～84岁,体重52～75 kg;20例择期行疝修补术的成年患者为青年组,年龄20～加岁,体重49～77kg.于k2,3椎间隙行硬膜外穿刺,头端置管3～5 cm,于15min内注射0.5%罗哌卡因1.5 mg/kg.评价感觉阻滞程度,于给药后30 min评价运动阻滞程度,并分别于硬膜外给药前、给药后5、10、20、30、45、60、75、90、120、150 min时抽取足背动脉血样3 ml,采用高效液相色谱法测定血浆罗哌卡因浓度,计算罗哌卡因的药代动力学参数.结果 与青年组比较,老年组罗哌卡因的起效时间缩短,感觉阻滞平面固定时间及感觉阻滞消退时间延长,最高感觉阻滞平面及运动阻滞程度升高(P<0,05).两组罗哌卡因的血药浓度一时间曲线符合二室开放模型,并按一级动力学进行消除.与青年组比较,老年组罗哌卡因的浅室分布半衰期、深室分布半衰期、药峰时间、AUC0→150min、AUC0→Inf差异无统计学意义(P>0.05),罗哌卡因的消除半衰期延长,药峰浓度升高,清除率和表观分布容积减小(P<0.05).结论 老年患者罗哌卡因的血药浓度-时间曲线均符合二室开放模型,与成年患者比较,老年患者硬膜外注射罗哌卡因的总吸收无变化,清除率和表观分布容积减小,药峰浓度升高,消除半衰期延长,感觉阻滞平面和运动阻滞程度升高,感觉阻滞时间延长.     

1%甲哌卡因与0.5%罗哌卡因用于肌间沟臂丛神经阻滞锁骨骨折术中的比较

目的观察1%甲哌卡因与0.5%罗哌卡因用于肌间沟臂丛神经阻滞锁骨骨折术中麻醉效果的比较。方法择期行肌间沟臂丛神经阻滞锁骨骨折成年患者30例,ASAⅠ~Ⅱ级,随机分为2组(n=15);1%甲哌卡因组(M组)和0.5%罗哌卡因组(R组)。两组均在神经刺激仪引导下,以肌间沟入路行臂丛神经阻滞,M组和R组分别注入1%甲哌卡因25 mL和0.5%罗哌卡因25 mL。观察两组血流动力学,感觉、运动阻滞起效及恢复时间,术后VAS评分,不良反应及麻醉满意度。结果与R组比较,M组感觉、运动阻滞起效时间缩短,阻滞恢复时间缩短(P0.05),术后6 h、12 h的VAS评分增加(P0.05)。结论 1%甲哌卡因与0.5%罗哌卡因行肌间沟臂丛神经阻滞,均能满足锁骨骨折手术。采用1%甲哌卡因较0.5%罗哌卡因起效更快,且感觉、运动恢复更早,利于早期活动,但术后镇痛效果不如0.5%罗哌卡因。     

0.5%罗哌卡因用于超声引导侧入路腘窝坐骨神经阻滞的半数有效剂量

目的 确定0.5%罗哌卡因用于超声引导侧入路腘窝坐骨神经阻滞时的半数有效剂量.方法 拟在脊椎-硬膜外联合麻醉下行足踝手术患者23例,性别不限,年龄l9～20岁,体重2～90 kg,ASA分级Ⅰ或Ⅱ级,在超声引导下行侧入路腘窝坐骨神经阻滞,定位成功后注入0.5%罗哌卡因.采用Dixon序贯法进行试验,5%罗哌卡因起始容量为18 ml,若阻滞效果完全,则下一例减少2 ml;若阻滞效果不完全,则下一例增加量2 ml.采用Probit概率单位回归法计算0.5%罗哌卡因超声引导侧入路腘窝坐骨神经阻滞时的半数有效剂量及其95%可信区间(95%CI).结果 0.5%罗哌卡因超声引导侧入路腘窝坐骨神经阻滞的半数有效剂量及其95%CI为13.0(11.3～14.9)ml.结论 0.5%罗哌卡因超声引导侧入路腘窝坐骨神经阻滞的半数有效剂量为13.0ml.     

Interscalene brachial plexus anaesthesia with 0.5%, 0.75% or 1% ropivacaine: a double-blind comparison with 2% mepivacaine

We have compared interscalene brachial plexus block performed with ropivacaine or mepivacaine in 60 healthy patients undergoing elective shoulder surgery. Patients were allocated randomly to receive interscalene brachial plexus anaesthesia with 20 ml of 0.5% ropivacaine (n = 15), 0.75% ropivacaine (n = 15), 1% ropivacaine (n = 15) or 2% mepivacaine (n = 15). Readiness for surgery (loss of pinprick sensation from C4 to C7 and inability to elevate the limb from the bed) was achieved sooner with 1% ropivacaine (mean 10 (SD 5) min) than with 0.5% ropivacaine (22 (7) min) (P < 0.001) or 2% mepivacaine (18 (9) min) (P < 0.02). Postoperative analgesia was similar with the three ropivacaine concentrations (11.5 (5) h, 10.7 (2) h and 10 (2.4) h with 0.5%, 0.75% and 1% concentrations, respectively) and nearly two-fold longer compared with 2% mepivacaine (5.1 (2.7) h) (P < 0.001).      

Interscalene brachial plexus anesthesia with either 0.5% ropivacaine or 0.5% bupivacaine

BACKGROUND: To compare intra- and postoperative clinical properties of interscalene brachial plexus block performed with either 0.5% ropivacaine or 0.5% bupivacaine. METHODS: Experimental design: prospective, randomized, double-blind study. Setting: in patient at the University Hospital, Department of Orthopedic Surgery. Patients: 30 ASA physical status I-II patients scheduled for elective shoulder surgery. Interventions: interscalene brachial plexus block was performed using the multiple injection technique and a nerve stimulator by injecting 20 ml of either 0.5% ropivacaine (n = 15) or 0.5% bupivacaine (n = 15). Postoperative analgesia consisted of 100 mg intravenous ketoprofen, if required. A blind observer evaluated hemodynamic variables as well as sensory and motor blocks from the end of injection to achieve a surgical anesthesia (readiness for surgery: loss of pinprick sensation from C4 to C7 with the inability to elevate the operated limb against gravity). The time lasting from block placement to first requirement for postoperative pain medication was also recorded. RESULTS: No differences in anthropometric parameters and hemodynamic variables were observed throughout the study, and no signs of central nervous system (CNS) and cardiovascular toxicity, or other untoward events were reported in any patients. Readiness for surgery was obtained after 28 +/- 15 min with 0.5% bupivacaine and 22 +/- 8 min after 0.5% ropivacaine (p = NS). No differences in postoperative pain relief was observed between the two groups (11.1 +/- 5 hrs after 0.5% ropivacaine and 10.9 +/- 3.9 hrs after 0.5% bupivacaine, respectively). CONCLUSIONS: This study confirmed that 0.5% ropivacaine has clinical properties similar to those of 0.5% bupivacaine, when used for interscalene brachial plexus block, providing similarly long duration in postoperative pain relief. Compared with bupivacaine, ropivacaine has the further advantage of a lower potential for central nervous system and cardiovascular toxicity.     

A clinical comparison of ropivacaine 0.75%, ropivacaine 1% or bupivacaine 0.5% for interscalene brachial plexus anaesthesia

In order to compare interscalene brachial plexus block performed with ropivacaine or bupivacaine, 45 healthy, unpremedicated patients, undergoing elective shoulder surgery, were randomly allocated to receive interscalene brachial plexus anaesthesia with 20 mL of either ropivacaine 0.75% (n = 15), ropivacaine 1% (n = 15), or bupivacaine 0.5% (n = 15). Readiness for surgery (loss of pinprick sensation from C4 to C7 and inability to elevate the limb from the bed) was achieved later with bupivacaine 0.5% (28 +/- 15 min) than with ropivacaine 1% (10 +/- 5 min) (P = 0.005) and ropivacaine 0.75% (15 +/- 8 min) (P = 0.0005). No differences in success rate were observed between the three groups; however, seven patients receiving bupivacaine 0.5% required intra-operative analgesic supplementation (fentanyl 0.1 mg intravenous) compared with one patient receiving ropivacaine 0.75%, and two patients treated with ropivacaine 1% (P = 0.02). The time from the block placement to first request for pain medication was similar in the three groups (10.7 +/- 2 h, 11 +/- 2.4 h, and 10.9 +/- 3.9 h after 0.75% and 1% ropivacaine or 0.5% bupivacaine, respectively). We conclude that interscalene brachial plexus block performed with 20 mL of either 0.75% or 1% ropivacaine allows for a prolonged post-operative pain relief, similar to that provided by bupivacaine 0.5%, with short onset time of surgical anaesthesia.     

罗哌卡因单独或复合肾上腺素用于臂丛麻醉的药代动力学比较

目的 研究罗哌卡因加和不加肾上腺素用于臂丛麻醉的药代动力学特征。方法 18例择期骨科下肢手术病人（ASAⅠ-Ⅱ级 ),分成两组,Ⅰ组为不加肾上腺素组（n＝9）,Ⅱ组加肾上腺素1：2000,000（n＝9）,0．75％罗哌卡因20ml加生理盐水10ml,共30ml,肌间沟径路径臂丛麻醉,操作在1min内完成。分别在给药前及给药后10、20、30、45、60、90min、3、4、6、9、12h采取颈内静脉血,用高效液相色谱仪测定罗哌卡因血药浓度,用药代动力学计算程序（3P97）统计处理。结果 两组血药浓度峰值（Cmax)、达峰值时间（tmax)及血药浓度曲线下面积（AUC）比较均没有统计差异（P＞0．05）。结论 加肾上腺素并不能改变罗哌卡因用于臂丛麻醉的药代动力学参数。     

罗哌卡因混合碳酸利多卡因与等效浓度罗哌卡因用于逆行锁骨下臂丛神经阻滞效果的比较

目的 比较罗哌卡因混合碳酸利多卡因与等效浓度罗哌卡因用于逆行锁骨下臂丛神经阻滞的效果.方法 择期行上肢手术患者60例,ASA分级Ⅰ或Ⅱ级,年龄18～64岁,体重49～ 98 kg,均在超声引导下行逆行锁骨下臂丛神经阻滞.采用随机数字表法,将患者随机分为2组(n＝30),A组应用0.35％罗哌卡因30ml,B组应用0.233％罗哌卡因和0.346％碳酸利多卡因混合液30 ml.于麻醉给药后每隔5 min记录臂丛神经各分支的阻滞效果(感觉阻滞效果评估采用针刺法,运动阻滞效果评估采用Bromage分级),记录感觉和运动阻滞起效时间、麻醉给药后30 min时感觉与运动阻滞有效情况和并发症的发生情况.结果 两组臂丛神经各分支的感觉和运动阻滞起效时间及阻滞有效率比较差异无统计学意义(P＞0.05).两组均未见严重并发症发生.结论 罗哌卡因混合碳酸利多卡因与等效浓度罗哌卡因行逆行锁骨下臂丛神经阻滞效果相似,提示碳酸利多卡因不能增强罗哌卡因的臂丛神经阻滞效应.     

Lidocaine versus ropivacaine for continuous interscalene brachial plexus block after open shoulder surgery

BACKGROUND: This study compared the postoperative infusion of 1% lidocaine and 0.2% ropivacaine for continuous interscalene analgesia in patients undergoing open shoulder surgery. METHODS: Forty patients undergoing open shoulder surgery received an interscalene brachial plexus block with 30 ml of either 1.5% lidocaine (n = 20) or 0.5% ropivacaine (n = 20), followed by a continuous patient-controlled interscalene analgesia with 1% lidocaine or 0.2% ropivacaine, respectively. A blinded observer recorded the quality of analgesia and recovery of motor function during the first 24 h of infusion. RESULTS: Onset of the block occurred after 7.5 (5-40) min with lidocaine and 30 (10-60) min with ropivacaine (P = 0.0005). Postoperative pain intensity was higher with lidocaine than ropivacaine for the first 8 h of infusion. The ratio between boluses given and demanded from the pump was 0.5 (0.13-0.7) with lidocaine and 0.7 (0.4-1.0) with ropivacaine (P = 0.005). Rescue IV tramadol was required during the first 24 h of infusion by 16 patients of the lidocaine group (84%) and eight patients of the ropivacaine group (46%) (P = 0.05). At the 16 h and 24 h observation times a larger proportion of patients receiving ropivacaine had complete regression of motor block (70% and 95%) than patients receiving lidocaine (50% and 55%) (P = 0.05 and P = 0.013, respectively). CONCLUSIONS: Although 1% lidocaine can be effectively used for postoperative patient-controlled interscalene analgesia, 0.2% ropivacaine provides better pain relief and motor function.     

Successful treatment of ropivacaine-induced central nervous system toxicity by use of lipid emulsion: effect on total and unbound plasma fractions

A 24-year-old man underwent surgery for a fractured left clavicle and received an interscalene brachial plexus block for intraoperative and postoperative analgesia. After injection of 40 ml 0.5% ropivacaine and confirmation of analgesia, general anesthesia was induced and maintained with propofol. Although the operation was completed uneventfully, the patient was restless and there was limb twitching during emergence from anesthesia. Ropivacaine-induced toxicity was suspected, and a dose of 100 ml 20% lipid emulsion was infused intravenously. The symptoms of toxicity disappeared, and there was full recovery of consciousness within 5 min. Plasma concentrations of total and protein-unbound ropivacaine measured 2 h 20 min after local injection were 1.99 and 0.13 μg/ml, respectively. After infusion of lipid emulsion, the ropivacaine concentrations decreased to 1.72 and 0.05 μg/ml, respectively. The patient had no pain, and neurological examination revealed sensory loss around the clavicle. The patient was discharged without any complications.