氯普鲁卡因复合芬太尼硬膜外阻滞用于剖宫产的效果观察

目的：观察氯普鲁卡因复合不同剂量芬太尼的硬膜外腔麻醉效果。方法：选择剖宫产手术产妇100例，ASAⅠ-Ⅱ级，随机分为4组。A组为对照组，硬膜外腔注射单纯的3％氯普鲁卡因；B组在硬膜外腔注射3％氯普鲁卡因加入芬太尼1．5μg／ml复合液；C组在硬膜外腔注射3％氯普鲁卡因加入芬太尼2．0μg／ml复合液；D组在硬膜外腔注射3％氯普鲁卡因加入芬太民2．5μ／ml复合液。分别观察和记绿阻滞起效时间、阻滞持续时间、麻醉效果及新生儿Apgar评分。结果：A组的阻滞起效时间和持续时间与B组比较．有显著性差异（P〈0．05）；与C、D两组比较，有非常显著性差异（P〈0．01）。麻醉效果在A组，优者占40％，良占60％：在B组优占60％，良占36％，差占4％；在C组优占92％，良占8％；在D组优占96％，良占4％。四组新生儿娩出后Apgar 5min评分均大于7分．未见新生儿窒息。结论：氯普鲁卡因复合芬太尼用于剖宫产术的硬膜外腔麻醉，阻滞起效时间缩短，阻滞作用时间延长，麻醉效果增强，对新生儿Apgar评分无明显影响。     

年龄对硬膜外注射氯普鲁卡因药效学和药代动力学的影响

目的 探讨年龄因素对患者硬膜外注射氯普鲁卡因药效学和药代动力学的影响.方法 择期连续硬膜外麻醉下下肢手术患者45例,根据年龄分为A组(≤45岁).B组(46～64岁)和C组(≥65岁),每组15例.以3%氯普鲁卡因6 mg/kg行硬膜外阻滞.硬膜外注药后记录感觉和运动阻滞效果及不良反应发生情况.于注药后即刻、注药后3、6、9、12、15、20、30、45、60和90 min采用高效液相色谱法测定血浆氯普鲁卡因浓度,计算药代动力学参数.结果 与A组比较,C组最高感觉阻滞平面明显升高,感觉和运动阻滞维持时间明显延长(P＜0.05).硬膜外注药后90 min时B组和C组氯普鲁卡因血药浓度高于A组(P＜0.05).结论 随年龄增加,氯普鲁卡因阻滞平面升高,感觉和运动阻滞恢复时间延长,药物代谢减慢.     

子宫切除术患者氯普鲁卡因混合罗哌卡因硬膜外麻醉的效果

目的探讨子宫切除术患者氯普鲁卡因混合罗哌卡因用于硬膜外麻醉的效果。方法拟行子宫切除术患者印例，随机分为R、C1-R、C1-R，、C2-R，四组（n=15），硬膜外分别给予0，75％罗哌卡因、1％氯普鲁卡因＋0．75％罗哌卡因、1％氯普鲁卡因＋0，5％罗哌卡因、1．5％氯普鲁卡因＋0．5％罗哌卡因。记录感觉阻滞最高平面、运动阻滞分级及感觉、运动阻滞起效时间、持续时间、术中辅助用药及不良反应。结果与R组比较，其它三组感觉阻滞的起效时间、达最高平面的时间、BromageI、Ⅱ级的起效时间均缩短，C1-R1、C1-R1组感觉阻滞持续时间、运动阻滞的持续时伺缩短，C1-R组Bromage Ⅲ级的起效时间缩短，C1-R组术中低血压发生率升高，内脏牵拉痛发生率降低（P＜0．05）。结论子宫切除术患者1％或1．5％氯普鲁卡因可增强0．5％％罗哌卡因硬膜外麻醉的效果。     

硬膜外国产盐酸氯普鲁卡因用于剖宫产的临床观察

盐酸氯普鲁卡因为酯类局麻药，而用于剖宫产硬膜外阻滞尚未见临床报道。该药具有代谢快，胎儿、新生儿血内浓度低的优点，适用于产科麻醉。本研究选用国产3％盐酸氯普鲁卡因与2％盐酸利多卡因，观察其用于剖宫产硬膜外麻醉的效果。     

氯普鲁卡因在下腹部手术麻醉的应用

盐酸氯普鲁卡因是一种短效局部麻醉药。国内已有文献报道,3％氯普鲁卡因用于硬膜外麻醉行产科或下腹部手术的麻醉。我们采用低浓度即1．5％氯普鲁卡因用于硬膜外麻醉,现报道如下。     

国产3%氯普鲁卡因硬膜外阻滞用于横切口剖宫产的临床观察

目前剖宫产较常选择横切口术式,本研究选用国产3％氯普鲁卡因与2％利多卡因对照,观察其用于横切口剖宫产时的硬膜外阻滞效果。 资料与方法 一般资料选择ASAⅠ～Ⅱ级行剖宫产术孕妇100例,无硬膜外阻滞禁忌及硬膜外阻滞史等（均不用术前药）,双盲、随机分为氯普鲁卡因组（观察组）和利多卡因组（对照组）,每组50例,两组孕妇的年龄、身高、体重及孕周无统计学意义。     

肾上腺素对氯普鲁卡因硬膜外阻滞患者药效学和药代动力学的影响

目的观察1:20万肾上腺素对3％盐酸氯普鲁卡因硬膜外阻滞患者药效学和药代动力学的影响。方法择期行下腹部手术患者20例,ASAⅠ或Ⅱ级,随机分为2组(n=10):盐酸氯普鲁卡因组(C组)和盐酸氯普鲁卡因加肾上腺素组(CE组)。分别用3％氯普鲁卡因6 mg·kg-1(C组)和含 1:20万肾上腺素3％氯普鲁卡因6 mg·kg-1(CE组)硬膜外阻滞,记录局麻药的起效时间、运动阻滞起效时间和给药后20min时运动阻滞程度;分别在给药前及给药后3、6、9、11、13、15、17、20、30、45、60、 90min采取桡动脉血1．5ml,高效液相色谱法检测血浆氯普鲁卡因浓度,经计算机软件拟合血药浓度 -时间曲线,并计算各项药代动力学参数。结果两组局麻药的起效时间、运动阻滞起效时间和运动阻滞程度差异无统计学意义。C、CE组血药浓度峰值(Cmax)分别为0．49±0．47、(0．32±0．22)mg· L-1,达峰值时间(Tmax)分别为8±3、(9±4)min;血药浓度曲线下面积(AUC)分别为10±6、(7±4)μg· min·ml-1;清除速率常数(K)分别为0．32±0．21、(0．36±0．32)min-1;两组间Cmax、Tmax、AUC及K比较差异无统计学意义(P>0．05)。结论 1:20万肾上腺素对3％盐酸氯普鲁卡因硬膜外阻滞的药代动力学和药效学没有影响。     

氯普鲁卡因与利多卡因小儿骶管麻醉的比较

目的研究氯普鲁卡因用于小儿骶管麻醉的可行性与安全性。方法62例在骶管麻醉下行下肢或会阴部手术患儿(3~8岁),随机、双盲均分为氯普鲁卡因组(研究组)和利多卡因组(对照组),每组31例。清醒或吸入七氟醚诱导后行骶管穿刺(垂直穿刺法),分别一次性注入1.5%氯普鲁卡因或0.8%利多卡因1ml/kg。观察记录HR、BP、RR、SpO2和阻滞作用。结果研究组起效[(1.52±0.71)min]、疼痛消失[(4.07±0.82)min]、麻醉平面固定[(6.50±0.71)min]时间均明显短于对照组[(3.95±0.97)、(5.93±1.57)、(8.59±1.68)min](P<0.01)。麻醉持续时间,研究组(78.52±5.71)min,对照组(81.38±6.68)min。两组最高感觉阻滞神经节段相当。用药后HR、BP、RR和SpO2变化两组对比差异无统计学意义。两组患儿均无明显不良反应。结论1.5%氯普鲁卡因骶管阻滞用于3~8岁小儿较0.8%利多卡因起效、疼痛消失及麻醉平面固定快。呼吸与循环功能基本稳定,无明显不良反应。     

氯普鲁卡因与利多卡因用于低位硬膜外麻醉的多中心临床研究

目的 比较氯普鲁卡因与利多卡因用于低位硬膜外麻醉的临床效应.方法 择期下腹部或下肢手术病人120例均分为3%氯普鲁卡因组(A组)和2%利多卡因组(B组).硬膜外注入试验剂量5 ml,5 min后一次性注入追加剂量10 ml.观察麻醉起效时间、痛觉消失时间、最高阻滞平面及时间、痛觉恢复时间、运动恢复时间、肌肉松弛程度以及呼吸、循环功能变化.结果 A组达最高阻滞平面时间(12.1±4.0)min,明显短于B组的(15.4±5.4)min;A组改良Bromage评分评1分的时间(56.8±10.9)min、评0分的时间(67.6±16.9)min,均明显短于B组的(69.1±14.1)min和(80.4±20.7)min(P<0.05).结论 氯普鲁卡因用于硬膜外麻醉起效迅速、感觉和运动阻滞效果好,且运动功能恢复快.     

盐酸氯普鲁卡因的临床研究进展

盐酸氯普鲁卡因属苯甲酸酯类的局部麻醉药,是在普鲁卡因的结构基础上引入-Cl基因,在化学结构上形成了麻醉效应强、麻醉后恢复快的优点.可以安全广泛的应用于临床麻醉.此文就盐酸氯普鲁卡因的硬膜外麻醉、脊髓麻醉、局部浸润麻醉、外周神经阻滞和区域静脉麻醉等方面的临床研究进展进行综述.     

氯普鲁卡因、布比卡因和罗哌卡因在下肢手术腰-硬联合麻醉中的比较

目的比较氯普鲁卡因、布比卡因和罗哌卡因在下肢手术腰-硬联合麻醉(CSEA)中的应用效果。方法择期行髋关节及以下部位手术患者300例,随机均分成三组:氯普鲁卡因组(C组)、布比卡因组(B组)和罗哌卡因组(R组),蛛网膜下腔分别给予1.5%氯普鲁卡因、0.5%布比卡因和0.5%罗哌卡因各2 ml。记录患者感觉阻滞起效时间、平面固定时间、阻滞平面、腰麻持续时间和运动阻滞效果。结果 C组阻滞平面固定时间、腰麻持续时间明显短于B、R组(P<0.05)。C组感觉阻滞起效时间短于B组,但长于R组(P<0.05)。C组最高阻滞平面明显高于B、R组(P<0.05)。结论与0.5%罗哌卡因和0.5%布比卡因比较,1.5%氯普鲁卡因具有起效快、阻滞完善和运动阻滞效果弱的特点,小剂量氯普鲁卡因可用于手术时间较短的CSEA中的脊麻。     

Is there a need for chloroprocaine 3% and bupivacaine 0.75%?

Bupivacaine and chloroprocaine have proven to be valuable local anesthetics for a variety of surgical and obstetrical situations. Bupivacaine is particularly useful as a long acting agent which provides excellent sensory analgesia particularly during labor with minimal blockade of motor fibers. The 0.75% solution is useful for epidural surgical anesthesia since it does result in a decrease in onset time and a more marked motor blockade. In recent years, this agent has been reported to cause rapid cardiovascular collapse in some patients. Cardiotoxicity associated with bupivacaine is related not to the concentration employed but to the total dosage administered as a rapid intravenous injection. The careful administration of this agents to avoid an accidental intravenous injection should not preclude the use of 0.75% bupivacaine for epidural anesthesia in surgical patients. This concentration is not recommended in obstetrical cases. Chloroprocaine is valuable as a rapid onset, short duration local anesthetic with a low potential for systemic toxicity. The 3% solution is particularly useful for providing a rapid onset of action. In recent years, localized neural irritation has occurred in some patients in whom large amounts of this agent were administered epidurally or intrathecally. The local neural toxicity of chloroprocaine solutions is referably to the low pH and the inclusion of sodium bisulfite in these particular solutions. The toxicity of chloroprocaine solutions is related to total dosage rather than the concentration of solution employed. Careful administration of chloroprocaine epidurally in order to avoid accidental subarachnoid injection should preclude the possibility of local neural toxicity.     

Epidural lidocaine for cesarean delivery of the distressed fetus

Lidocaine with epinephrine and sodium bicarbonate has a rapid onset of action. We therefore wished to compare its use with that of chloroprocaine for urgent cesarean delivery. Thirty parturients for cesarean section under epidural anesthesia were divided into three groups. Group 1 required elective cesarean section and served as the control group for neonatal lidocaine levels. Groups 2 and 3 had been receiving epidural infusions of 0.125% bupivacaine with epinephrine 1:400,000 and required urgent cesarean section. They were randomized to receive either 1.5% lidocaine with epinephrine or 3% chloroprocaine, both with sodium bicarbonate 2 ml in a total volume of 25 ml. All patients had adequate anesthesia and none required supplementation. The time from completion of injection to the achievement of a T4 sensory level was significantly shorter in the chloroprocaine group (3.1 vs. 4.4 min). There were no differences in Apgar scores or Neurologic and Adaptive Capacity Scores between the lidocaine and chloroprocaine groups. Lidocaine was detectable in maternal serum from four of the urgent cases and all of the elective cases. It was detectable in five neonates from the elective group but none from the emergency group. In parturients with preexisting epidural catheters and a baseline epidural infusion to maintain a T10 sensory level, chloroprocaine is faster in onset than lidocaine, but the difference in this study was only 1.3 min, and both agents provided excellent anesthesia.     

3%国产盐酸氯普鲁卡因在老年人低位硬膜外麻醉中的临床观察

目的对比观察3%盐酸氯普鲁卡因与2%盐酸利多卡因在老年人低位硬膜外麻醉中的麻醉效果。方法 90例患者随机分为2组:观察组注入3%盐酸氯普鲁卡因4 mL,对照组注入2%盐酸利多卡因4 mL,观察6 min无全脊麻征象再分别给同类药8～10 mL维持麻醉。每组45例。观察痛觉开始减退时间、痛觉完全消失时间、运动阻滞时间、运动恢复时间、痛觉恢复时间。结果观察组和对照组痛觉开始减退时间及运动阻滞时间差异均无统计学意义(P>0.05),而痛觉恢复时间和运动恢复时间,观察组明显快于对照组(P<0.05),特别是运动时间的恢复几乎和痛觉同时恢复。结论 3%盐酸氯普鲁卡因应用于老年人低位硬膜外麻醉时,具有麻醉起效快,效果确切,毒性低,特别具有运动恢复时间快的特点,特别适合于老年人的麻醉。     

Comparative maternal, fetal, and neonatal effects of chloroprocaine with and without epinephrine for epidural anesthesia in obstetrics

The effects of epidural chloroprocaine with and without 1:200,000 epinephrine during labor and delivery on uterine activity, progress of labor, fetal heart rate, maternal blood pressure, newborn Apgar scores, neonatal acid-base status, and the Neurologic and Adaptive Capacity Scoring System (NACS) were compared in 28 parturients. Patients in group I (n = 14) received 2% chloroprocaine with 1:200,000 epinephrine and patients in group II (n = 14) received 2% plain chloroprocaine. Addition of epinephrine to chloroprocaine had no significant effects on uterine activity, duration of first or second stages of labor, or fetal heart parameters. Apgar scores, neonatal acid-base status, and the NACS were equally good in the two groups. Duration of analgesia was significantly longer in group I than in group II patients (76 +/- 3.8 vs 42.9 +/- 1 min, P less than 0.001). We conclude that addition of epinephrine to chloroprocaine during epidural anesthesia in the normal parturient has no adverse effects on mother, fetus, neonate, or the progress of labor and that it significantly prolongs the duration of anesthesia.     

Non-alkalinized and alkalinized 2-chloroprocainevs lidocaine for intravenous regional anesthesia during outpatient hand surgery

PURPOSE: Chloroprocaine should be an ideal agent for intravenous regional anesthesia (IVRA) because of its rapid onset and ester hydrolysis. Raising the pH of local anesthetics may increase the speed of onset and the intensity of nerve blocks. We compared plain and alkalinized 2-chloroprocaine 0.5% with lidocaine for IVRA. METHODS: In two separate double-blind studies, 78 patients scheduled for daycare hand surgery were randomized to receive 40 mL plain 2-chloroprocaine 0.5%, alkalinized 2-chloroprocaine 0.5% or lidocaine 0.5% for IVRA. Time to sensory and motor block, need for supplemental analgesia, and side effects were compared. RESULTS: There was no difference in time to sensory or motor block in either group. Patients who received plain chloroprocaine required more supplemental opioid and had a higher incidence of metallic taste and of hives than patients who received lidocaine (P < 0.05). Comparing alkalinized chloroprocaine with lidocaine, there was no difference found with respect to opioid supplementation, CNS side effects, or incidence of hives. CONCLUSION: In conclusion, alkalinized chloroprocaine was found to be an effective agent for IVRA but no benefit over lidocaine was detected. Plain chloroprocaine for IVRA produced more minor side effects than lidocaine.     

Clinically significant concentrations of local anesthetics inhibit Staphylococcus aureus in vitro

This study explores which concentrations of local anesthetics might be expected to inhibit the growth of Staphylococcus aureus. Serial dilutions were made of 0.5% and 0.75% bupivacaine, 2% and 5% lidocaine, 2% and 3% chloroprocaine, and 0.2% and 1% ropivacaine. To each concentration of local anesthetic solution, Mueller Hinton broth medium and Staphylococcus aureus were added. The resulting solutions were incubated and then observed for growth 24 and 48 h later. The minimum concentrations of the local anesthetics that could inhibit growth of Staphylococcus aureus were 0.25% bupivacaine, 1.25% lidocaine and 0.75% chloroprocaine. The inhibitory concentration of ropivacaine could not be determined because the more concentrated solutions precipitated in the Mueller Hinton broth. Local anesthetics may help protect against epidural abscess formation if they are used in sufficiently high concentrations. This effect may help explain the very low reported incidence of epidural abscess.     

氯普鲁卡因腰麻或腰-硬联合麻醉的临床研究

目的 探讨国产氯普鲁卡因用于腰麻或腰一硬联合麻醉的效果和安全性.方法 回顾性分析10 000例下腹部以下手术患者采用国产氯普鲁卡因冻干粉(生理盐水稀释成2.5%或3%溶液)腰麻或腰-硬联合麻醉.结果 腰麻平均起效时间24 s,平面固定时间7.7 min.最高阻滞平面平均为T_5.下肢运动阻滞3级者超过94%.腰麻效果平均满意率99.8%,硬膜外辅助麻醉后满意率提高到99.9%.单次腰麻完全消失平均72 min.产科患者腰麻后低血压和恶性呕吐发生率较高(分别为34%和43%).未见明显神经系统并发症和其他不良反应.结论 国产氯普鲁卡因冻干粉溶解后用于腰麻或腰一硬联合麻醉安全、有效.     

10000例氯普鲁卡因腰麻或腰-硬联合麻醉经验

目的：探讨国产氯普鲁卡因膜麻或腰-硬联合麻醉的效果和安全性。方法：回顾分析10000例下腹部以下手术患者按产科、妇科．营外科．骨科和泌尿外科分为五组,均采用西产氯普鲁卡西冻干粉用生理盐水稀释成2．5％或3％溶液用于膜麻或腰-硬联合麻醉（L2-3）。监测患者BP、HR、SpO2,观察麻醉起效与消失过程。以及下胶运动阻滞程度与麻醉并发症。结果：腰麻平均起效和平面固定时间五组相似,分别为24s和7.7min,最高阴滞平面平均为T5（C1-T10）。取得下肢运动阻滞3级者五组均超过94%。腰麻效果满意率平均99.8%,硬膜外辅助后麻醉满意率提升到99.9%,单次腰麻完全消失平均72min,其中产科组长于其他组（P〈0.05）。腰麻后所有患者BP都下降。五组低血压发生率分别为34%,7%,9%,15%和10%。恶性呕吐发生率分别为43%,11%,14%,14%和9%,在产科和妇科分别因腰麻有16例和9例发生呼吸抑制。这些情况经麻黄碱,阿托品和人工辅助通气处理好转,未发生硬膜外用药误入蛛网膜下腔现象,未见明显神经系统并发症和其他不良反应。结论：国产氯普鲁卡因冻干粉溶解后腰麻或腰-硬联合麻醉有效、安全。