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罗哌卡因与布比卡因蛛网膜下腔阻滞的比较研究 总被引:34,自引:1,他引:33
罗哌卡因(Ropivacaine,Rop)是一种新型长效酰胺类局部麻醉药,心脏毒性低于布比卡因(Bupivacaine,Bup)[1],多用于神经阻滞和硬膜外阻滞[2],本文比较研究了0.75%Rop与0.75%Bup在蛛网膜下腔阻滞的起效、维持时间、麻醉最高平面等。资料与方法一般情况 20例拟在蛛网膜下院阻滞下择期行下腹部及其以下手术的患者,ASAⅠ~Ⅱ级,其中男11例,女9例。年龄20~63岁,体重55~70kg,身高153~18Icm。随机分为2组,每组10例。方法及观察指标 患者入手术室… 相似文献
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罗哌卡因用于蛛网膜下腔阻滞的实验研究 总被引:88,自引:2,他引:86
目的:观察不同浓度不同剂量罗哌卡因注入犬的蛛网膜下腔后,脊髓,神经根早期超微结构及脊髓组织髓钙含量的变化。方法:杂种犬18只,雌雄兼有,体重10kg左右,随机分为三组,A组为对照组6只,生理盐水2ml,B组6只,0.5%罗哌卡因2ml(10mg),C组6只,1%罗哌卡因2ml(20mg),动物麻醉后对氯胺酮,芬太尼间断静脉注射射维持麻醉。于L3-4穿刺,注入生理盐水或罗哌卡因,于注药后3h,迅速处死动物后,取L1-2脊髓及神经根,每组随机取1mm3脊髓前角组织和神经根,固定于2.5%戊二醛磷酸缓冲液中行透射电镜观察脊髓及神经根超微结构的改变。并采用原子吸收分光光度法测脊髓组织钙含量。结果:(1)C组脊髓组织钙离子含量明显高于A,B两组。(2)A,B两组电镜标本正常,神经膜完整,脊髓标本显示线粒体,内质网完整。C组神经膜分层,部分断裂,脊髓组织线粒体肿胀,部分空泡变性,内质网肿胀。结论:1%浓度的罗哌卡因用于蛛网膜下腔可以造成脊髓缺血损伤,所以诮地蛛网膜下腔还需谨慎。 相似文献
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罗哌卡因蛛网膜下腔阻滞在剖宫产术中的应用 总被引:6,自引:1,他引:5
目的观察不同浓度罗哌卡因用于蛛网膜下腔阻滞剖宫产术的麻醉效能、母婴安全和相关不良反应。方法采用随机双盲法,将60例剖宫产手术的足月单胎产妇均分为三组:0.5%罗哌卡因组(L1组),0.75%罗哌卡因组(L2组)和0.5%布比卡因组(C组)。记录蛛网膜下腔阻滞后产妇的感觉阻滞和运动阻滞的起效和持续时间、麻醉质量评价、恶心呕吐等不良反应及术中HR、BP、SpO2和新生儿1min和5min Apgar评分。结果L1和L2组比C组起效慢,阻滞平面低,平面固定时间长。L2组感觉阻滞时间比L1组和C组长。L2组和C组肌松评分优于L1组。运动神经阻滞改良Bromage评分,L1组〈k组〈C组(P〈0.05)。三组术中低血压及其他不良反应发生率差异无统计学意义。结论0.75%罗哌卡因用于蛛网膜下腔阻滞剖宫产时,其麻醉效能弱于0.5%布比卡因,而强于0.5%罗哌卡因,三者均具有较好的安全性。 相似文献
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罗哌卡因蛛网膜下腔阻滞用于剖宫产的量效关系 总被引:3,自引:0,他引:3
目的 研究罗哌卡因蛛网膜下腔阻滞用于剖宫产的量效关系.方法 择期剖宫产患者100例,随机、双盲分为四组.于L2-3间隙蛛网膜下腔穿刺成功后,分别注射罗哌卡因15 mg(A组)、17.5 mg(B组)、20 mg(C组)、22.5 mg(D组).采用针刺法测定感觉阻滞平面,改良Bromage评分法测定下肢运动神经阻滞程度,VAS评分评估患者疼痛程度,术者评定腹壁松弛度,记录麻醉后不良反应.采用Probit法计算50%和95%患者镇痛有效的罗哌卡因剂量(ED50和ED95)及其95%可信区间(CI).结果 随着剂量加大,运动阻滞起效时间逐渐缩短,Bromage评分逐渐增高,感觉和运动恢复时间逐渐延长.四组镇痛有效率分别为36%、64%、96%、100%,腹壁松弛度"很松"的分别为24%、48%、92%、100%.麻醉后不良反应少.罗哌卡因的ED50为15.95 mg(95%CI 15.31~16.62 mg),ED95为18.76 mg(95%CI 17.67~19.54 mg).结论 国大罗哌卡因用于剖宫产蛛网膜下腔阻滞的ED50为15.95 mg,ED95为18.76 mg. 相似文献
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目的探讨罗哌卡因复合舒芬太尼蛛网膜下腔阻滞麻醉用于剖宫产术的效果。方法随机将蛛网膜下腔阻滞麻醉下择期行剖宫产术的88例产妇分为2组,各44例。对照组应用0.75%罗哌卡因,观察组采用0.75%罗哌卡因复合舒芬太尼。比较2组的麻醉效果。结果观察组达到阻滞平面的时间短于对照组,镇痛维持时间长于对照组,差异有统计学意义(P<0.05)。2组新生儿5 min Apgar评分、心率、平均动脉压,以及不良反应发生率,差异均无统计学意义(P>0.05)。结论 0.75%罗哌卡因复合舒芬太尼行蛛网膜下腔阻滞麻醉用于剖宫产术,麻醉效果良好、术中血流动力学稳定、不良反应少、安全性较高。 相似文献
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目的:观察不同浓度罗哌卡因用于蛛网膜下腔阻滞的效果。方法:45例择期膝关节镜手术病人,随机分为三组,每组15例,分别于蛛网膜下腔注入0.5%布比卡因2.5ml(C组),0.5%罗哌卡因2.5ml(R1组)或0.75%罗哌卡因2.5ml(R2组)。记绿麻醉后的血压、心率、脉博血氧饱和度,感觉与运动阻滞的起效时间,达最高阻滞平面和最大阻滞程度的时间。感觉与运动阻滞的恢复时间。术后第二天随访记录术后并发症。结果:三组病人感觉阻滞起效和达到最高阻滞平面无显著性差异。感觉阻滞维持时间以0.75%罗哌卡因组与0.5%布比卡因组明显长于0.5%罗哌卡因组,而前两组间无显著性差异,运动阻滞起效时间三组组无显著性差异。运动阻滞程度及维持时间以0.5%罗哌卡因组较0.75%罗哌卡因组或0.5%布比卡因组有显著性差异。而后两组间无显著性差异。结论:蛛网膜下腔阻滞应用0.75%罗哌卡因与0.5%d布比卡因的作用相似,均可以安全使用于蛛网膜下腔阻滞麻醉。0.75%罗哌卡因可提供更完善的运动和感觉阻滞。 相似文献
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目的观察0.5%罗哌卡因、布比卡因10 mg蛛网膜下腔阻滞对感觉、运动神经的阻滞效果及对血流动力学影响。方法随机选取择期行下肢、下腹或肛肠手术病人48例,ASAⅠ~Ⅱ级,分为布比卡因组(BP组)和罗哌卡因组(RP组),于L2~3、L3~4间隙行腰硬联合穿刺,蛛网膜下腔穿刺成功后于蛛网膜下腔分别注入0.5%的布比卡因或罗哌卡因10 mg,之后于硬膜外腔向头侧置管4 cm以备蛛网膜下腔阻滞不能满足手术需要时追加局麻药。观查并记录感觉阻滞平面,运动神经阻滞程度及血流动力学变化。结果两组病人血流动力学稳定,麻醉平面均能满足手术要求。BP组感觉平面高于RP组,RP组术后下肢运动恢复快于BP组。结论0.5%罗哌卡因、布比卡因10 mg用于腰硬联合麻醉可作为肛肠、部分下腹、下肢手术的麻醉选择;其中罗哌卡因术后下肢运动恢复快,较快恢复自主排尿为其优点。 相似文献
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目的 评价0.33%等比重罗哌卡因蛛网膜下腔阻滞在高龄半髋关节置换术中应用的安全性和有效性. 方法 年龄≥70岁,ASA分级Ⅱ、Ⅲ级,行半髋关节置换术的患者150例,按随机数字表法分为A组、B组、C组(每组50例).所有患者均采用健侧卧位,穿刺间隙为L3~L4椎间隙,用脑脊液将1%盐酸罗哌卡因注射液稀释成0.33%(1 ml罗哌卡因+2 ml脑脊液),A组、B组、C组分别给予2.2、2.0、1.8 ml.于麻醉前(T0),蛛网膜下腔注药后5 min (T1)、10 min(T2)和15 min(T3),手术开始时(T4),手术开始后30 min(T5),术毕(T6)时点,记录MAP、HR和感觉阻滞平面高度,并记录麻醉诱导时间、手术时间、术中出血量、尿量和输液量以及术中、术后相关并发症. 结果 蛛网膜下腔阻滞有效率和阻滞效果A组明显优于B组、C组,且B组优于C组(P<0.05).麻醉诱导时间A组[(15.6±1.4) min]明显短于B组[(19.5±6.3)min]、C组[(26.6±7.1) min],且B组短于C组(P<0.05).HR在A组T1~T6时[(80±12)、(80±11)、(78±10)、(77±10)、(77±10)、(77±10)次/min]和B组T1~T2时[(77±8)、(77±7)次/min]较各组To时[(71±11)、(73±9)次/min]明显增快(P<0.05);MAP在A组T1、T2时[(96±8)、(98±8) mmHg(1 mmHg=0.133 kPa)]、B和C组T4~T6时[(100±8)、(100±8)、(100±8) mmHg和(96±8)、(98±7)、(99±8) mmHg]较各组To时[(104±8)、(104±8)、(103±8) mmHg]均明显降低(P<0.05),且C组T4~T6时较T3时也明显降低(P<0.05).T1~T3时A组感觉阻滞平面明显高于B组和C组,且B组高于C组(P<0.05);在T4~T6时A组和B组明显高于C组(P<0.05);与T3比较,A组感觉阻滞平面在T6时明显降低(P<0.05);B组、C组感觉阻滞平面在T4~T6时明显升高(P<0.05).术中低血压和恶心呕吐的发生率A组、B组均明显低于C组(P<0.05),而A组和B组比较,差异均无统计学意义(P>o.05). 结论 0.33%等比重罗哌卡因蛛网膜下腔阻滞应用于高龄半髋关节置换术中具有安全性和有效性. 相似文献
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罗哌卡因用于脊麻的研究进展 总被引:6,自引:0,他引:6
罗哌卡因已广泛用于临床上成人和儿童的硬膜外麻醉和外周神经阻滞,但能否用于蛛网膜下腔阻滞一直存有争议。现就罗哌卡因用于脊麻的麻醉效应和安全性的研究作一综述。 相似文献
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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 总被引:10,自引:0,他引:10
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。 相似文献
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Ropivacaine, a relatively new amide local anaesthetic, reputedly produces less motor block than equivalent doses of bupivacaine, potentially combining high-quality analgesia with the ability to ambulate. We report two cases of prolonged, profound motor block with patient-controlled epidural analgesia using 0.1% ropivacaine, following spinal bupivacaine for Caesarean section. As there was no evidence of inadvertent intrathecal ropivacaine administration or of any neurological injury, we hypothesise that epidural ropivacaine may interact with intrathecal bupivacaine to prolong its effect. 相似文献
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Objective:The purpose of this prospective, randomized, double-blind study was to compare the low epidural block efficacy of ropivacaine and bupivacaine at the equivalent concentrations. Methods Eighty patients (44 male and 36 female patients) undergoing selective lower abdominal or lower extremity surgery were allocated randomly to four groups with 20 in each, receiving 0.5% bupivacaine (group B0.5), 0.5% ropivacaine (group R0.5), 0.75% bupivacaine (group B0.75) and 0.75% ropivacaine (group R0.75), respectively. Prior to surgery, with double blind method, 0.5%, 0.75% ropivacaine, or 0.5%, 0.75% bupivacaine as local anesthetic solutions were injected respectively via epidural catheters at interspace of L2-3 or L3-4. Patients received the experimental drug 4 ml as a catheter test dose in order to avoid the catheter being improperly placed into the subarechnoid space. Ropivacaine or bupivacaine 3-5ml was administered at five minutes intervals until anesthetic effect had met surgery demand. (The segmental level of sensory block by pinpricking had extended above the top of surgery incision.) During the procedure, no additional study drug was injected into the epidurel space while the patients were being recorded, including onset time, the efficacy of sensory moter block, duration, cardiovascular effects, the quality of analgesia and neuromuscular block, adverse reactions and complications. All subjects were continuously monitored non-invasion blood pressure, heart rate(HR), oxygen saturation measured by pulse oximetry(SpO2) and electrocardiogram(EEG) throughout surgery. Results:The anesthesia of all subjects was appropriate for surgery. With 0.5%, 0.75% ropivacaine, or 0.5%, 0.75% bupivacaine in the equivalent dosages, onset time, duration of sensory block, and the efficacy of motor block(mostly Bromage 3) was not significantly different between the groups(P 〉0.05). Increasing the concentration of ropivacaine could leaded to a longer duration of motor block, especially in group R0.75(P〈0.01). The cephalad dermatomal level of analgesia accessed by pinpricking was mostly T8-T10 for all groups. Because the difference between the peak or the valley ,and the baseline ,of SpO2, HR, BP, and PP was not statistically significant(P 〉 0.05), the study drug didn't show obvious effects on haemodynamics. The minority of the patients, distributed among the four groups, complained of udnary retention after the operation.
Conclusions:The data from the patients undergoing lower abdominal or lower extremity surgery, who received lower anesthesia with 0.5%, 0.75% ropivacaine or 0.5%, 0.75% bupivacaine in the equivalent volumes respectively revealed that anesthetic efficiency could meet surgery demand. Onset time of the tow drugs, ropivacaine and bupivacaine, was similar at the equivalent concentrations, there was no difference in duration and efficacy of sensory and motor block, and in the cephalad spread degree of epidurel anesthetics, between ropivacaine and bupivacaine at the equal dosages. The higher concentrations of ropivacaine appeared to be obviously associated with a more prolonged duration of sensory block. 相似文献
Conclusions:The data from the patients undergoing lower abdominal or lower extremity surgery, who received lower anesthesia with 0.5%, 0.75% ropivacaine or 0.5%, 0.75% bupivacaine in the equivalent volumes respectively revealed that anesthetic efficiency could meet surgery demand. Onset time of the tow drugs, ropivacaine and bupivacaine, was similar at the equivalent concentrations, there was no difference in duration and efficacy of sensory and motor block, and in the cephalad spread degree of epidurel anesthetics, between ropivacaine and bupivacaine at the equal dosages. The higher concentrations of ropivacaine appeared to be obviously associated with a more prolonged duration of sensory block. 相似文献
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目的 比较右美托咪定和地塞米松混合于罗哌卡因用于腰丛阻滞的临床效果。方法 选择单侧膝部或股骨手术的成年患者90例,ASAⅠ或Ⅱ级,随机分为三组:对照组、地米组和右美组,每组30例。三组患者均在超声联合神经刺激仪引导下行后路腰丛阻滞,对照组注入浓度为0.375%(3.75 mg/mL)的盐酸罗哌卡因0.5 mL/kg,地米组注入相同浓度、等效容量的局麻药和地塞米松0.1 mg/kg,右美组注入相同浓度、等效容量的局麻药和右美托咪定1 μg/kg。比较感觉、运动阻滞的起效时间和持续时间,记录术后24 h内VAS疼痛评分和镇痛药用量,观察并发症的发生情况。结果 感觉和运动阻滞的起效时间:右美组<地米组<对照组(P<0.05);感觉和运动阻滞的持续时间:右美组>地米组>对照组(P<0.05)。地米组和右美组术后24 h的VAS疼痛评分低于对照组(P<0.05);地米组和右美组术后24 h内的镇痛药用量少于对照组(P<0.05),右美组少于地米组(P<0.05)。三组患者并发症的发生率无统计学差异。结论 右美托咪定或地塞米松与罗哌卡因混合应用均能加快腰丛阻滞的起效时间、延长持续时间和降低患者术后疼痛程度,但右美托咪定的作用更为显著。 相似文献
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鞘内注射右旋美托咪啶对大鼠罗哌卡因蛛网膜下腔阻滞效果的影响 总被引:2,自引:0,他引:2
目的 探讨鞘内注射右旋美托咪啶对大鼠罗哌卡因蛛网膜下腔阻滞效果的影响.方法 清洁级雄性SD大鼠,体重250~300 g,取鞘内置管成功的大鼠36只,随机分为6组(n=6),C组:鞘内注射生理盐水20 μl;D组:鞘内注射右旋美托咪啶3 μg/kg 20 μl;R组:鞘内注射0.5%罗哌卡因20 μl;DR1组:鞘内注射右旋美托咪啶1 μg/kg+0.5%罗哌卡因20 μl;DR2组鞘内注射右旋美托咪啶2 μg/kg+0.5%罗哌卡因20 μl;DR3组鞘内注射右旋美托咪啶3 μg/kg+0.5%罗哌卡因20 μl.于鞘内注药前(基础状态)和鞘内注药后5、30、60、120和240 min时计算最大抗伤害效应百分比(MPE),测定机械缩足阈值(PWT),并进行倾斜板实验.于鞘内注药后第2周,取脊髓组织进行病理学观察,计算神经元异常率,行脊髓病理学评分和损伤分级.结果 与R组比较,DR1组鞘内注药后30、60 min时PWT升高,DR3组鞘内注药后120 min时PWT降低(P<0.05),DR2组各时点差异无统计学意义(P>0.05),DR1组鞘内注药后5~240 min时、DR2组鞘内注药后5和240 min时、DR3组鞘内注药后5 min时MPE升高,DR1组鞘内注药后30、60 min时下滑角度降低(P<0.05);DR2组与DR3组各时点上述指标差异无统计学意义(P>0.05);与C组比较,DR3组神经元异常率、脊髓病理学评分和损伤分级升高(P<0.05),其余各组差异无统计学意义(P>0.05).结论 右旋美托咪啶可增强0.5%罗哌卡因蛛网膜下腔阻滞的效果,且具有封顶效应. 相似文献
18.
Pharmacokinetics and analgesic effect of ropivacaine following ilioinguinal/iliohypogastric nerve block in children 总被引:11,自引:0,他引:11
Bernard Dalens MD Claude Ecoffey MD Agnes Joly MD Elisabeth Giaufré MD Urban Gustafsson PhD Gunilla Huledal MSc Pharm & Lars E. Larsson MD PhD 《Paediatric anaesthesia》2001,11(4):415-420
BACKGROUND: The aim was to investigate the efficacy, tolerance and pharmacokinetics of ropivavcaine when administered for ilioinguinal/iliohypogastric block in children. METHODS: We examined the pharmacokinetics and analgesic efficacy after ilioinguinal/iliohypogastric nerve block with 3 mg.kg-1 ropivacaine 5 mg.ml-1 in 22 children, aged 1-12 years, who were scheduled for inguinal surgery. Sixteen of 22 patients had a postoperative pain score < 4 (Objective Pain Scale). Nine children were given supplementary analgesics during the first six postoperative hours. RESULTS: The peak plasma concentration of total ropivacaine was 1.50 +/- 0.93 mg.l-1 (mean +/- SD) (range 0.64-4.77 mg.l-1) 15-64 min after the injection. The peak plasma concentration of free ropivacaine was 0.05 +/- 0.03 mg.l-1 (0.02-0.14 mg.l-1), which is well below the threshold for toxicity in adults. The terminal half-life was 2.0 +/- 0.7 h. No safety concerns or symptoms suggestive of systemic toxicity were observed. CONCLUSION: A dose of 3 mg.kg-1 of ropivacaine given as a single ilioinguinal/iliohypogastric nerve block in 1-12-year-old children provides satisfactory postoperative pain relief, and is well tolerated. 相似文献
19.
Mehdi Trifa Sonia Ben Khalifa Ali Jendoubi Najeh Zribi Tarek Regaya Thomas Engelhardt 《Paediatric anaesthesia》2012,22(5):425-429
Background: The addition of clonidine to peripheral nerve blocks is controversial in children. Objective: The aim of our study was to evaluate the effect of clonidine added to ropivacaine in pediatric axillary brachial plexus block (ABPB). Methods: Children aged 1–6 years, scheduled to undergo forearm or hand surgery, were recruited into this prospective, double‐blind controlled trial. Patients were randomly allocated to receive an ABPB either with ropivacaine 0.2% 0.4 ml·kg?1 plus saline in 1 ml (RS) or ropivacaine 0.2% 0.4 ml·kg?1 plus clonidine 1 μg·kg?1 in 1 ml (RC). Primary endpoints were quality of postoperative analgesia as assessed by pain scores and total 24‐h postoperative analgesia requirements. Secondary outcomes were time to first analgesia request and duration of motor blockade. Results: Sixty patients were recruited (n = 30 per group) into the study. Pain scores were comparable throughout the first 24 h between the two groups. Ten children in the (RS) and six in (RC) groups required supplementary analgesia during the first 24 h (P = 0.24). Children who required further analgesia did so after 288 ± 94 min in the (RS) and 437 ± 204 min in the (RC) group (P = 0.06). There was no difference in the duration of motor block [186 ± 71 and 154 ± 56 min, P = 0.12 for (RS) and (RC), respectively]. Conclusion: Ropivacaine (0.2% 0.4 ml·kg?1) for ABPB provides sufficient postoperative analgesia in children scheduled for forearm or hand surgery. The addition of clonidine to ABPB does not improve overall postoperative analgesia but may increase the time to first analgesia request. 相似文献
20.
Yu-Nan Lin Qiang Li Rui-Min Yang Zhong-Xuan Mao Jing-Chen Liu 《Acta anaesthesiologica Taiwanica》2013,51(2):63-66
ObjectiveTo investigate the sensory block onset time, duration time, and side effects of adding dexmedetomidine to ropivacaine for cervical plexus block.MethodsForty American Society of Anesthesiologists (ASA) Class I or II adult patients who were scheduled to undergo thyroid surgery were randomly allocated to the following groups to receive cervical plexus block: 30 mL of 0.375% ropivacaine combined with 1 μg kg?1 of dexmedetomidine; 30 mL of 0.375% ropivacaine combined with saline (control). The sensory block onset time, duration of analgesia, mean arterial pressure (MAP), heart rate (HR), and the incidences of side effects, such as hypotension, bradycardia, and hypoxemia were recorded.ResultsThe addition of dexmedetomidine to ropivacaine (Group D) shortened the sensory block onset time compared with the ropivacaine group (Group C) (95% confidence interval [CI] 4.18–5.26; p < 0.05). The duration of analgesia of cervical plexus block in Group D was significantly longer than that in Group C (95% CI 295.96–311.12; p < 0.05). The Ramsay sedation score at 5, 10, 20, 40, 60, 90, and 120 minutes after local anesthetic administration in Group D was significantly higher than that in Group C (p < 0.05). MAP level and HR level in Group D were significantly lower than that in Group C (p < 0.05).ConclusionThe addition of 1 μg kg?1 dexmedetomidine to ropivacaine for cervical plexus block could shorten the sensory block onset time and extend the duration of analgesia, and increased the quality of analgesia, with the patients being sedated and arousable. 相似文献