罗哌卡因用于脊麻的研究进展

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。     

蛛网膜下腔阻滞麻醉应用0.5%或0.75%罗哌卡因或0.5%布比卡因的效果比较

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。     

罗哌卡因蛛网膜下腔阻滞用于肛门直肠手术的临床观察

目的 探讨罗哌卡因蛛网膜下腔阻滞用于肛门直肠手术的麻醉效果.方法 AsA Ⅰ～Ⅱ级肛门直肠手术患者60例,按数字随机法分成两组,分别采用0.75%布比卡因(B组)和0.75%罗哌卡因(L组)施行蛛网膜下腔阻滞用于肛门直肠手术.观察两组患者感觉阻滞维持时间和麻醉效果.结果 B组患者麻醉效果满意率明显高于L组,感觉阻滞时间L组明显长于B组.结论 0.75%罗哌卡因蛛网膜下腔阻滞用于肛门直肠手术虽然有较高的安全性和长效性,但麻醉效果略逊于0.75%布比卡因.     

高原地区罗哌卡因用于腰麻行剖宫产术的量效观察

本研究旨在观察高原地区不同剂量罗哌卡因蛛网膜下腔阻滞用于剖宫产手术临床效果的异同,对罗哌卡因的量效关系作初步探讨.     

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

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。     

0.5%罗哌卡因与布比卡因10mg在蛛网膜下腔阻滞的比较

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。     

甲磺酸罗哌卡因注射液用于蛛网膜下腔阻滞的临床观察

甲磺酸罗哌卡因注射液是酰胺类长效局麻药，海南斯达制药有限公司研制。规格：10m1：119．2mg，说明书上没有写明可用于蛛网膜下腔阻滞，有关这方面的资料报道不多。我们通过有关资料的学习探讨后，制定了甲磺酸罗哌卡因在蛛网膜下腔阻滞实施方案，从2008年7—12月施行了84例麻醉。将临床观察的体会报道如下。     

鞘内注射罗哌卡因和布比卡因对大鼠早期脊髓细胞凋亡的影响

罗哌卡因是一种新型长效酰胺类局麻药,因其毒性作用小、低浓度时可使运动和感觉神经阻滞分离而在手术麻醉、分娩镇痛及术后镇痛等中得到广泛应用,但罗哌卡因用于蛛网膜下腔阻滞对骨髓的损伤尚无定论[1].     

老年经尿道前列腺切除术患者罗哌卡因蛛网膜下腔阻滞的量效关系

罗哌卡因是一种新型的长效酰胺类局麻药,其中枢神经系统及心血管系统毒性较低,运动神经阻滞程度轻,术后恢复快,更适合于老年人麻醉[1]。罗哌卡因蛛网膜下腔阻滞用于老年经尿道前列腺切除术(TURP)文献已有报道,但对其     

重比重联合轻比重罗哌卡因在蛛网膜下腔麻醉剖宫产术中的应用

目的 分析剖宫产术中使用重比重罗哌卡因联合轻比重罗哌卡因的蛛网膜下腔麻醉与单一重比重罗哌卡因蛛网膜下腔麻醉效果及血流动力学变化. 方法 选择142例在蛛网膜下腔-硬膜外腔联合麻醉下拟行择期剖宫产术患者.根据标准纳入的患者(132例)按计算机编码被随机分配到单一重比重罗哌卡因组(A组)或重比重和轻比重罗哌卡因联合组(B组),每组66例.主要观察指标是低血压的发生率,次要观察指标是感觉阻滞水平. 结果 两组均表现出相似的麻醉效果.A组低血压发生率比B组显著增高(74％比45％)(P＜0.05),A组恶心发生率比B组显著增加(23％比8％)(P＜0.05). 结论 重比重联合轻比重罗哌卡因蛛网膜下腔麻醉相比单一的重比重罗哌卡因蛛网膜下腔麻醉可提供相似的麻醉效果及更加稳定的血流动力学.     

罗哌卡因复合不同佐剂行竖脊肌平面阻滞的研究进展

超声引导下竖脊肌平面阻滞作为一种躯干筋膜间的平面内区域阻滞技术,在围术期镇痛中的应用日渐增多。为了延长竖脊肌平面阻滞镇痛时间,改善手术患者预后,罗哌卡因复合不同佐剂行竖脊肌平面阻滞已成为近年来的研究热点。不同佐剂复合罗哌卡因行竖脊肌平面阻滞,具有延长镇痛时间、减轻不适症状、改善肺功能等诸多优势。全文主要介绍罗哌卡因复合不同佐剂行竖脊肌平面阻滞的临床研究现状,以期为临床上竖脊肌平面阻滞的应用提供参考。     

Randomized double-blind comparison of ropivacaine-fentanyl and bupivacaine-fentanyl for spinal anaesthesia for urological surgery

BACKGROUND: Early studies have suggested that ropivacaine causes less motor block than bupivacaine, which might be advantageous in spinal anaesthesia for short procedures. The aim of this study was to compare plain ropivacaine 10 mg and plain bupivacaine 10 mg, both with fentanyl 15 microg, for spinal anaesthesia in urological surgery. Methods: This was a prospective randomized double-blind study. After written informed consent had been obtained, 34 ASA I-III patients scheduled for urological surgery were randomly assigned to receive intrathecal injection of either plain ropivacaine 10 mg with fentanyl 15 microg (ropivacaine group) or plain bupivacaine 10 mg with fentanyl 15 microg (bupivacaine group) using a combined spinal-epidural technique. RESULTS: All patients achieved sensory block to the T10 dermatome or higher at 15 min after intrathecal injection. One patient in the ropivacaine group was excluded because of unexpectedly prolonged surgery. The primary outcome, the duration of motor block, was shorter in the ropivacaine group (median, 126 min; interquartile range, 93-162 min) compared with the bupivacaine group (median, 189 min; interquartile range, 157-234 min; difference between medians, 71 min; 95% confidence interval, 28-109 min; P = 0.003). The duration of complete motor block was also shorter in the ropivacaine group compared with the bupivacaine group. There was no difference in the onset time of motor block. The characteristics of sensory block and the haemodynamic changes were similar between the groups. CONCLUSION: Plain ropivacaine 10 mg plus fentanyl 15 microg provided similar sensory anaesthesia, but with a shorter duration of motor block, compared with plain bupivacaine 10 mg plus fentanyl 15 microg when used for spinal anaesthesia in urological surgery.     

Total knee replacement: a comparison of ropivacaine and bupivacaine in combined femoral and sciatic block

BACKGROUND: Femoral and sciatic nerve block may improve post-operative analgesia following total knee replacement. OBJECTIVES: To compare the post-operative analgesia following primary total knee replacement provided by spinal anaesthesia alone or in combination with femoral and sciatic nerve block with bupivacaine or ropivacaine. METHODS: Seventy-five patients were randomised into one of three groups: spinal anaesthesia only; spinal anaesthesia and combined femoral and sciatic nerve block with 1 mg x kg(-1) bupivacaine 7.5 mg x ml(-1) to each nerve; spinal anaesthesia and combined femoral and sciatic nerve block with 1 mg x kg(-1) ropivacaine 7.5 mg x ml(-1) to each nerve. RESULTS: The mean (SD) time to first morphine request was significantly prolonged for both groups receiving combined femoral and sciatic block, 912 (489) min for the bupivacaine group and 781 (394) min for the ropivacaine group (P<0.001) compared with 413 (208) min for the group receiving spinal anaesthesia alone. Morphine consumption was significantly reduced in both groups receiving combined femoral and sciatic block. There were no systemic or neurological sequelae in any of the groups. CONCLUSIONS: Femoral and sciatic blockade following intrathecal bupivacaine/diamorphine provided superior analgesia when compared with intrathecal bupivacaine/diamorphine alone. There were no significant clinical differences between the group receiving bupivacaine 7.5 mg x ml(-1) and the group receiving ropivacaine 7.5 mg x ml(-1).     

Intrathecal Ropivacaine in Rabbits: Pharmacodynamic and Neurotoxicologic Study

Background: Ropivacaine is available for spinal or intrathecal use in humans, although data on neurotoxicity after spinal injection are not yet available. The authors experimentally determined the relationship between doses of intrathecal ropivacaine and spinal effects and local neurotoxic effects.

Methods: Eighty rabbits equipped with an intrathecal lumbar catheter were studied. Sixty were randomly assigned to receive 0.2 ml of intrathecal solutions as a sole injection of: 0.2%, 0.75%, 1.0%, and 2.0% ropivacaine (doses from 0.4-4.0 mg; groups R0.2 to R2.0), 5.0% lidocaine (10 mg; group L), or 0.9% NaCl as control (group C). Twenty other rabbits received either repeated injections of 0.2 ml of 0.2% ropivacaine every 2 days during 2 weeks (total dose of 2.8 mg; group RINT); or a continuous intrathecal infusion of 0.2% ropivacaine at the rate of 1.8 ml/h over 45 min (2.7 mg; group RCONT). Injection rate was 30 s in all groups except Rcont. Time to onset, duration and extent of motor block, and variations of mean arterial blood pressure were recorded in all groups. Somatosensory evoked potentials were also recorded in group RCONT and RINT. Seven days after the last intrathecal injection spinal cord and nerves were sampled for histopathologic study.

Results: In groups R0.2 and RINT, the lowest dose of ropivacaine induced a clinically visible spinal block in only 50% of rabbits, but SEPs recorded in group RINT were decreased by 70% in the lumbar dermatome. Complete motor block was observed with doses greater than 1.5 mg of ropivacaine (group RCONT and R0.75 to R2.0). Onset time was shorter and duration of block increased as doses of ropivacaine increased. Significant hypotension was observed only with 4.0 mg of ropivacaine (concentration of 2.0%). Complete paralysis and hypotension were observed with 5.0% lidocaine. No neurologic clinical lesion was observed in rabbits receiving saline or ropivacaine within the 7 days after the last intrathecal injection, and histopathologic study revealed no sign of neurotoxicity in these groups. In contrast, intrathecal lidocaine induced clinical and histopathologic changes.     

Intrathecal fentanyl added to hyperbaric ropivacaine for cesarean delivery

BACKGROUND AND OBJECTIVES: Hyperbaric ropivacaine produces adequate spinal anesthesia for cesarean delivery. Addition of opioid to local anesthetics improves spinal anesthesia. We assessed the effect of fentanyl added to hyperbaric ropivacaine for spinal anesthesia for cesarean delivery. METHODS: Fifty-nine healthy, full-term parturients scheduled for elective cesarean delivery under spinal anesthesia were randomly assigned in a double-blind fashion to receive either fentanyl 10 micro g or normal saline 0.2 mL added to 0.5% hyperbaric ropivacaine 18 mg. Characteristics of spinal block, intraoperative quality of spinal anesthesia, side effects, complete analgesia (time to first feeling of pain), and effective analgesia (time to first request of analgesics) were assessed. RESULTS: Duration of sensory block was prolonged in the fentanyl group (P <.05). Duration of motor block was similar in both groups. The quality of intraoperative analgesia was better in the fentanyl group (P <.05). Incidence of side effects did not differ between groups. Duration of complete analgesia (143.2 +/- 34.2 minutes v 101.4 +/- 21.4 minutes; P <.001) and effective analgesia (207.2 +/- 32.2 minutes v 136.3 +/- 14.1 minutes; P <.001) were prolonged in the fentanyl group. CONCLUSIONS: Adding fentanyl 10 micro g to hyperbaric ropivacaine 18 mg for spinal anesthesia for cesarean delivery improves intraoperative anesthesia and increases the analgesia in the early postoperative period.     

Intrathecal ropivacaine in rabbits: pharmacodynamic and neurotoxicologic study

BACKGROUND: Ropivacaine is available for spinal or intrathecal use in humans, although data on neurotoxicity after spinal injection are not yet available. The authors experimentally determined the relationship between doses of intrathecal ropivacaine and spinal effects and local neurotoxic effects. METHODS: Eighty rabbits equipped with an intrathecal lumbar catheter were studied. Sixty were randomly assigned to receive 0.2 ml of intrathecal solutions as a sole injection of: 0.2%, 0.75%, 1.0%, and 2.0% ropivacaine (doses from 0.4-4.0 mg; groups R0.2 to R2.0), 5.0% lidocaine (10 mg; group L), or 0.9% NaCl as control (group C). Twenty other rabbits received either repeated injections of 0.2 ml of 0.2% ropivacaine every 2 days during 2 weeks (total dose of 2.8 mg; group RINT); or a continuous intrathecal infusion of 0.2% ropivacaine at the rate of 1.8 ml/h over 45 min (2.7 mg; group RCONT). Injection rate was 30 s in all groups except Rcont. Time to onset, duration and extent of motor block, and variations of mean arterial blood pressure were recorded in all groups. Somatosensory evoked potentials were also recorded in group RCONT and RINT. Seven days after the last intrathecal injection spinal cord and nerves were sampled for histopathologic study. RESULTS: In groups R0.2 and RINT, the lowest dose of ropivacaine induced a clinically visible spinal block in only 50% of rabbits, but SEPs recorded in group RINT were decreased by 70% in the lumbar dermatome. Complete motor block was observed with doses greater than 1.5 mg of ropivacaine (group RCONT and R0.75 to R2.0). Onset time was shorter and duration of block increased as doses of ropivacaine increased. Significant hypotension was observed only with 4.0 mg of ropivacaine (concentration of 2.0%). Complete paralysis and hypotension were observed with 5.0% lidocaine. No neurologic clinical lesion was observed in rabbits receiving saline or ropivacaine within the 7 days after the last intrathecal injection, and histopathologic study revealed no sign of neurotoxicity in these groups. In contrast, intrathecal lidocaine induced clinical and histopathologic changes. CONCLUSION: Ropivacaine induced dose-dependent spinal anesthesia, and did not induce any neurotoxicologic lesion in this experimental animal model.     

Spinal ropivacaine for cesarean delivery: a comparison of hyperbaric and plain solutions

We compared, in this prospective, randomized, double-blinded study, the characteristics of spinal anesthesia with plain and hyperbaric ropivacaine for elective cesarean delivery. We hypothesized that the addition of glucose would change the onset, offset, and extent of motor and sensory block from intrathecal ropivacaine. Forty ASA physical status I--II women were given 25 mg of either ropivacaine (n = 20) or ropivacaine in 8.3% glucose (n = 20) intrathecally, via a combined spinal/epidural technique in the right lateral position. Sensory changes to ice and pinprick and motor block (Bromage score) were recorded at 2.5-min intervals. Adequate anesthesia for surgery was achieved in all patients in the Hyperbaric group, whereas in the Plain group, five (25%) patients required epidural top-up because of insufficient rostral spread (P < 0.05). With hyperbaric ropivacaine, we found the following: higher cephalic spread (median [range] maximum block height to pinprick, T1 [T4 to C2] versus T3 [T11 to C3], P < 0.001); lower coefficient of variation of maximum block height (17.7% vs 21.9%); faster onset to T4 dermatome (mean [SD] 7.7 [4.9] vs 16.4 [14.1] min, P = 0.015); and faster recovery to L1 (189.0 [29.6] vs 215.5 [27.0] min, P = 0.01). The onset of complete motor block (9.9 [5.3] vs 13.8 [5.4] min, P = 0.027) and complete recovery (144.8 [28.4] vs 218.5 [56.8] min, P < 0.001) was also faster. No neurologic symptoms were found at 24 h. IMPLICATIONS: We compared hyperbaric and plain ropivacaine for combined spinal/epidural analgesia in the lateral position in patients undergoing elective cesarean delivery. Hyperbaric ropivacaine produced more rapid block with faster recovery and less requirement for epidural supplementation compared with plain ropivacaine.     

鞘内注射不同浓度甲磺酸罗哌卡因对大鼠脊髓的神经毒性

目的 评价鞘内注射不同浓度甲磺酸罗哌卡因对大鼠脊髓的神经毒性.方法 取鞘内置管成功的Wistar大鼠60只,体重210～220 g,雌雄不拘,随机分为5组(n=12),对照组(C组)鞘内注射0.9%NaCl溶液0.4 ml;不同浓度甲磺酸罗哌卡因组(R1～4组)鞘内注射甲磺酸罗哌卡因0.4 ml,浓度依次为0.224%、0.447%、0.671%、0.894%.记录阻滞起效时间(鞘内给药结束至鼠尾丧失运动的时间)和维持时间(鼠尾丧失运动至恢复运动的时间).鞘内给药后第7天处死大鼠,取L4.5脊髓节段,透射电镜下观察超微结构,并进行脊髓损伤评分.脊髓损伤评分≥2分为发生神经毒性,记录脊髓神经毒性的发生情况.结果 随甲磺酸罗哌卡因浓度的升高起效时间逐渐缩短,维持时间逐渐延长(P＜0.05或0.01).脊髓神经毒性发生率C组为0,R1组为0,R2组为17%,R3组为42%,R4组为100%;随甲磺酸罗哌卡因浓度的升高,脊髓神经毒性发生率逐渐增加(P＜0.05或0.01).结论 鞘内注射甲磺酸罗哌卡因对大鼠可产生脊髓神经毒性,且取决于其浓度.     

轻比重罗哌卡因在高龄患者腰-硬联合麻醉髋关节手术的应用

目的 观察高龄患者髋关节手术小剂量罗哌卡因腰-硬联合麻醉的麻醉效果及对循环呼吸功能的影响.方法 ASA Ⅱ或Ⅲ级髋关节手术60例,男18例,女42例,年龄(85.5±10.5)岁,体重(65.35±13.91)kg,随机分为两组,各组30例.A组腰麻用轻比重0.2%罗哌卡因5～7 mg,硬膜外阻滞用0.2%罗哌卡因;B组腰麻用重比重0.5%布比卡因8～10 mg,硬膜外阻滞用0.375%布比卡因硬膜外阻滞.记录两组麻醉效果和术中BP、HR、SpO2变化.结果 A组麻醉平面T8～T10,单侧,术中各时点BP、HR、SpO2平稳,Bromage评分患肢1～2分,健肢0～1分;B组麻醉平面T6～T8,双侧,术中各时点BP明显下降,HR明显减慢(P<0.01),也低于A组(P<0.05),Bromage评分双下肢以3～4分为主.结论 轻比重罗哌卡因腰-硬联合麻醉更适用于高龄髋关节手术患者.