Spinal anaesthesia for Caesarean section with bupivacaine 5 mg ml(-1) in glucose 8 or 80 mg ml(-1)

The standard spinal preparation of bupivacaine contains a highconcentration of glucose (80 mg ml^–1). However,the addition of only a small amount of glucose (8 mg ml^–1)to plain solutions of bupivacaine results in a solution which,although no more than marginally hyperbaric, produces a morepredictable block when used for spinal anaesthesia in non-pregnantpatients. However, bupivacaine 5 mg ml^–1 inglucose 8 mg ml^–1 has a density [1.00164 (SD0.00008) at 37°C] which is relatively greater than thatof the cerebrospinal fluid (CSF) of the pregnant patient atterm (1.0003 at 37°C) because CSF density decreases duringpregnancy. Therefore, a double-blind, randomized, controlledstudy was carried out to compare intrathecal bupivacaine (glucose8 mg ml^–1) with bupivacaine (glucose 80 mg ml^–1)in 40 pregnant patients at term. Although there was no differencebetween groups in onset of sensory block, dose of ephedrineor patient satisfaction, patients receiving bupivacaine (5 mg ml^–1)with glucose (8 mg ml^–1) had persistently highersensory blocks between 60 and 120 min after intrathecalinjection, suggesting that the spread of spinal solutions inthe pregnant patient at term is not dependent on density. Br J Anaesth 2001; 86: 805–7     

Spinal anaesthesia: comparison of plain ropivacaine 5 mg ml(-1) with bupivacaine 5 mg ml(-1) for major orthopaedic surgery

Background. Ropivacaine provides effective spinal anaesthesiafor total hip arthroplasty. This study was designed to comparethe efficacy and safety of plain ropivacaine with plain bupivacainefor spinal anaesthesia in patients undergoing total hip arthroplasty. Methods. Sixty-six patients, ASA I or II, were randomized toreceive an intrathecal injection of one of two local anaestheticsolutions. Group R (n=32) received 3.5 ml of ropivacaine 5 mgml^–1 (17.5 mg). Group B (n=34) received 3.5 ml of bupivacaine5 mg ml^–1 (17.5 mg). The onset and duration of sensoryblock at dermatome level T10, maximum upper and lower spreadof sensory block and the onset, intensity and duration of motorblock were recorded, as were safety data. Results. Onset of motor and sensory block was rapid with nosignificant differences between the two groups. The median timeof onset of sensory block at the T10 dermatome was 2 min (range2–5 min) in Group R and 2 min in Group B (range 2–9min). The median duration of sensory block at the T10 dermatomewas 3.0 h (range 1.5–4.6 h) in Group R and 3.5 h (2.7–5.2h) in Group B (P<0.0001). The median duration of completemotor block (modified Bromage Scale 3) was significantly shorterin the ropivacaine group compared with the bupivacaine group(2.1 vs 3.9 h, P<0.001). Conclusions. Intrathecal administration of either 17.5 mg plainropivacaine or 17.5 mg plain bupivacaine was well toleratedand an adequate block for total hip arthroplasty was achievedin all patients. A more rapid postoperative recovery of sensoryand motor function was seen in Group R compared with Group B. Br J Anaesth 2002; 89: 702–6     

Spinal anaesthesia: a comparison of plain ropivacaine 5 mg ml(-1) with bupivacaine 5 mg ml(-1) for major orthopaedic surgery

Editor—I am interested in the article by McNamee and colleagues¹comparing the use of plain bupivacaine 0.5% with plain ropivacaine0.5% during spinal anaesthesia for orthopaedic surgery. Bothgroups received 3.5 ml of 0.5% of the chosen local anaesthetic. The authors report spinal blockade with a median sensory blockof T2 in the bupivacaine group and T3 in the ropivacaine group.They report ‘moderate fall in arterial blood pressurein keeping with expected sympathetic block’. Hypotensionrequiring ephedrine in the two groups occurred in 12 and 26%of patients, respectively. Up to ephedrine 35 mg was requiredin patients in either group. Adverse events included oliguria,hypotension and nausea, although incidences are not reported.The high levels of sensory blockade are considered as acceptableand part of the consequences of regional anaesthesia in elderlypatients. I     

Comparison of ropivacaine 2 mg ml(-1) and prilocaine 5 mg ml(-1) for i.v. regional anaesthesia in outpatient surgery

Background. Ropivacaine 2 mg ml^–1 (0.2%) provides longer-lastinganalgesia after deflation of the tourniquet cuff, with fewerside-effects, than lidocaine 5 mg ml^–1 (0.5%) after i.v.regional anaesthesia (IVRA). Whether ropivacaine 2 mg ml^–1also exerts this advantage over prilocaine 5 mg ml^–1,the local anaesthetic of choice in IVRA in most European countrieswas investigated in this study. Methods. Sixty outpatients scheduled for forearm or hand surgeryreceived IVRA with 40 ml of ropivacaine 2 mg ml^–1 (Ropi)or prilocaine 5 mg ml^–1 (Prilo) in a randomized, double-blindedfashion. The development and recovery of pin-prick analgesiaand motor power of the hand, as well as ropivacaine and prilocaineplasma concentrations (n=30), were assessed during and afteroperation. Results. Anaesthesia for surgery was adequate in both groups.Pin-prick analgesia was achieved at a similar rate, except inthe radial nerve distribution area where at 10 min 60% of Ropiand 90% of Prilo patients had analgesia (P=0.017). At 10 min100 and 97% had motor block of the hand in the Ropi and Prilogroups, respectively. Recovery of the sensory block in all innervationareas was already observed 2 min after the tourniquet cuff release.At 10 min after releasing the tourniquet cuff 31% of the Ropipatients and none of the Prilo patients still had analgesiain the median nerve distribution (P=0.004). At 12 min, 42% inthe Ropi group and none in the Prilo group had decreased gripstrength. After the release of the tourniquet, mean plasma concentrationsof ropivacaine were higher than those of prilocaine. The highestindividual concentration of ropivacaine was 1.65 µg ml^–1and that of prilocaine 0.6 µg ml^–1. None of theRopi patients experienced any symptoms of local anaesthetictoxicity. Conclusions. Compared with prilocaine 5 mg ml^–1, analgesiain IVRA with ropivacaine 2 mg ml^–1 developed slightlymore slowly, while motor block developed at a similar rate.After the release of the tourniquet, sensation recovered quicklyand at a similar rate in the two groups, except for a slightlyslower recovery after ropivacaine in the innervation area ofthe median nerve, but no surgically useful extended analgesiaafter the cuff deflation was observed. Despite a 60% lower milligram-dose,ropivacaine plasma concentrations were markedly higher thanthose of prilocaine.     

Double-blind comparison of ropivacaine 7.5 mg ml(-1) with bupivacaine 5 mg ml(-1) for sciatic nerve block

Two groups of 12 patients had a sciatic nerve block performedwith 20 ml of either ropivacaine 7.5 mg ml^–1 or bupivacaine5 mg ml^–1. There was no statistically significant differencein the mean time to onset of complete anaesthesia of the footor to first request for post-operative analgesia. The qualityof the block was the same in each group. Although there wasno statistically significant difference in the mean time topeak plasma concentrations the mean peak concentration of ropivacainewas significantly higher than that of bupivacaine. There wereno signs of systemic local anaesthetic toxicity in any patientin either group. Br J Anaesth 2001; 86: 674–7     

Intrathecal ropivacaine for total hip arthroplasty: double-blind comparative study with isobaric 7.5 mg ml(-1) and 10 mg ml(-1) solutions

This study was designed to evaluate the efficacy and safetyof two concentrations of intrathecal ropivacaine, 7.5 and 10mg ml^–1, in patients undergoing total hip arthroplasty.One hundred and four patients, ASA I–III, were randomizedto receive an intrathecal injection of one of two concentrationsof isobaric ropivacaine. Group 1 (n=51) received 2.5 ml of 7.5mg ml^–1 ropivacaine (18.75 mg). Group 2 (n=53) received2.5 ml of 10 mg ml^–1 ropivacaine (25 mg). The onset andoffset of sensory block at dermatome level T10, maximum upperand lower spread of sensory block and the onset, intensity andduration of motor block were recorded, as were safety data.Onset of motor and sensory block was rapid with no significantdifferences between the two groups. The median time of onsetof sensory block at the T10 dermatome was 2 min (range 1–25min) in Group 1 and 2 min (range 1–21 min) in Group 2.The median duration of sensory block at the T10 dermatome was3.0 h (range 0.5–4.2 h) in Group 1 and 3.4 h (1.1–5.9h) in Group 2 (P=0.002). The median duration of complete motorblock was significantly prolonged (P<0.05) in Group 2 comparedwith Group 1 (1.9 vs 1.2 h, respectively). Anaesthetic conditionswere excellent in all but one patient. Intrathecal ropivacaine,in doses of 18.75 and 25 mg, was well tolerated and providedeffective anaesthesia for total hip arthroplasty. Br J Anaesth 2001; 87: 743–7     

Long-term sedation with propofol 60 mg ml(-1) vs. propofol 10 mg(-1) ml in critically ill, mechanically ventilated patients

BACKGROUND: Hypertriglyceridaemia is the main cause of therapeutic failure during propofol use in long-term sedated mechanically ventilated patients. Propofol 60 mg ml(-1) has been developed to reduce fat and volume load for the critically ill patient. The purpose of the study was to compare the effectiveness of sedation, achievability of effective concentrations and the effects on serum lipid concentrations of propofol 60 mg ml(-1) vs. propofol 10 mg ml(-1) for long-term sedation in critically ill patients. METHODS: In this randomized, open, prospective study, 20 critically ill, mechanically ventilated patients who required sedation for a minimum of 48 h received propofol 60 mg ml(-1) or propofol 10 mg ml(-1) in doses as required during 2-5 days. RESULTS: No differences between propofol 60 mg ml(-1) and propofol 10 mg ml(-1) were observed in the effectiveness of sedation using the Ramsay Sedation score and the Subjective Sedation score, nor in relation to the propofol concentrations. Between the two groups, there were no significant differences in the daily propofol dose, number of daily infusion rate adjustments or need for additional sedatives. Mean serum triglyceride concentrations were higher in the propofol 10 mg ml(-1) group compared with the propofol 60 mg ml(-1) group [5.26 (3.19) vs. 3.22 (2.05) mmol l(-1), P > 0.05][mean (SD)]. Patients in the propofol 10 mg ml(-1) group received more fat from the propofol infusion than from the propofol 60 mg ml(-1) group [53.2 (29.6) vs. 10.0 (4.7) % compared with fat from nutrition, respectively]. A significant relationship was observed between the daily total fat dose and the serum triglyceride concentration (r2 = 0.32, P < 0.001), whereas there was no significant correlation between the daily propofol dose and the serum triglyceride concentration. CONCLUSION: Propofol 60 mg ml(-1) is a useful alternative to propofol 10 mg ml(-1) for the long-term sedation of critically ill patients. Sedation with propofol 60 mg ml(-1) reduces fat and volume load by 83%, which reduces the risk of hypertriglyceridaemia.     

Intrathecal ropivacaine 5 mg/ml for outpatient knee arthroscopy: a comparison with lidocaine 10 mg/ml

Purpose: The aim of this prospective, randomised, blind study was to compare the evolution of spinal block produced with 50 mg lidocaine 10 mg/ml and 10 mg ropivacaine 5 mg/ml for outpatient knee arthroscopy.
Methods: Thirty outpatients undergoing knee arthroscopy received 50 mg of lidocaine 10 mg/ml ( n =15) or 10 mg of ropivacaine 5 mg/ml ( n =15) intrathecally. The evolution of spinal block was recorded until home discharge, while the occurrence of transient neurologic symptoms (TNS) was evaluated through phone-call follow-ups.
Results: The median onset time was 15 (10–21) min with lidocaine and 24 (11–37) min with ropivacaine ( P =0.109). Spinal lidocaine resulted in a faster resolution of sensory block [148 (130–167) min vs. 188 (146–231) ( P =0.022)], unassisted ambulation with crutches [176 (144–208) min vs. 240 (179–302) min ( P =0.014)], and voiding [208 (163–254) min vs. 293 (242–343) min ( P =0.001)] than ropivacaine. Recovery of motor function required 113 (95–131) min with lidocaine and 135 (87–183) with ropivacaine ( P =0.219). Six lidocaine patients reported TNS (40%) as compared with no patient receiving ropivacaine (0%) ( P =0.005).
Conclusions: Spinal block produced with 10 mg ropivacaine 5 mg/ml is as effective as that produced by 50 mg of lidocaine 10 mg/ml. Recovery of unassisted ambulation and spontaneous voiding occurred earlier with lidocaine, but this was associated with a markedly higher incidence of TNS.     

Transient radicular irritation after spinal anesthesia induced with hyperbaric solutions of cerebrospinal fluid-diluted lidocaine 50 mg/ml or mepivacaine 40 mg/ml or bupivacaine 5 mg/ml

Background : Transient radicular irritation (TRI) is common after spinal anesthesia induced with hyperbaric lidocaine 50 mg/ml. The purpose of this study was to determine the incidence of TRI after spinal anesthesia with hyperbaric lidocaine 50 mg/ ml diluted with cerebrospinal fluid (CSF) 1:1 and hyperbaric mepivacaine 40 mg/ml and hyperbaric bupivacaine 5 mg/ml.
Methods : Ninety ASA class I-IV patients undergoing mostly brief urological procedures under spinal anesthesia were randomly allocated to receive either hyperbaric lidocaine 50 mg/ ml diluted with CSF 1:1 (Group L), hyperbaric mepivacaine 40 mg/ml (Group M) or hyperbaric bupivacaine 5 mg/ml (Group B). Characteristics of the patients and details of the surgical procedures and spinal anesthesias were similar in all groups except for the intensity of motor block. The patients were evaluated on the first postoperative day by an anesthesiologist who did not know which spinal anesthetic agent had been used.
Results : Six patients (20%) in Group L, 11 patients (37%) in Group M and none (0%) in Group B experienced pain in the legs and /or back (TRI) after spinal anesthesia.
Conclusion : TRI is frequent after spinal anesthesia induced with hyperbaric lidocaine 50 mg/ml diluted with CSF 1:1. The incidence of TRI after hyperbaric mepivacaine 40 mg/ml is of the same magnitude. TRI could not be observed after bupivacaine spinal anesthesia.     

Comparison of 5 mg tetracaine diluted in 1 ml, 2 ml and 4 ml of 10% glucose for spinal anesthesia

The influence of variations in the volume of injectate when maintaining an identical dose of a hyperbaric local anesthetic has not previously been investigated when performing spinal anesthesia. This study compares spinal anesthesia of 5 mg of lyophilized tetracaine diluted in 1 ml, 2 ml or 4 ml of 10% glucose in 45 elderly patients undergoing elective hip surgery. While supine and horizontal, each patient received double–blind one of the three solutions through a catheter inserted 4 cm into the intrathecal space at the L2–L3 or L3–L4 interspace. No difference in the anesthetic effects was found between the three groups. The median value of the maximal sensory level was T6 (range T3–L2), T4 (range T3–T9) and T5 (range T3–T11) in the 1–ml, 2–ml, and 4–ml groups, respectively. The number of patients with a motor blockade of grade 2 or 3 was 12/ 15, 14/15 and 13/15, and the time from the initial dose to the need for the first top–up dose (mean ± s.d.) was 88 ± 35 min, 75±15 min and 68 ±x 15 min for the 1–ml, 2–ml and 4–ml groups, respectively. Hemodynamic changes were also comparable between the three groups. The authors conclude that in elderly patients, undergoing spinal anesthesia while supine and horizontal, variations in volume from 1 to 4 ml do not influence the characteristics of hyperbaric spinal anesthesia while injecting an identical dose of local anesthetic.     

Transient neurological symptoms after spinal anaesthesia with levobupivacaine 5 mg/ml or lidocaine 20 mg/ml

Background: Transient neurological symptoms (TNS) after spinal anaesthesia have been reported most commonly in association with lidocaine, but have been observed with other local anaesthetics. The aim of this prospective, randomized, double-blind study was to investigate the incidence of TNS after spinal anaesthesia with either levobupivacaine or lidocaine.
Methods: Patients undergoing inguinal hernia, appendectomy, varicose vein or minor orthopaedic operations were included in the study (60 patients; 47 male, 13 female, overall mean age 30 years). All patients had an American Society of Anesthesiologists score of I or II. The patients were randomly assigned to receive spinal anaesthesia with either 20 mg isobaric levobupivacaine (5 mg/ml) or 80 mg isobaric lidocaine (20 mg/ml). Onset of sensory and motor block and side effects were recorded. On post-operative days 1, 2, and 3, patients were interviewed by an investigator blinded to the spinal anaesthetic used. The patients were classified as having TNS if, following recovery from anaesthesia, there was pain in the buttocks, thighs and/or lower limbs.
Results: In the levobupivacaine group, one patient (3.33%) experienced TNS, whereas in the lidocaine group, eight (26.6%) experienced TNS ( P =0.002). Maximum times to arrival of sensory blocks were shorter with lidocaine ( P <0.001). The levobupivacaine and lidocaine groups did not differ significantly in terms of the highest dermatome included in sensory block or motor block grade.
Conclusion: After spinal anaesthesia with levobupivacaine, the incidence of TNS was much less than after lidocaine. However, it appears that TNS may occur in association with levobupivacaine.     

Isobaric ropivacaine 5 mg/ml for spinal anesthesia in children

In this clinical trial, we evaluated the clinical effects of ropivacaine for spinal anesthesia in children. An open, prospective study was performed on 93 children, aged 1-17 yr, undergoing elective lower abdominal or lower limb surgery. A plain solution of ropivacaine 5 mg/mL at a dose of 0.5 mg/kg body weight (up to 20 mg) was administered via the L3-4 or L4-5 interspace with the patient in the lateral decubitus position. After injection, the patients were placed supine. The spread and duration of sensory analgesia and the degree of motor block were recorded. Satisfactory surgical anesthesia was achieved in 92 of the 93 children. Three children received general anesthesia; in one child spinal anesthesia failed, and in two cases surgery outlasted the duration of the sensory block. Four children received supplemental analgesia for skin incision. The mean highest level of sensory block was T6 (range, T2 to T12), and the mean time to the regression of sensory block to T10 was 96 min (range, 34-210 min). One child developed transient bradycardia and one hypotension. After discharge four children developed mild transient radiating neurologic symptoms and one epidural blood patch was performed for persistent position-dependent headache. We conclude that the block performance of intrathecal isobaric ropivacaine in children (>1 yr) is similar to that obtained in adults but the safety of the larger dose used in children warrants further studies.     

Axillary brachial plexus block with ropivacaine 7.5 mg/ml

BACKGROUND: Ropivacaine is less cardiotoxic than bupivacaine and may be used in higher doses in order to increase the quality of a block. The aim of this study was to compare the efficacy and safety of 40 ml ropivacaine 7.5 mg/ml (300 mg) and 40 ml bupivacaine 5 mg/ml (200 mg) for axillary plexus block. METHODS: One hundred and four adult patients were included in a prospective, double-blind study. Sensory and motor block were tested for the five main terminal nerves of the arm at 10-min intervals until start of surgery and every second hour there-after until full resolution of the block. RESULTS: The overall evaluation of the block by the surgeon and the anesthesiologist showed a significantly better quality in the ropivacaine patients, regarding both anesthesia and motor block. There were no differences in the time to onset and duration of the block. Except for one patient, who had seizures after an accidental IV injection of ropivacaine, there were no major side effects. CONCLUSION: Ropivacaine 7.5 mg/ml, 40 ml, produces axillary plexus block of similar onset and duration but better quality than 40 ml of bupivacaine 5.0 mg/ml.     

Epidural ropivacaine 7.5 mg/ml for elective Caesarean section: A double-blind comparison of efficacy and tolerability with bupivacaine 5 mg/ml

BACKGROUND: Ropivacaine is a new local anaesthetic drug known to be less cardiotoxic than bupivacaine. The aims of this comparative study with bupivacaine were to evaluate efficacy, safety and tolerability for the mother and the neonate when using ropivacaine 7.5 mg/ml for epidural anaesthesia for elective Caesarean section. METHODS: In a double-blind, multicentre trial the patients were randomised to receive 20 ml of either ropivacaine 7.5 mg/ml or bupivacaine 5 mg/ml. The quality of the peroperative analgesia and abdominal muscle relaxation as well as tolerability and safety in both the mother and the neonate were evaluated. RESULTS: A total of 122 patients were evaluated for efficacy and tolerability. There were no significant differences in the onset time and the extent of the sensory spread or motor block. The peroperative quality of anaesthesia and muscle relaxation was similar in both groups. No significant side effects were observed, except for a more profound drop in systolic blood pressure in the ropivacaine group. The anaesthetics were well tolerated by the neonate in both groups, evaluated by Apgar and NACS scores. CONCLUSION: Ropivacaine 7.5 mg/ml administered epidurally resulted in equally effective anaesthesia for Caesarean section as bupivacaine 5 mg/ml. Because of the lower cardiotoxicity of ropivacaine, the new amide has a potential in replacing bupivacaine when used epidurally for Caesarean section.     

Ropivacaine 3.75 mg/ml, 5 mg/ml, or 7.5 mg/ml for cervical plexus block during carotid endarterectomy

OBJECTIVE: To examine the effect of 225 mg (7.5 mg/mL), 150 mg (5 mg/mL), and 112.5 mg (3.75 mg/mL) ropivacaine on quality of cervical plexus block during carotid endarterectomy. METHODS: Patients (n = 93) scheduled for carotid endarterectomy were randomized to receive a cervical plexus block with deep infiltration of 10 mL and superficial infiltration of 20-mL volumes of ropivacaine 7.5, 5.0, or 3.75 mg/mL. Pain, coughing, hemodynamic consequences of the block, postoperative visual analog scores, and pain satisfaction index were recorded. If necessary, anesthesia supplements with aliquots of 3 mL lidocaine 1% were given during surgery. RESULTS: Incidences of coughing and hoarseness were similar in all groups. More local anesthetic infiltrations were required in the ropivacaine 3.75-mg/mL and 5-mg/mL groups. Postoperatively, no intragroup differences were observed. A trend toward better pain satisfaction was observed in the ropivacaine 7.5-mg/mL group. CONCLUSION: The best quality of cervical plexus block associated with the smallest incidence of pain for patients undergoing carotid endarterectomy was obtained with 30 mL of 225 mg and 150 mg of ropivacaine, respectively.     

Pharmacokinetics and clinical effect during continuous epidural infusion with ropivacaine 2.5 mg/ml or bupivacaine 2.5 mg/ml for labour pain relief

Background: Ropivacaine has shown less systemic toxicity than bupivacaine, and comparatively low muscle-blocking properties could constitute another advantage when used epidurally for obstetric pain relief. We aimed primarily to compare maternal and foetal drug disposition following continuous epidural infusion of ropivacaine or bupivacaine.
Methods: Twenty-four full-term, nulliparous women were randomized to continuous epidural infusion (10 ml/h) of ropivacaine 2.5 mg/ml or bupivacaine 2.5 mg/ml for labour pain relief in a double-blind, parallel-group design. Maternal blood samples were collected up to 24 h after the end of infusion as well as taken from the umbilical cord at the time of delivery. Sensory and motor block as well as analgesia were assessed. All the women were monitored by cardiotocography and neonatal assessment was performed.
Results: The sensory block was adequate for both drugs. Higher plasma levels (total and free) were seen with ropivacaine, although the infusion with bupivacaine continued on average for about 2 hours longer. However, the ratios between maternal and umbilical blood concentrations were similar for both drugs. Normal neonatal Apgar and neonatal adaptive capacity scores (NACS) were found in both groups.
Conclusion: A continuous epidural infusion of 25 mg/h ropivacaine or bupivacaine both produced good labour pain relief. Higher total and free plasma concentrations were seen for ropivacaine. The ratios between maternal and umbilical plasma levels were similar for both drugs.     

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。     

Bupivacaine 2.5 mg/ml versus bupivacaine 0.625 mg/ml and sufentanil l microg/ml with or without epinephrine 1 microg/ml for epidural analgesia in labour

We have compared three different methods of epidural analgesia in labour, bupivacaine 2.5 mg/ml (group B), bupivacaine 0.625 mg/ml + sufentanil 1 microg/ml (group BS) and bupivacaine 0.625 mg/ml + sufentanil 1 microg/ml + epinephrine 1 microg/ml (group BSE). One hundred and forty parturients with a singleton fetus with cephalic presentation were randomly allocated to one of the three groups. Group BSE had significantly less pain than groups B and BS. Group B had a significantly higher degree of motor blockade assessed on the Bromage scale. Significantly, more women in group B required urinary bladder catheterization than in the two other groups and they also had significantly less urge to push during active delivery. The incidence of mild pruritus was 18% in group BS and 36% in group BSE. The frequency of instrumental delivery and caesarean section was low (12% and 6.4%, respectively) with no significant differences between the groups. All women were highly satisfied with the method of analgesia and 97% would prefer the same kind of pain alleviation at the next delivery. We conclude that epidural analgesia with low-dose bupivacaine and sufentanil is as good an analgesic method as high-dose bupivacaine. Addition of low-dose epinephrine improves the analgesia.     

Continuous interscalene analgesia with ropivacaine 2 mg/ml after major shoulder surgery

BACKGROUND: In this open, randomized study, the pharmacokinetics, clinical efficacy, and safety of a 48-h continuous interscalene infusion of 2 mg/ml ropivacaine for postoperative pain relief were investigated in patients undergoing open major shoulder surgery. METHODS: An initial interscalene block with 30 ml ropivacaine, 7.5 mg/ml (225 mg), was performed. After completion of interscalene block, all patients (n = 24) received general anesthesia, and 6 h after interscalene block, a 48-h continuous interscalene infusion of 12 or 18 mg/h using 2 mg/ml ropivacaine was started. Total and unbound plasma concentrations of ropivacaine and 2.6-pipecoloxylidide (PPX; a major active metabolite) were determined during and up to 6 h after the interscalene infusion. Postoperative pain at rest was assessed by a visual analog scale. Supplementary analgesics and adverse events were recorded. RESULTS: Plasma concentrations of total and unbound ropivacaine were proportional to the total dose. At the end of the interscalene infusion of 9 ml/h, the mean +/- SD plasma concentrations of total and unbound ropivacaine were 1.40 +/- 0.54 and 0.03 +/- 0.01 mg/l, respectively, and of total and unbound PPX were 0.70 +/- 0.38 and 0.30 +/- 0.20 mg/l, respectively. Plasma concentrations of unbound ropivacaine and unbound PPX, added together, remained well below threshold levels for systemic central nervous system toxicity. There were no significant differences between the groups for postoperative pain (median maximum of about 20 mm on the visual analog scale in both groups), analgesic consumption, or quality of pain relief assessed by the patient. No signs or symptoms of systemic local anesthetic toxicity were observed. CONCLUSION: A 48-h continuous interscalene infusion of 6 or 9 ml/h ropivacaine, 2 mg/ml, started 6 h after an initial interscalene block of 30 ml ropivacaine, 7.5 mg/ml, provided satisfactory postoperative pain relief after major shoulder surgery and was well tolerated. Unbound plasma concentrations of ropivacaine and PPX remained well below threshold levels for systemic central nervous toxicity.