罗哌卡因、布比卡因和利多卡因对小鼠中枢神经系统毒性作用的比较

背景有证据表明罗哌卡因导致的心脏毒性比相同剂量的布比卡因低,但布比卡因脂溶性高,且作用强度大,临床上只需较小的剂量即可.中枢神经系统明显的神经毒性作用(如惊厥)往往是心脏毒性产生的先兆,半数致死剂量和半数致惊厥剂量的比值能够反应局麻药的安全性.目的确定罗哌卡因、布比卡因、利多卡因的半数致惊厥剂量和半数致死量,比较在引起50%致惊厥反应率时3种酰胺类局部麻醉药对中枢神经系统的毒性作用.设计随机对照,3个实验各自独立.单位华中科技大学同济医学院附属同济医院麻醉科.材料实验于2002-07/12在武汉华中科技大学同济医学院附属同济医院麻醉科实验室完成.选取1月龄雄性昆明小白鼠310只,清洁级.方法①局麻药剂量与致惊厥率及致死率关系的确定选择240只小鼠,确定罗哌卡因的量效关系时采取的小鼠数量为50只,分为76.80,68.69,61.44,49.15,31.46 mg/kg 5种剂量,10只/剂量组;确定布比卡因的量效关系时采取的小鼠数量为90只,分为50.00,47.29,44.72,42.29,40.00,35.78,32.00,28.62,25.60 mg/kg 9种剂量,10只/剂量组;确定利多卡因的量效关系时采取的小鼠数量为100只,分为183.11,163.77,146.48,131.02,117.19,93.75,75.00,60.00,48.00,38.40 mg/kg 10种剂量,10只/剂量组.不同剂量的局麻药腹腔注射时,尽量使每种麻醉药致各组小鼠的惊厥率和致死率对称分布在50%左右,给药5 min后记录各组的致惊厥率和死亡率.使用Probit法将量效曲线直线化,建立3种局麻药的对数剂量一概率单位的回归直线方程,确定各自的量效关系.②不同剂量利多卡因对小鼠惊厥时间和大脑c-Fos表达的影响选择40只小鼠,随机分成4组空白对照组、30%致惊厥剂量组、60%致惊厥剂量组、90%致惊厥剂量组,10只/组.空白对照组腹腹腔注射生理盐水,利多卡因各剂量组依次腹腔注射47,57,73 mg/kg的利多卡因,观察并记录各组小鼠惊厥的持续时间.将发生惊厥的小鼠妥善标记,2 h后制作冰冻冠状切片,检测神经元核蛋白c-Fos的表达,镜下计算不同区域表达c-Fos的棕黄色颗粒数目,每个颗粒代表1个神经元.③50%致惊厥剂量的局麻药对小鼠毒性反应的测定选择30只小鼠,随机分成3组罗哌卡因组、布比卡因组、利多卡因组,10只/组.各组依次腹腔注射50%致惊厥剂量的对应局麻药后,对发生惊厥的小鼠观察其惊厥持续时间,2 h后制作冰冻冠状切片,免疫组织化学ABC法检测神经元核蛋白c-Fos的表达.主要观察指标观察小鼠对腹腔注射不同局麻药的反应,记录惊厥持续时间,使用免疫组织化学方法检测小鼠脑组织c-Fos蛋白的表达.结果实验选用310只小鼠,全部进入结果分析.①各种局麻药不同剂量与惊厥及死亡率的关系利多卡因、布比卡因、罗哌卡因的治疗指数(半数致死量/50%致惊厥剂量)分别为2.89,1.48,1.34.②利多卡因致小鼠惊厥后脑组织c-Fos蛋白的表达情况表达c-Fos蛋白的神经元主要分布在侧脑室以下,第3脑室周围的丘脑区域;正中隆起以上,第3脑室旁边的下丘脑区域;以及下侧部皮质的梨状皮质与杏仁体.③不同剂量利多卡因致小鼠惊厥持续时间和c-Fos阳性神经元数目的比较与空白对照组比较,30%,60%,90%致惊厥剂量组的惊厥持续时间呈逐渐上升趋势(P均＜0.05),杏仁体表达的c-Fos神经元数亦呈逐渐上升趋势(P均＜0.05).④各种局麻药50%致惊厥剂量对小鼠毒性反应的测定结果利多卡因组、布比卡因组引起的惊厥时间和梨状皮质及杏仁体c-Fos阳性神经元数基本相似(P＞0.05),而罗哌卡因均显著高于利多卡因组和布比卡因组(P＜0.05).结论罗哌卡因在临床麻醉中的使用剂量较少超过布比卡因,很少达到其致惊厥剂量,具有较高的安全性.但一旦发生中枢毒性反应,罗哌卡因导致的惊厥则会更加严重,可能与其脂溶性低,吸收后分布容积小,血浆浓度高有关.     

布比卡因、左旋布比卡因和罗哌卡因的剖宫产硬膜外阻滞效果比较

目的:比较3种局麻药用于剖宫产硬膜外阻滞的麻醉效果与不良反应。方法:在硬膜外阻滞下行剖宫产手术的90例产妇被随机分为3组。硬膜外穿刺置管成功后,先给试验量含1:200 000肾上腺素的2%利多卡因3 ml,再分别给予浓度均为0.5%的布比卡因、左旋布比卡因和罗哌卡因中的一种,分次给药。记录各组的感觉和运动阻滞的起效、时效及不良反应。结果:3组均有较好的麻醉镇痛效果,但有一些肌松不满意的病例。罗哌卡因组的感觉阻滞起效、时效较其他两组长,但尚无统计学差异;其运动阻滞起效与时效和运动阻滞程度均不及其他两组,且有统计学差异(P<0.05)。3组均未发生严重不良反应。结论:硬膜外0.5%布比卡因、左旋布比卡因或罗哌卡因用于剖宫产均有较好的麻醉镇痛效果,有一些肌松不满意的病例;但罗哌卡因的运动阻滞起效与时效和运动阻滞程度均不及其他两药。     

罗哌卡因联合碳酸利多卡因在臂丛神经阻滞麻醉中的应用

目的 研究罗哌卡因联合碳酸利多卡因在臂丛神经阻滞中的麻醉有效性和安全性。方法选择美国麻醉医师协会（ASA）Ⅰ～Ⅱ级、各类上肢手术的患者80例,随机分成两组,每组40例。A组：0．375％罗哌卡因30ml;B组：0．75％罗哌卡因15ml,联合1．73％碳酸利多卡因15ml,共30ml。按手术部位的不同,分别从肌间沟和腋路给药。观察生理指标变化、麻醉起效时间、麻醉持续时间和麻醉效果及不良反应。结果B组患者麻醉起效时间明显快于A组,差异有统计学意义（P〈0．05）。运动阻滞时间及感觉阻滞时间两组差异无统计学意义（P〉0．05）。麻醉效果B组优者达92．5％,A组麻醉优者达65．0％,A组有4例患者术中感疼痛明显需加用静脉辅镇痛助药物。两组患者均未出现局麻药中毒反应。结论罗哌卡因联合碳酸利多卡因经肌间沟及腋路臂丛神经阻滞,是一种麻醉效果优且安全的方法。     

Lidocaine has better antioxidant potential than ropivacaine and bupivacaine: in vitro comparison in a model of human erythrocytes submitted to an oxidative stress.

BACKGROUND: Local anesthetic agents may exert antioxidant properties in various models. The aim of this work was to compare the antioxidant properties of lidocaine, bupivacaine and ropivacaine using an in vitro model of human erythrocytes submitted to an oxidative stress. METHODS: Blood was obtained from healthy volunteers. After separation, erythrocytes were suspended in phosphate buffer. Oxidative stress was induced by incubation with 2,2'-azobis (2-amidinopropane) hydrochloride (AAPH). (1) Effects of four different concentrations (50, 100, 300 and 600 microg ml(-1)) of lidocaine, bupivacaine and ropivacaine were studied in absence or presence of AAPH (20 mM). Potassium efflux was assessed by flame photometry. (2) Effects of 50 and 600 microg ml(-1) of lidocaine, bupivacaine and ropivacaine on AAPH (50 mM) induced hemolysis were also studied. (3) The oxygen radical absorbing capacity of lidocaine, bupivacaine and ropivacaine at the four concentrations was evaluated by the analysis of the allophycocyanin fluorescence. RESULTS: In absence of AAPH, neither extracellular potassium nor hemolysis was noted. AAPH (20 mM) induced a significant increase in extracellular potassium that was reduced by all local anesthetic agents, with greater effects for lidocaine. AAPH-induced hemolysis was significantly decreased by all the local anesthetic agents at higher concentration, but only by lidocaine at 50 microg ml(-1). Finally, none of the local anesthetic agents modified the allophycocyanin fluorescence. CONCLUSION: In this model, lidocaine was proved more effective than bupivacaine and ropivacaine in protecting human erythrocytes submitted to an oxidative challenge. This was not due to a free radical scavenging effect.     

Bupivacaine and lidocaine blockade of calcium-mediated slow action potentials in guinea pig ventricular muscle

The effects of bupivacaine and lidocaine on the slow-rising action potentials, induced by superfusion with high-K+ (26 mM) Tyrode's solution with 10(-6) M isoproterenol, were studied in guinea pig ventricular muscle. The concentrations of bupivacaine or lidocaine necessary to result in a 50% depression of the maximum upstroke velocity were about 10(-5) and 10(-4) M, respectively. The concentrations necessary to completely block the slow action potentials were about 10(-4) M for bupivacaine and 5 X 10(-4) M for lidocaine. The relative potencies of lidocaine to bupivacaine in abolishment of the slow action potentials are in the ratio of 1:5. These results suggest that local anesthetics do affect the slow Ca++ channel of ventricular muscle.     

酰胺类局麻药对脂肪来源间充质干细胞成软骨能力的影响

目的 探讨不同种类酰胺类局麻药对脂肪起源间充质干细胞成软骨能力影响。 方法 分离培养四月龄新西兰大白兔脂肪起源干细胞（ADMSCs）并向软骨方向诱导分化。取贴壁生长的第三代软骨方向分化ADMSCs，分别用磷酸缓冲液（对照组）、1%利多卡因（1%利多卡因实验组）、2%甲哌卡因（2%甲哌卡因实验组）、0.5%布匹卡因（0.5%布匹卡因实验组）和0.5%罗哌卡因（0.5%罗哌卡因实验组）浸泡30 min、60 min。5组在各时间点处理完成后，洗去局麻药，重新加入软骨方向诱导分化培养液，分别于培养第3天和第7天后采用流式细胞术检测细胞凋亡情况，并行番红-固绿染色评估软骨分化形态学变化，筛选出毒性最小的局麻药。将筛选出的毒性最小的一种局麻药稀释至25%，50%，75%，100%的浓度分别与软骨分化方向ADMSCs接触30 min和60 min，然后洗去局麻药重新加入软骨方向诱导分化培养液，在培养第3天和第7天后采用实时荧光定量（qPCR）和Western blot法检测软骨分化相关基因collagen Ⅰ、collagen Ⅲ、SOX9的表达，明确其对ADMSCs成软骨能力的影响。 结果 软骨方向分化的ADMSCs与对应的局麻药物接触后，1%利多卡因实验组、2%甲哌卡因实验组、0.5%布匹卡因实验组和0.5%罗哌卡因实验组软骨方向分化的ADMSCs凋亡率较对照组均显著增加，差异有统计学意义（P<0.05）。软骨分化方向ADMSCs与以上4个实验组接触60 min后的细胞凋亡率均高于组内接触30 min后，差异均有统计学意义（P<0.05）；4个实验组培养第3天后的细胞凋亡率高于组内培养第7天后，差异均有统计学意义（P<0.05）。1%利多卡因处理组的细胞凋亡率低于2%甲哌卡因实验组、0.5%布匹卡因实验组和0.5%罗哌卡因实验组，差异均有统计学意义（P<0.05）。进一步研究显示，与不同浓度利多卡因接触后，collagen Ⅰ、collagen Ⅲ、SOX9的mRNA和蛋白表达均显著降低，差异均有统计学意义（P<0.05），且随着利多卡因浓度和接触时间的增加，其表达量的降低更为显著，细胞成软骨受到的影响也更大。 结论 酰胺类局部麻醉药可抑制ADMSCs的软骨分化能力，且呈现时间-浓度依赖性。在等效工作浓度的酰胺类局麻药中，1%的利多卡因对ADMSCs的软骨分化能力影响较其他酰胺类局麻药小。     

Tetrodotoxin-resistant action potentials in dorsal root ganglion neurons are blocked by local anesthetics

Evidence from animal models and studies of human sensory nerves demonstrate that tetrodotoxin (TTX)-resistant Na(+) channels are present in sensory neurons and might play an important role in pain conduction and chronic pain. Recent investigations suggest that TTX-resistant Na(+) channels in the peripheral nervous system are less sensitive to local anesthetics than TTX-sensitive Na(+) channels. To test the effects of the clinically used local anesthetics lidocaine and bupivacaine on TTX-resistant action potentials (APs) in sensory neurons, we performed electrophysiological experiments on small dorsal root ganglion (DRG) neurons from young rats. Amplitudes, time to peak and duration of TTX-resistant APs were measured in Adelta- and C-type neurons using the patch-clamp technique in a thin slice preparation (150 microm), thus avoiding enzymatic treatment. With increasing concentrations of the local anesthetics, the AP amplitude was gradually reduced but the AP did not disappear abruptly. The concentrations needed to reduce the amplitudes of TTX-resistant APs by half were 760 microM for lidocaine and 110 microM for bupivacaine. Time to peak and duration of TTX-resistant APs were prolonged by local anesthetics. Trains of APs could be elicited in some neurons by long-lasting current injections, and the half-maximal concentrations needed to suppress these trains were 30 microM lidocaine or 10 microM bupivacaine. We suggest that the reduction in firing frequency at low concentrations of local anesthetic may explain the phenomenon of paresthesia when sensory information is gradually suppressed during spinal anesthesia.     

Mode of delivery following labor epidural analgesia: influence of ropivacaine and bupivacaine.

Epidural analgesia is a popular and effective method for pain relief during labor. Bupivacaine is a commonly used local anesthetic for labor epidural analgesia. Ropivacaine is an amino acid local anesthetic that is structurally related to bupivacaine with a similar potency and duration, but ropivacaine has less cardiac toxicity than bupivacaine and produces less motor blockade. These properties make ropivacaine a desirable local anesthetic agent for obstetrical analgesia. The purpose of the present study was to compare the cesarean section and instrumental delivery rates for patients receiving labor epidural analgesia using bupivacaine and ropivacaine. The medical records of 500 consecutive patients receiving bupivacaine for labor epidural analgesia were reviewed. After a 3-month familiarization period for ropivacaine, the records of 500 consecutive patients receiving ropivacaine for labor epidural analgesia similarly were reviewed. The groups did not differ demographically. The instrumental delivery rate was 14.2% for the bupivacaine group and 9.8% for the ropivacaine group. The cesarean section rate was 14% for the bupivacaine group and 10.2% for the ropivacaine group. At our facility, the use of ropivacaine decreased both cesarean section and instrumental delivery rates when compared with bupivacaine in the population studied.     

局部麻醉剂通过丝裂原活化蛋白激酶途径诱导人甲状腺癌细胞凋亡

目的探讨局部麻醉剂对人甲状腺癌细胞凋亡的影响及其作用机制。方法MTT法检测人甲状腺癌细胞经0 mM、1 mM、2 mM、4 mM、8 mM和16 mM的利多卡因及0 mM、0.2 mM、0.4 mM、0.8 mM、1.6 mM和3.2 mM的布比卡因分别干预24 h和48 h后的细胞活力流式细胞仪检测经4 mM和8 mM的利多卡因和0.8 mM和1.6 mM的布比卡因干预48 h后癌细胞的凋亡及线粒体膜电位;Western Blot检测凋亡相关因子及丝裂原活化蛋白激酶(MAPK)途径相关蛋白的表达;分别采用SP600125(JNK抑制剂)、PD98059(MEK抑制剂)、SB203580(p38 MAPK抑制剂)联合利多卡因或布比卡因对细胞进行处理,Western Blot检测凋亡相关蛋白的表达。结果利多卡因和布比卡因干预24 h和48 h均可呈剂量依赖式抑制人甲状腺癌细胞的生长。利多卡因和布比卡因干预48 h可降低癌细胞线粒体膜电位,增加Caspase-3和Bax的表达,降低Bcl-2的表达激活p38和JNK,抑制ERK的活性。MAPK信号通路抑制剂可降低利多卡因和布比卡因诱导Caspase-3和Bax的表达,增加Bcl-2的表达。结论局部麻醉剂利多卡因和布比卡因可诱导人甲状腺癌细胞生存抑制和凋亡,其机制与MAPK通路激活有关。     

髋关节置换过程中应用不同麻醉药物的对比

背景：目前,对髋关节置换临床上的麻醉用药方案较多,但在选择麻醉药物上的争议还较大。目的：对比观察不同麻醉药物在髋关节置换患者中的应用效果。方法：选取在上海交通大学医学院附属新华医院崇明分院接受手术治疗的髋关节置换患者81例,随机等分为3组,分别用体积分数0.75%的罗哌卡因、0.5%的布比卡因和2%的利多卡因进行麻醉。监测并记录患者的麻醉效果与不良反应情况。结果与结论：相对布比卡因组和利多卡因组,罗哌卡因组患者的平均动脉压与心率具有更加显著的稳定性;切皮前、切皮后20 min的平均动脉压与心率增加（P〈0.05）;感觉阻滞起效的时间、阻滞平面固定的时间与麻醉过程持续的时间都较长,且最高阻滞平面较大（P〈0.05）;Bromage评级效果具有显著的优势（P〈0.05）。3组患者的血氧饱和度差异无显著性意义（P〉0.05）,在术中不良反应方面总体表现均较好。结果证实,罗哌卡因、布比卡因与利多卡因作为麻醉药应用于髋关节置换,总体上效果都比较好,不良反应少。同布比卡因与利多卡因相比,采用罗哌卡因进行麻醉的髋关节置换患者血流动力学稳定性好、感觉阻滞完善、运动阻滞效果弱、不良反应少。     

A ropivacaine-lidocaine combination for caudal blockade in haemorrhoidectomy

A single dose of caudal lidocaine does not provide a sufficiently long anaesthetic duration and is not generally used for complicated anorectal surgery. This study evaluated the safety and efficacy of a ropivacaine-lidocaine combination for caudal anaesthesia in patients undergoing haemorrhoidectomy. A total of 287 haemorrhoid patients with successful initial caudal anaesthesia were randomized to receive either a mixture of 0.375% ropivacaine and 1.0% lidocaine (ropi-lido group; n=146) or 1.0% lidocaine alone (placebo-lido group; n=141). Significantly fewer patients in the ropi-lido group required intra-operative supplemental anaesthesia than in the placebo-lido group. Patients treated with the ropivacaine-lidocaine combination had significantly lower scores for pain at each post-operative time point, and a longer mean time to the first requirement for post-operative analgesic than patients in the placebo-lido group. These results suggest that caudal anaesthesia with a combination of ropivacaine and lidocaine is a safe and effective method of inducing anaesthesia during haemorrhoidectomy.     

舒芬太尼与利多卡因复合罗哌卡因骶管注入用于小儿尿道术后镇痛的临床比较

目的：比较舒芬太尼与利多卡因分别复合罗哌卡因经骶管注入用于小儿尿道术后镇痛的临床效果。方法60例择期行尿道下裂尿道成形术的患儿采用随机数字表法分为3组,每组20例。分别经骶管注入0.2％罗哌卡因1 ml/kg （ R组）、0.8％利多卡因＋0.2％罗哌卡因1 ml/kg（L组）和舒芬太尼0.5μg/ml＋0.2％罗哌卡因1 ml/kg（S组）。术后0、1、2、4、6、8、12、24 h分别用改良CHEOPS和Bromega进行评分,并记录不良反应。结果所有患儿未观察到局麻药中毒反应。 S组4 h后各时点CHEOPS评分均低于L组和R组（ P＜0.05）。术后6小时所有患儿运动功能完全恢复（ Bromage 评分＞1分, P ＞0.05）,在观察期均未出现不良反应。结论舒芬太尼复合罗哌卡因骶管注入用于小儿尿道术后镇痛安全有效,镇痛效果好。     

Ropivacaine (naropin), local anesthetic of choice for epidural blockade]

The purpose of this study, carried out in 132 patients with intense acute radicular pain, was search for an optimal local anesthetic to be used in combination with a steroid for therapeutic epidural blockade. Comparative analysis of analgesia attained by epidural injections of 5 ml 2% lidocaine, 4 ml 0.5% bupivacaine, and 4 ml 1% ropivacaine showed the advantages of the latter drug in stable arrest of radicular pain immediately after injection. The duration of analgesia after blockade was 1.4 +/- 0.5, 3.1 +/- 0.3, and 9.5 +/- 1.2 h, respectively. Use of ropivacaine eliminated the main shortcoming of epidural blockade in the treatment of patients with radicular pain, consisting in temporary pain relapse after discontinuation of the local anesthetic effect before development of antiinflammatory effect of the steroid.     

Intrathecal tri-cyclic antidepressants produce spinal anesthesia

Tri-cyclic antidepressants (TCAs) have been widely used in treating major depressive disorders. Recent studies further demonstrated that TCAs have potent sodium channel blocking effect, and amitriptyline, one of the TCAs, has a potent spinal anesthetic effect. The aim of the study was to evaluate the spinal anesthetic effect of various TCAs and to see whether these TCAs could likewise act as local anesthetics after a single intrathecal injection. Bupivacaine, a potent and long-acting traditional local anesthetic, acted as control. The spinal anesthetic effect of nine TCAs (amitriptyline, doxepin, imipramine, trimipramine, clomipramine, protriptyline, desipramine, nortriptyline, and amoxapine) and three traditional local anesthetics (bupivacaine, lidocaine, and mepivacaine) was evaluated in rats and so were dose-response studies of amitriptyline, bupivacaine, and lidocaine. Under a given concentration of 5mM, bupivacaine had the most potent spinal blockade of motor, propioception, and nociception (P<0.001) and the longest duration of action of nociception (P<0.01) among the three traditional local anesthetics. Under this concentration, amitriptyline had a similar potency but longer duration of spinal blockade of motor, propioception, and nociception (P<0.001) than did bupivacaine, whereas several other TCAs had similar or less potencies of spinal blockade than did bupivacaine. In dose-response studies, amitriptyline had a more potent (P<0.005) and longer duration (P<0.001) of spinal blockade than did bupivacaine. We concluded that intrathecal amitriptyline had a more potent and longer duration of spinal anesthetic effect than did bupivacaine, whereas several other TCAs had similar or less potencies than did bupivacaine.     

The effects of spinal anesthesia vs epidural anesthesia on 3 potential postoperative complications: pain,urinary retention,and mobility following inguinal herniorrhaphy

This study was conducted to determine the effects of spinal (n = 113) vs epidural (n = 31) anesthetic techniques on 3 common postoperative complications: pain, urinary retention, and mobility for patients undergoing inguinal herniorrhaphy. The study design was a retrospective chart review. Data were collected on 144 subjects who underwent herniorrhaphy between January 1 and December 31, 1999, had an ASA classification of I to III, and were older than 18 years. The local anesthetics used to provide spinal anesthesia were 5% lidocaine, 0.75% bupivacaine, and 1% tetracaine solutions. The anesthetics used to provide epidural anesthesia were a solution of 2% lidocaine with epinephrine or 3% chloroprocaine with epinephrine. Results revealed that pain was not significantly different between the 2 anesthetic groups (P = .65); however, subjects in the epidural anesthesia group were able to ambulate (P = .008) and void (P = .02) sooner than subjects in the spinal anesthesia group. This study demonstrates that epidural anesthesia results in less urinary retention and earlier mobility than spinal anesthesia in men undergoing inguinal herniorrhaphy. Minimizing postoperative complications is essential in order for the nurse anesthetist to provide a satisfactory anesthetic experience. This study's findings suggest that epidural anesthesia optimizes recovery for the patient undergoing inguinal herniorrhaphy.     

Prevalence of facet joint pain in chronic low back pain in postsurgical patients by controlled comparative local anesthetic blocks

OBJECTIVE: To evaluate the prevalence of facet joint pain in patients with chronic low back pain (CLBP) after surgical intervention(s). DESIGN: A prospective, nonrandomized, consecutive study. SETTING: An ambulatory interventional pain management setting. PARTICIPANTS: The prevalence of facet joint pain was evaluated in patients with CLBP after various surgical intervention(s) referred to an interventional pain management practice. The sample was derived from 282 patients with persistent CLBP after various surgical intervention(s). Of these, 242 patients consented to undergo interventional techniques. A total of 117 consecutive patients with chronic, nonspecific low back pain, after lumbar surgical intervention(s) were evaluated with controlled, comparative local anesthetic blocks. INTERVENTIONS: Controlled, comparative local anesthetic blocks (1% lidocaine or 1% lidocaine followed by .25% bupivacaine) under fluoroscopic visualization using 0.5mL to block each facet joint nerve. MAIN OUTCOME MEASURES: A positive response was defined as at least 80% reduction of pain with ability to perform previously painful movements. A positive response was considered to be pain relief from the lidocaine block lasting at least 1 hour or at least 2 hours or greater than duration of relief with lidocaine when bupivacaine was used. Controlled, comparative local anesthetic blocks were used to eliminate false-positive results. Valid information is only obtained by performing controlled blocks in the form of comparative local anesthetic blocks, in which, on 2 separate occasions, the same joint is anesthetized by using local anesthetics with different durations of action. If patients obtained appropriate response with both blocks, they were considered a positive. If they obtained appropriate response with lidocaine but not with bupivacaine, they were considered false-positive, whereas if the response was negative with lidocaine, they were considered negative. RESULTS: The prevalence of lumbar facet joint pain in patients with recurrent pain after various surgical intervention(s) was 16% (95% confidence interval, 9%-23%). The false-positive rate with a single block with lidocaine was 49%. CONCLUSIONS: Facet joints are clinically important pain generators in a small but significant proportion of patients with recurrent CLBP after various surgical intervention(s).     

低浓度罗哌卡因腰麻在高龄患者下肢手术中的可行性研究

目的评价高龄患者骨科下肢手术低浓度罗哌卡因应用的可行性。方法择期骨科下肢手术的高龄病人46例，临床观察随机分为腰麻（sA）A组和连续硬膜外阻滞组（CEA）B组，两组均选L2-3或L3-4间隙行椎管内麻醉；A组蛛网膜下腔穿刺成功后，注入0．375％罗哌卡因重比重液2ml，B组行硬膜外穿刺置管注入2％利多卡因试验量3ml，然后追加1．O％利多卡因和O．25％罗哌卡因混合液6～8ml，术中根据阻滞平面追加上述局麻药，观察两组在麻醉前（TO）和给予首剂量麻醉药后5min（T1）、15min（T2）、30min（T3）、lh（T4）、术毕（T5）相关指标，比较两组感觉阻滞平面，改良的Bromage评分，观察下肢运动恢复情况，术中及术后24h心动过缓、低血压、恶心、呕吐、头痛、神经系统并发症的发生率。结果与TO比较，A组平均动脉压（MAP）在Tl-T5降低，B组MAP在T2-T5降低（P〈0．05或P〈0．01）：与B组比较，A组术中低血压的发生率及术后寒战，恶心，呕吐发生率均降低（P〈0．05）；与B组比较，A组患者感觉阻滞平面降低，改良Bromage评分升高（P〈0．05）。结论sA较CEA感觉运动神经阻滞完善，血流动力学平稳，并发症少，用于高龄骨科下肢手术病人是可行的。     

A comparison of motor block between ropivacaine and bupivacaine for continuous labor epidural analgesia.

The aim of the present study was to compare the amount of motor block produced by different loading doses of ropivacaine and bupivacaine when delivered in a dilute solution with added opioid. Sixty-eight healthy term primigravid parturients were randomized to receive an initial bolus dose of 10 mL of 1 of the following: 0.25% bupivacaine (high bupivacaine), 0.25% ropivacaine (high ropivacaine), 0.125% bupivacaine (low bupivacaine), or 0.125% ropivacaine (low ropivacaine). Each loading dose had 10 micrograms of sufentanil added to it. All groups received a continuous infusion of a 0.1% study drug infusion with 0.6 microgram/mL of sufentanil at a rate of 8 to 14 mL/h to maintain analgesia. Supplemental doses of 10 mL of a 0.125% study solution with 10 micrograms of sufentanil were given as needed. Pain scores and a modified Bromage scale were used to assess analgesia and motor block. A statistically significant greater percentage of parturients receiving bupivacaine had motor block than those who received ropivacaine, with a marked decrease in the occurrence of motor block in the low ropivacaine group. The pain relief seemed to be less satisfactory in the ropivacaine groups, but the difference was not statistically significant. Ropivacaine produced significantly less motor block than bupivacaine in the 0.25% and the 0.125% loading doses, with the greatest difference seen in the lower concentration loading dose of ropivacaine.     

Permanent Neurologic Symptoms after Prolonged Epidural Analgesia

Objective: Although transient neurologic symptoms may occur after neuraxial anesthetics with lidocaine, permanent neurologic symptoms (PNS) are unusual after uncomplicated continuous epidural analgesia (CEA). This report demonstrates that PNS may follow CEA uncomplicated by paresthesias, dural puncture, spinal hemorrhage, or intravascular local anesthetic injection; and performed with bupivacaine alone administered at high dosages with vasoconstrictors over a prolonged time period. Case Report: An obstetrical patient developed fixed left L5‐S1 sensorimotor radiculopathy following L5‐S1 level CEA with bupivacaine alone administered at high doses (270 mg) with a vasoconstrictor (epinephrine, 225 mg) over a prolonged time period (62 hours). Conclusions: CEA should be administered at higher lumbar levels for labor analgesia rather than at lumbosacral levels that may require higher volumes and concentrations of local anesthetics with greater potential for local anesthetic neurotoxicity. Local anesthetics with vasoconstrictors should only be used as sentinel markers of unrecognized intravascular entry, rather than as primary local anesthetics during CEA to avoid any potential for ischemic neuropathy.     

Assessment of the anesthetic management during laparoscopic procedures in pediatric oncosurgery

The estimation of modern methods of sevoflurane anesthesia under APV, in 40 child patients undergoing laparoscopic surgery. Most of the interventions were radical and carried out under the retroperitoneal tumors, tumors of the kidneys, adrenal glands and liver. The role of analgesia during balanced anesthesia performed epidural block with amido class local anesthetics (ropivacaine, lidocaine). We have investigated the role of risk factors associated with laparoscopic interventions (the influence of intra-abdominal pressure increase on cardiorespiratory system as well as insufflated CO2 on acid-base blood balance and the concentration of etCO2. Positive results have been achieved, which were in a stable state during the operative period and the absence of complications. Anesthesia during major abdominal interventions in pediatric oncosurgery, performed by laparoscopy, described in Russian literature for the first time.