罗哌卡因蛛网膜下腔阻滞在剖宫产术中的应用

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。     

重比重罗哌卡因用于老年蛛网膜下腔麻醉

目的研究重比重罗哌卡因用于老年患者蛛网膜下腔阻滞的安全性和有效性。方法择期肛门会阴部手术老年患者120例,ASA Ⅰ或Ⅱ级。随机分为三组,每组40例。于 L_(3～4)间隙穿刺。注药时患者取坐位,以0.2 ml/s 的速度分别注入重比重混合局麻药。用针刺法测感觉阻滞平面.用改良 Bromage 法评估下肢运动神经阻滞程度.以患者提肛收缩肛门和指诊观察肛门括约肌阻滞程度。比较三组患者在感觉、运动阻滞及恢复上的异同,记录血压、心率变化及不良反应。结果三组均能达到感觉阻滞。但 R_1组肛门括约肌阻滞不完善者多于 R_2、R_3组(P<0.01);R_2组下肢运动神经阻滞起效时间长于 R_3组(P<0.01);运动阻滞恢复时间短于 R_2组(P<0.01);R_2组感觉阻滞消退到 S_(1～2)时间、完全下肢运动神经阻滞发生率及尿潴留发生率明显少于 R_3组(P<0.01)。结论罗哌卡因重比重液6 mg 于老年患者应用蛛网膜下腔麻醉安全有效.并发症少。     

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。     

罗哌卡因蛛网膜下腔阻滞的研究进展

罗哌卡因是第一个纯左旋异构体局麻药，1999年被引进我国，目前在我国多用于外周神经阻滞和硬膜外腔阻滞麻醉，但是在国外已是官方认证的蛛网膜下腔阻滞用药，且自引入我国以来就不断有学者进行了罗哌卡因蛛网膜下腔阻滞的动物实验和临床研究，现就国内外罗哌卡因用于蛛网膜下腔阻滞的研究情况作一综述。     

重比重甲磺酸罗哌卡因复合舒芬太尼蛛网膜下腔注射用于剖宫产的最佳剂量

目的探讨重比重甲磺酸罗哌卡因复合舒芬太尼蛛网膜下腔注射用于剖宫产的最佳剂量。方法 31例ASAⅠ或Ⅱ级在腰-硬联合麻醉下行择期剖宫产的产妇,首先选择L1~2间隙进行硬膜外置管,然后在L3~4间隙进行蛛网膜下腔穿刺,在30 s内注入混合的重比重甲磺酸罗哌卡因溶液。注药后立即头低脚高位调节平面,到达T7平面时,将床摇平,并略向左侧倾斜。罗哌卡因起始剂量为13.410 mg,腰麻成功的定义为10 min内到达T7平面和术中手术条件满意,硬膜外不需要追加利多卡因完成手术。根据罗哌卡因腰麻成功或不成功的反应,采用改良Dixon序贯法,减少或者增加0.894 mg来确定下一个产妇的腰麻剂量。结果 Probit分析表明,复合5μg舒芬太尼时,重比重甲磺酸罗哌卡因半数有效剂量(ED50)为10.713 mg(95%的可信区间为10.126~11.236 mg),95%有效剂量(ED95)为12.002 mg(95%的可信区间11.405~14.547 mg)。结论复合5μg舒芬太尼时,重比重甲磺酸罗哌卡因使50%产妇行剖宫产时获得满意麻醉的最佳剂量为10.713mg。甲磺酸罗哌卡因适合用于剖宫产腰麻。     

罗哌卡因复合舒芬太尼蛛网膜下腔麻醉在剖宫产术中的应用

目的探讨罗哌卡因复合小剂量舒芬太尼蛛网膜下腔注射在剖宫产术中的应用。方法将120例择期行剖宫产术产妇随机均分3组:A组为0.75%罗哌卡因10 mg。B组为0.75%罗哌卡因10 mg复合舒芬太尼3μg。C组为0.75%罗哌卡因10 mg复合舒芬太尼5μg。经L2-3行腰—硬联合麻醉,留置硬膜外导管备用。记录3组产妇麻醉效果,感觉和运动阻滞程度和时间,术中血流动力学变化和不良反应、新生儿apgar评分及硬膜外追加局麻药情况。结果 3组均安全完成手术,最高感觉阻滞平面、运动阻滞程度及恢复时间、新生儿apgar评分差异无统计学意义。麻醉优良率C组>B组>A组,但皮肤瘙痒的例数C组>B组>A组,C、B 2组镇痛时间长于A组(P<0.05),3组产妇生命体征变化差异无统计学意义,均无呼吸抑制发生。硬膜外追加局麻药的例数A组明显高于C、B 2组(P<0.05)。结论罗哌卡因复合舒芬太尼蛛网膜下腔麻醉效果满意,术后镇痛时间长,不良反应少,可安全用于剖宫产术。     

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。     

罗哌卡因蛛网膜下腔阻滞用于剖宫产的量效关系

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.     

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。     

罗哌卡因与布比卡因蛛网膜下腔阻滞的比较研究

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…     

罗比卡因蛛网膜下隙阻滞用于剖宫产的量-效关系

目的　探讨罗比卡因在剖宫产蛛网膜下隙阻滞中的量 效关系。方法　 6 0例行择期剖宫产术的初产妇随机分为三组 ,分别接受 10、15、2 0mg的同容量 (3ml)、同比重 (1.0 2 2 ,37℃ )罗比卡因腰麻液 ,观察温度觉、痛觉及下肢运动阻滞的起效和持续时间、温度和痛觉的最高阻滞平面、腹肌松弛度、新生儿Apgar评分及脐动脉血血气、低血压、心动过缓及神经系统不良反应 (术后 4 8h内 )发生情况。结果　温痛觉及下肢运动阻滞时间随剂量增加而逐渐延长 (P <0 0 5 ) ;Ⅰ组Bromage评分明显低于Ⅱ、Ⅲ组 (P <0 0 5 ) ;腹肌松弛度Ⅱ、Ⅲ组优于Ⅰ组 (P <0 0 5 ) ;其余指标三组间无统计学差异 (P >0 0 5 ) ;三组均未观察到明显神经系统不良反应。结论　 15mg罗比卡因重比重腰麻液应用于剖宫产蛛网膜下隙阻滞 ,可达较完善的临床效果 ,且较安全     

剖宫产术患者重比重罗哌卡因混合小剂量舒芬太尼腰麻的效果

目的探讨重比重罗哌卡因混合小剂量舒芬太尼用于剖宫产术患者腰麻的效果。方法择期行剖宫产术的单胎和妊娠足月初产妇40例,年龄22～34岁,体重60～73 kg,ASAⅠ级。随机分为2组（n=20）,罗哌卡因组（R组）蛛网膜下腔注射1%罗哌卡因1.5 ml（15 nag）＋生理盐水0.7ml＋ 50%葡萄糖0.3 ml;罗哌卡因＋舒芬太尼组（R＋S组）蛛网膜下腔注射1%罗哌卡因1.5 ml（15 mg）＋舒芬太尼5μg（0.1 ml）＋生理盐水0.6 ml＋50%葡萄糖0.3ml。蛛网膜下腔穿刺成功后,将混合药液注入蛛网膜下腔,速率0.1 ml/s。记录感觉阻滞、运动阻滞情况,术中疼痛程度、腹肌松弛程度和牵拉反应程度,术中低血压、心动过缓、恶心、呕吐及瘙痒等不良反应的发生和处理情况,新生儿体重及出生后1 min和5 min Apgar评分。结果R＋S组蛛网膜下腔注药后感觉阻滞平面达到T10、T6和最高阻滞平面的时间短于R组,且最高阻滞平面升高（P〈0.05或0.01）;蛛网膜下腔注药后2组下肢运动阻滞起效时间和达最大运动阻滞时间差异无统计学意义,2组最大运动阻滞评分均为3分（P〉0.05）。R＋S组感觉阻滞恢复至L3、首次感觉疼痛和开始PCA镇痛的时间比R组长（P〈0.05或0.01）,下肢运动阻滞完全恢复时间组间比较差异无统计学意义（P〉0.05）。R＋S组牵拉反应程度低于R组（P〈0.01）。2组不良反应发生率、麻黄碱和阿托品使用率及新生儿体重、出生后1min和5 min Apgar评分差异无统计学意义（P〉0.05）。结论剖宫产术患者重比重罗哌卡因混合舒芬太尼5μg腰麻感觉阻滞起效时间缩短,阻滞平面上移,持续镇痛作用时间延长。     

腰硬联合麻醉剖宫产术中布比卡因剂量的临床进展

布比卡因腰硬联合麻醉(combined spinal-epidural anesthesia,CSEA)在剖宫产中的应用较多,但其腰麻用于剖宫产术的最佳剂量较难确定,通过阅读文献发现有4种方法分别为给予小剂量腰麻,把腰麻限制在低位节段,通过硬膜外追加利多卡因来加强麻醉效果;根据身高与体重调节腰麻的剂量;通过硬膜外注射盐水来减少腰麻剂量;通过布比卡因腰麻复合阿片类药物来减少腰麻剂量,可使母体血液动力学相对稳定,副作用发生率低,麻醉效果好,但在这4种给药方法中,究竟哪一种能使剖宫产患者血液动力学最稳定、麻醉效果最好、副作用最少,还有待于进一步研究.     

罗哌卡因混合舒芬太尼用于剖宫产术患者腰麻的半数有效剂量

目的 确定剖宫产术患者混合舒芬太尼时罗哌卡因腰麻的半数有效剂量(ED50).方法 择期行剖宫产术患者28例,ASA分级Ⅰ或Ⅱ级,经L2,3间隙行脊椎.硬膜外联合穿刺.蛛网膜下腔注射罗哌卡因混合舒芬太尼5 μg,注射时间30 s.第1例患者罗哌卡因剂量为11 mg,采用序贯法,根据腰麻是否成功确定下一例患者的罗哌卡因剂量,相邻剂量梯度为1 mg.采用序贯法计算罗哌卡因腰麻的ED50(95%可信区间).结果 罗哌卡因腰麻的ED50为7.780 mg(95%可信区间为6.850～8.836 mg).结论 罗哌卡因混合舒芬太尼5 μg用于剖宫产术腰麻的ED50为7.780 mg.

Abstract：

Objective To determine the median effective dose (ED50 ) of ropivacaine for spinal anesthesia when combined with sufentanil in patients undergoing caesarean section. Methods Twenty-eight ASA Ⅰ or Ⅱ parturients, aged 18-40 yr, weighing 50-110 kg, undergoing cesarean section under combined spinal-epidural anesthesia, were enrolled in this study. Combined spinal-epidural anesthesia was performed at L2,3 interspace. The mixture of ropivacaine and 5 fig sufentanil was injected into the subarachnoid space over 30 s. The initial dose of ropivacaine was 11 mg. The dose was increased/decreased by 1 mg in the next patient. The ED50 and 95% confidence interval were calculated by up-and-down method. Results The ED50 of ropivacaine was 7.780 mg (95% confidence interval 6.850-8.836 mg). Conclusion When combined with sufentanil 5 μg, the ED50 of ropivacaine for spinal anesthesia is 7.780 mg in patients undergoing caesarean section.     

Effect of the lithotomy position on spinal anesthesia with hyperbaric tetracaine

This study was performed to determine the effects of lithotomy position on the spread of analgesia and hemodynamics following spinal anesthesia with 0.5% hyperbaric tetracaine. Thirty patients who underwent hysterectomy due to myoma uteri were studied. All patients received spinal anesthesia in the left lateral decubitus position and were turned supine immediately after intrathecal administration of the drug. Fifteen patients were then placed in the horizontal lithotomy position within 10 s, and the remaining 15 were kept in the horizontal supine position for 30 min. There were no significant differences between the groups in mean arterial pressure, heart rate, cardiac output, and in the cephalad spread of analgesia. The lithotomy position had no effect on the spread of analgesia or anesthetic course of spinal anesthesia with hyperbaric tetracaine.     

Comparison of hemodynamic and anesthetic effects of hyperbaric bupivacaine and tetracaine in spinal anesthesia

Purpose.To compare the anesthetic and hemodynamic effects and the predictive factor of anesthesia level of commonly used preparations of hyperbaric bupivacaine and tetracaine in spinal anesthesia. Methods.Two hundred patients aged 40 to 75 years with ASA physical status I or II were anesthetized spinally via the L4–5 interspace using 0.5% hyperbaric bupivacaine in 7.27% glucose (Bupivacaine group, n = 100) or 0.5% hyperbaric tetracaine dissolved in a 10% glucose solution (Tetracaine group, n = 100) in a lateral position. The volume of anesthetic used was decided by the resident according to the surgical procedure. Patients were returned to the supine position immediately after drug injection. Blood pressure, heart rate, and anesthesia level tested by cold sensation were measured for 30min. Results.Blood pressure and heart rate decreased significantly but without any differences between the groups. The volume of drug used was significantly larger in the Bupivacaine group (2.6 ± 0.5ml) than in the Tetracaine group (2.1 ± 0.4ml) to obtain the same maximum anesthesia level. The time to reach the maximum anesthesia level was significantly longer in the Bupivacaine group (18 ± 7min) than in the Tetracaine group (15 ± 6min). The volume of the drug was the only predictive factor of the maximum anesthesia level in both groups: Level (as expressed by the number of anesthetized segments from S5 to cephalad) = 1.55 × (volume in ml) + 13.06 in the Bupivacaine group, and 2.59 × (volume) + 11.46 in the Tetracaine group. Conclusion.In spinal anesthesia, hyperbaric tetracaine in 10% glucose induced a faster and higher spread of anesthesia than hyperbaric bupivacaine in 7.27% glucose without any differences in hemodynamics.     

Distribution of hypobaric tetracaine within cerebrospinal fluid in a spinal canal model

We studied the distribution of hypobaric tetracaine within cerebrospinal fluid (CSF) using a spinal canal model to examine the spread of a hypobaric anesthetic solution during spinal anesthesia. In our study, 0.2% tetracaine colored with methylene blue was observed to migrate upwards rapidly and spread horizontally in the upper portion of the model placed horizontally and filled with CSF which was collected from several neurosurgical patients. The boundary between the hypobaric solution and CSF could be clearly identified. These results suggest that the hypobaric tetracaine will distribute in the upper portion of the spinal canal during spinal anesthesia. It can be used to produce unilateral spinal blockade in the lateral decubitus position despite a small difference in specific gravity between the hypobaric anesthetic and CSF. In addition, the fact that the hypobaric solution showed a rapid horizontal spread suggests that correct positioning both during and following administration of the anesthetic is important to control the level of anesthesia.(Aoyama K, Fukutome T, Shigematsu A: Distribution of hypobaric tetracaine within cerebrospinal fluid in a spinal canal model. J Anesth 6: 376–378, 1992)     

Epidural ropivacaine 1% with and without sufentanil addition for Caesarean section

BACKGROUND: So far only ropivacaine concentrations of 0.5 and 0.75% have been used for Caesarean section. This prospective double-blind trial evaluated the anaesthetic quality of ropivacaine 1% with and without sufentanil addition. METHODS: Three groups of patients (n=20 each) scheduled for an elective Caesarean section were studied. The patients received initially 120 mg ropivacaine, or 120 mg ropivacaine plus 10 microg or 20 microg sufentanil. Additional epidural ropivacaine was injected if necessary. Primary outcome parameter was time to achieve sensory block at T4. Moreover, pain intensity at delivery (visual analogue scale, VAS), incidence of maternal side-effects (hypotension, bradycardia, nausea, vomiting, shivering, pruritus), and neonatal outcome (Apgar score, neurologic and adaptive capacity score, umbilical cord blood-gas values) were recorded. RESULTS: The onset time for the sensory block was not significantly different among the groups. Also, VAS scores at delivery did not differ significantly between the plain ropivacaine 1% group (18 +/- 29 mm), the 10-microg sufentanil group (1 +/- 5 mm), and the 20-microg sufentanil group (6 +/- 18 mm). The total dose of ropivacaine was significantly higher in the plain ropivacaine 1% group (145 +/- 19 mg) compared to the patients receiving additional 10 microg sufentanil (130 +/- 15 mg, P = 0.02) or 20 microg sufentanil (129 +/- 16 mg, P = 0.01). The incidence of maternal side-effects and neonatal outcome were similar in all groups. CONCLUSION: Ropivacaine 1% alone provided sufficient analgesia. Sufentanil addition did not significantly improve the quality of epidural anaesthesia with ropivacaine 1.0% for Caesarean section.     

An observational prospective cohort study of incidence and characteristics of failed spinal anaesthesia for caesarean section

BackgroundA prospective cohort study was performed in 800 parturients undergoing elective caesarean section under spinal anaesthesia from May 2005 to April 2006 in a large maternity hospital in Singapore, in order to determine the incidence of and risk factors for total and partial failure of spinal anaesthesia.MethodsA routine single-shot spinal technique using intrathecal 0.5% heavy bupivacaine 2.0 mL (10 mg) and morphine 100 μg was administered with a 27-gauge Whitacre spinal needle via a 20-gauge introducer. Demographic, surgical and anaesthetic data were collected to determine risk factors for failure of spinal anaesthesia.ResultsIncidence of total failure requiring conversion to general anaesthesia was 0.5% (4 cases) in which three cases had inadequate block (loss of sensation to cold less than T6) and one case had no sensory block. Thirty-three parturients (4.1%) required intravenous fentanyl and seven (0.9%) required Entonox for intraoperative analgesic supplementation. Postpartum sterilization (P < 0.001) was an independent risk factor for partial failure requiring intravenous fentanyl and Entonox.ConclusionSpinal anaesthesia using bupivacaine 10 mg with morphine 100 μg produces reliable anaesthesia for elective caesarean section. Postpartum sterilization involves exteriorisation of the uterus with additional surgical manipulation and hence may necessitate analgesic supplementation. The initial use of a combined spinal-epidural technique or the addition of intrathecal fentanyl or clonidine or an increased dose of local anaesthetic may be considered to decrease the incidence of intraoperative pain.     

轻比重罗哌卡因腰麻用于老年病人人工关节置换术的量-效关系

目的 探讨轻比重罗哌卡因腰麻用于老年病人人工关节置换术的量-效关系.方法 选择70～98岁的人工关节置换术病人75例,随机均分为三组.用Spinocath 24G导管针于L3～4椎间隙穿刺,蛛网膜下腔置管2.0～2.5 cm.Ⅰ、Ⅱ、Ⅲ组依次应用0.3%、0.4%、0.5%罗哌卡因轻比重(1.001～1.002,20℃)腰麻液1.0～1.2ml.观察镇痛起效时间、运动阻滞起效时间、最高痛觉阻滞平面、麻醉持续时间、最大运动阻滞程度、痛觉及运动恢复时间、阻滞完全病人比例及用药后的不良反应.结果 三组镇痛起效时间、最高痛觉阻滞平面、完全阻滞病人比例(Ⅰ组2例痛觉阻滞不全)差异无统计学意义;运动阻滞起效时间Ⅲ组比Ⅰ组短(P<0.01),麻醉持续时间、最大Bromage评分、痛觉和运动恢复时间Ⅲ组>Ⅱ组>Ⅰ组(P<0.05或P<0.01).三组均出现单侧下肢阻滞.结论 0.4%罗哌卡因轻比重液4.0～4.8 mg腰麻用于老年病人人工关节置换术,可达到完善的镇痛效果,且较安全.