布比卡因微球剂型对大鼠坐骨神经阻滞的效果

目的 评价布比卡因微球剂型对大鼠坐骨神经阻滞的效果.方法 雌性Wistar大鼠60只,体重230～250 g随机分为4组:对照组(A组,n=6)、布比卡因组(B组,n=6)、空白微球组(C组,n=24)和微球给药组(D组,n=24).A组和B组给药方法:在右侧大转子和坐骨结节之间连线的靠近大转子的1/3处,用27号针向前内侧方向针尾抬高45°进针,直至针尖抵达坐骨后给药,A组和B组分别注射生理盐水1 ml或0.5%布比卡因20 mg/kg 1 ml;C组和D组给药方法:采用外科植入术法给药,C组和D组分别于坐骨神经周围的肌肉间隙中植入空白微球或布比卡因微球400 mg/kg(布比卡因载药量26.75%),于给药前和给药后评价运动阻滞程度,并测定热痛阈.给药后28 d内观察不良反应的发生情况,C组和D组分别在给药后2 d、7 d、14 d和28 d随机取6只大鼠,取用药部位肌肉和坐骨神经组织,光镜下观察病理学结果.结果 与A组比较,B组在给药后0.5～3 h时运动阻滞程度及热痛阈增加,D组在给药后0.5～36 h时运动阻滞程度增加,在给药后0.5～72 h时热痛阈增加(P＜0.05).C组和D组给药后用药部位肌肉组织未见变性和坏死,仅有轻微的炎性反应,用药部位坐骨神经未见轴索变性和脱髓鞘.结论 大鼠布比卡因微球剂型坐骨神经阻滞可延长阻滞时间,组织相容性较好.     

罗哌卡因在后路腰椎融合术多模式镇痛中的临床应用

[目的]观察罗哌卡因切口周围浸润联合脊神经后支阻滞的多模式镇痛方案在后路腰椎融合术术后的镇痛效果及安全性。[方法]将2014年2月~2015年2月本院收治的60例后路腰椎融合患者随机分为两组,阻滞组30例,术中用罗哌卡因行切口周围浸润联合脊神经后支阻滞,对照组30例,不进行切口周围浸润或脊神经后支阻滞。分别观察各组术后6h、12h、24h、48h、72h休息及锻炼时视觉模拟评分(visual analogue score,VAS)、对疼痛超过4分的患者给予加用镇痛药物。比较两组的VAS评分,首次加用镇痛药物时间、使用量及副作用发生率,进行统计分析。[结果]两组患者在年龄、性别、体重指数、ASA分级、手术节段、主要病因方面差异无统计学意义,具有统计学可比性。在融合术后6h、12h、24h、48h休息及锻炼时,阻滞组视觉模拟评分均明显降低(P<0.05)。但在术后72h时两组视觉模拟评分差异无统计学意义。阻滞组术后首次使用镇痛药物时间比对照组明显延迟(P<0.05),同时使用量也明显降低(P<0.05)。[结论]罗哌卡因切口周围浸润联合脊神经后支阻滞的多模式镇痛方案可显著缓解后路腰椎融合术后48h内疼痛;减少吗啡用量,降低不良事件发生率,为腰椎后路融合术后早期镇痛提供了一种选择。     

超声引导下连续收肌管阻滞联合坐骨神经阻滞在老年膝关节置换术后镇痛的效果

目的评价超声引导下连续收肌管阻滞联合连续坐骨神经阻滞用于老年患者全膝关节置换术后镇痛的效果。方法择期全麻下行单侧全膝关节置换术患者80例,男46例,女34例,年龄65～80岁,体重55～82 kg,ASAⅠ—Ⅱ级,采用随机数字表法分为两组,连续收肌管阻滞组(A组)和连续收肌管阻滞联合连续坐骨神经阻滞组(B组),每组40例。手术结束后两组在超声引导下行收肌管阻滞,然后B组在超声引导下行坐骨神经阻滞,两组分别注入负荷剂量0.2%罗哌卡因20 ml后,置入神经丛导管,连接PCA泵。记录术后4、8、12、24、48 h的静息和活动VAS疼痛评分,镇痛泵有效按压次数,补救镇痛,改良Bromage运动阻滞分级,以及神经阻滞相关并发症等。结果与A组比较,B组术后4～24 h的静息VAS评分,4～48 h的活动VAS评分均明显降低,术后48 h内镇痛泵有效按压次数和补救镇痛明显减少(P0.05)。术后24 h两组改良Bromage运动阻滞分级均恢复到0级。两组均未见神经阻滞相关并发症。结论连续收肌管阻滞联合连续坐骨神经阻滞用于老年患者全膝关节置换术后镇痛的效果优于单纯连续收肌管阻滞。     

尿道注射聚(乳酸-羟基乙酸)共聚物微球治疗压力性尿失禁

目的 观察聚(乳酸-羟基乙酸)(PLGA)共聚物微球在大鼠尿道的组织相容性以及对实验大鼠尿失禁模型的治疗作用.方法 双相乳化法制备PLGA微球,电子显微镜及计算机图像分析仪分析其表征;将40只成年雌性SD大鼠随机均分为2组(实验组和对照组),并接受尿道松解术形成压力性尿失禁模型.实验组接受微球尿道注射,对照组仅接受等量生理盐水注射.在注射前1周和注射后2、4和8周,所有大鼠接受腹部漏点压(ALPP)的检测.此外,术后第2、4和8周,每组动物每个时间点处死3只,应用苏木素.伊红(HE)染色方法检测微球在尿道组织的形态学演变,此外应用免疫组织化学方法检测巨噬细胞特异性的炎症标志物CD68在注射部位尿道组织的表达,以评价微球与尿道肌层的组织相容性.结果 PLGA微球可成功地注射于大鼠尿道的肌层,并诱导局部炎症反应;CD68免疫染色证实浸润细胞以单核细胞和巨噬细胞为主.以微球和增生细胞为主的混杂组织位于黏膜下肌层内,发挥尿道填充作用.在术后2周,炎症反应最为明显,以后随着时间逐渐减退.全程未见变性、坏死等破坏性病理改变;实验组ALPP在微球注射后较注射前和对照组明显改善,并可维持到注射后8周.结论 PLGA微球在尿道组织是安全的,可起到尿道填充作用增加尿道阻力,发挥治疗压力性尿失禁的作用.PLGA微球作为可注射的细胞支架可用于尿失禁的组织工程.     

一种安全简单的超声引导髂筋膜间隙阻滞新方法:“沙漏法”

目的探讨"沙漏法"超声引导髂筋膜间隙阻滞(fascia iliaca compartment block,FICB)用于全髋关节置换术后镇痛的有效性。方法经伦理委员会批准,选择2014年1~5月我院择期全髋关节置换术30例,腰硬联合麻醉前应用"沙漏法"行超声引导FICB,辨认出"沙漏征"(腹内斜肌与缝匠肌),放置导管,给予负荷量0.2%罗哌卡因40 ml,随后连接镇痛泵,0.2%罗哌卡因10 ml/h持续输注,使用时间48 h。记录30 min内股神经和股外侧皮神经感觉阻滞起效情况,阻滞后4、8、12、24、36、48 h患者静息状态疼痛评分,阻滞后48 h患者满意度评分,以及不良反应发生率。结果 30 min内股神经和股外侧皮神经感觉阻滞成功率100%,阻滞后4、8、12、24、36、48 h疼痛数字评价量表(numerical rating pain scale,NRPS)中位数均4分,阻滞后48 h患者满意度评分为(8.0±0.9)分。无一例出现感染、局麻药中毒、出血及血肿等并发症。结论全髋关节置换术应用"沙漏法"进行超声引导FICB,操作安全、简便,能够为患者提供有效的术后镇痛,可在临床上推广应用。     

会阴侧切皮下美容缝合联合综合护理干预对产后切口愈合的影响

目的:探讨会阴侧切皮下美容缝合术联合综合护理干预对产后切口愈合的影响。方法:选取2018年4月-2019年4月接诊的顺产会阴侧切初产妇60例,按照随机数字表法分成两组,对照组30例采用会阴侧切皮下美容缝合术联合常规护理配合,观察组30例在围术期联合综合护理干预,对比两组产妇总产程时间、产后48h会阴疼痛情况、切口愈合时间,记录两组产妇产后4周内线结反应,产后3个月、6个月时采用温哥华瘢痕评价量表(Vancouver scar scale,VSS)、患者瘢痕自我评分(Patient scar assessment scale,PSAS)评估侧切口的美观度。结果:观察组总产程、产后48h会阴疼痛程度优于对照组,差异有统计学意义(P0.05)。观察组会阴侧切口一期愈合率略高于对照组,组间比较差异无统计学意义(P0.05)。产后4周内观察组结线反应发生率显著低于对照组,差异有统计学意义(P0.05)。产后3个月、6个月时观察组VSS评分、PSAS评分均显著低于对照组,差异有统计学意义(P0.05)。结论:会阴侧切皮下美容缝合术联合综合护理能够有效缩短初产妇生产时间、缓解产后疼痛,切口愈合快,美观度和安全性较高。     

竖脊肌平面阻滞与切口浸润麻醉对全麻胸腔镜肺部分切除术患者术后早期恢复影响的比较

目的比较竖脊肌平面阻滞与切口浸润麻醉对全麻胸腔镜肺部分切除术患者术后早期恢复的影响。方法选取拟在全麻胸腔镜下行肺部分切除术患者80例, 性别不限, 年龄50～78岁, BMI 18～30 kg/m2 , ASA分级Ⅱ或Ⅲ级, 采用随机数字表法分为2组(n=40):切口局部浸润组(D组)和竖脊肌平面阻滞组(E组)。E组在麻醉诱导完成, 改为侧卧位后, 在超声引导下行患侧竖脊肌平面阻滞, 注射0.25%盐酸罗哌卡因30 ml;D组切皮前采用0.25%盐酸罗哌卡因行切口浸润麻醉。术后行自控静脉镇痛, 当静态NRS评分>3分或咳嗽时NRS评分≥6分时, 静脉注射氟比洛芬酯补救镇痛。分别于术前1 d和术后24、48 h时行QOR-15评分。分别于切皮前、术毕和术后24 h时, 采用ELISA法测定血浆IL-6和IL-1β浓度。记录术中瑞芬太尼用量、术后48 h内镇痛泵有效按压次数、补救镇痛情况、术后首次下床活动时间、首次肛门排气时间、住院时间和术后48 h内恶心呕吐、肺部感染的发生情况。结果与D组比较, E组术后24和48 h时QOR-15评分升高, 术中瑞芬太尼用量和镇痛泵有效按压次数减...     

静脉注射帕瑞昔布联合股神经阻滞用于老年病人膝关节置换术后镇痛及膝关节功能康复的效果

目的 评价静脉注射帕瑞昔布联合股神经阻滞用于老年病人膝关节置换术后镇痛及膝关节功能康复的效果.方法 拟在全身麻醉下行单侧膝关节置换术老年病人40例,ASA分级Ⅱ级,年龄65～74岁,体重45～90 kg,采用随机数字表法,将其随机分为2组:单纯股神经阻滞组(FNB组,n＝20)和股神经阻滞联合间断静脉注射帕瑞昔布组(FNB-Pa组,n＝20).FNB组术毕时通过股神经阻滞导管注入0.25％罗哌卡因25 ml镇痛,每8h给药1次,至术后72 h;FNB-Pa组在术毕前30 min、术后12、24、48 h分别静脉注射帕瑞昔布40 mg;股神经阻滞用药同FNB组,至术后72 h.于术后2、12、24、36、48及72 h时记录静态时VAS评分,并于术后36、48及72 h时记录动态时VAS评分.于术前、术后24、48及72 h对患膝关节功能进行评分(HSS评分);并记录有关不良反应的发生情况.结果 FNB-Pa组术后静态、动态时VAS评分均比FNB组明显降低(P<0.05).与术前比较,术后两组病人HSS评分均明显提高(P<0.05或0.01);FNB- Pa组术后48、72 h HSS评分明显高于FNB组(P<0.05).两组均未见有关不良反应发生.结论 股神经阻滞联合间断静脉注射帕瑞昔布,可安全、有效地缓解老年病人膝关节置换术后静态和动态时疼痛,有助于术后关节功能的康复.     

超声引导下髂筋膜腔隙阻滞对全髋关节置换术患者术后镇痛的效果

目的 评价超声引导下髂筋膜腔隙阻滞对全髋关节置换术患者术后镇痛的效果.方法 择期行全髋关节置换术患者36例,年龄54～82岁,体重48～72 kg,ASA分级Ⅰ～Ⅲ级,采用随机数字表法,将其随机分为2组(n=18):生理盐水组(NS组)和罗哌卡因组(R组).手术结束后30 min内行患侧超声引导下髂筋膜腔隙阻滞.R组髂筋膜腔隙注射0.25％罗哌卡因30 ml;NS组注射等容量生理盐水.阻滞完成后,采用0.01 mg/ml芬太尼行PCIA,无背景输注,PCA量2ml,锁定时间15 min.于阻滞前即刻(T0)、阻滞后3 h(T1)、6 h(T2)、8 h(T3)、12 h(T4)、24 h(T5)、48 h(T6)和72 h(T7)时,记录静态VAS评分;于T4、T5、T6和T7时,记录被动运动VAS评分;于T5、T6和T7时,记录主动运动VAS评分.记录阻滞后0～12h、12～24 h、24～48 h、48～ 72 h各时段内芬太尼用量.记录术后不良反应的发生情况.结果 与NS组比较,R组T1～T7时静态VAS评分、T4～T7时被动运动VAS评分和T5～T7时主动运动VAS评分均降低,各时段芬太尼用量减少(P＜0.05).两组不良反应发生率差异无统计学意义(P＞0.05).结论 全髋关节置换术患者超声引导下髂筋膜腔隙阻滞的镇痛效果好,安全性良好.     

超声引导下腰方肌阻滞对剖宫产术后镇痛的影响

目的探讨超声引导下腰方肌阻滞(quadratus lumborum block,QLB)对剖宫产术后镇痛效果的影响。方法择期行剖宫产产妇60例,年龄20～40岁,ASAⅠ或Ⅱ级,采用随机数字表法分为两组:QLB组(Q组)和对照组(C组),每组30例。Q组术毕在超声引导下行双侧QLB,每侧注射0.33%罗哌卡因20ml,C组不阻滞。两组术毕均行PCIA,镇痛泵药液配方为曲马多800mg、奈福泮40mg,用生理盐水配成80ml。记录术后4、8、12、24、48h曲马多累计消耗量以及静息、咳嗽、翻身NRS评分、BCS舒适度评分;术后4、8、12、24、48h测定QLB的阻滞平面;记录总体镇痛满意度评分以及术后不良反应的发生情况。结果与C组比较,Q组术后4、8、12、24、48h曲马多累计消耗量明显减少、静息NRS评分明显降低、BCS舒适度评分明显升高,术后12、24h咳嗽NRS评分以及术后4、48h翻身NRS评分明显降低(P0.05);术后4、8、12hQLB的阻滞平面主要为T7—L1,阻滞的节段数为7,术后24hQLB的阻滞平面主要为T8—L1,阻滞的节段数为6,术后48hQLB的阻滞平面消退;Q组总体镇痛满意度明显高于C组(P0.05);两组术后恶心呕吐、头晕的发生率差异无统计学意义。结论超声引导下QLB能够明显减少剖宫产术后曲马多用量,降低术后疼痛评分,提高产妇术后舒适度和满意度。     

罗哌卡因用于犬坐骨神经阻滞时的药代动力学

目的 探讨罗哌卡因用于犬坐骨神经阻滞时的药代动力学.方法 成年健康杂种犬12只,雌雄各半,体重14～17 k异,6～8月龄,随机分为2组(n=6),分别采用0.5%罗哌卡因10 mg/kg(A组)和20 mg/kg(B组)行单次坐骨神经阻滞,分别于罗哌卡因给药前、给药后10、20、30、40、60、90、120、150、180、240、360、720 min时抽取股动脉血样5 ml,采用反相高效液相色谱法测定血浆罗哌卡因浓度,监测ECG、BP和HR,记录局麻药毒性反应的发生情况(同时在该点采血测定血浆罗哌卡因浓度).结果 罗哌卡因阻滞犬坐骨神经时的血药浓度-时间曲线符合二室模型,A组血药浓度峰值和曲线下面积低于B组(P<0.01),而其他参数两组间比较差异无统计学意义(P>0.05);各时点HR、SP、DP和MAP差异无统计学意义(P>0.05).B组有2只犬发生惊厥,惊厥时的血药浓度分别为12.56、13.67 mg/L.结论 罗哌卡因用于犬坐骨神经阻滞时的药代动力学特征符合二室模型,大剂量(20 mg/kg)时易产生中枢毒性反应.     

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).     

Sciatic Nerve Blockade in Infant, Adolescent, and Adult Rats: , A Comparison of Ropivacaine with Bupivacaine

Background: Ropivacaine is a newly introduced local anesthetic. anesthetic. No data are available regarding its safety, efficacy, or sensory-selectivity in children. The sciatic block duration and systemic toxicity of bupivacaine and ropivacaine were compared compared among infant, adolescent, and adult rats.

Methods: Infant, adolescent, and adult rats received blocks with ropivacaine or bupivacaine. Nociceptive, proprioceptive, and motor blockade were assessed. Systemic effects (contralateral leg analgesia, seizures, respiratory distress, apnea) were quantified. Plasma local anesthetic concentrations were measured at terminal apnea.

Results: Nerve blockade for a given absolute dose lasted longer in infants than in older rats for both drugs. Block duration duration from ropivacaine generally was the same as or slightly shorter than bupivacaine. There was no difference in sensory-selectivity between the drugs. Doses required to induce all systemic toxicity indices were inversely related to age (e.g., the lethal dose in 50% of animals [LD50] of ropivacaine in infants is 155 mg/kg; in adults it is 54 mg/kg). All indices of toxicity occurred at higher doses per kilogram for ropivacaine than bupivacaine, at all ages (e.g., the LD50 of bupivacaine in infants is 92 mg/kg; in adults it is 30 mg/kg). Plasma concentrations at terminal apnea were higher for ropivacaine than for bupivacaine at all ages, and were higher in infants than in older rats.     

罗哌卡因神经束内或周围给药对大鼠坐骨神经损伤的影响

目的 探讨罗哌卡因神经束内或周围给药对大鼠坐骨神经损伤的影响.方法 健康成年Wistar雄性大鼠72只,体重220～250 g,采用血管夹压迫一侧坐骨神经2 min的方法建立大鼠坐骨神经损伤模型,随机分为4组(n=18):损伤神经束内或周围注射生理盐水(Intra-NS组,Epi-NS组)、1%罗哌卡因(Intra-Ropi组,Epi-Ropi组)0.2 ml.于给药后1、3、7、14、21、28 d时测定坐骨神经功能指数(SFI),给药后14、28 d时测定坐骨神经传导速度(NCV),观察神经组织病理学结果.结果 Epi-NS组、Epi-Ropi组和Intra-NS组各时点SFI均依次升高(P＜0.05或0.01),给药后28 d时SFI恢复,各组问差异无统计学意义(P＞0.05),神经纤维和髓鞘无明显病理改变;与Epi-NS组、Epi-Ropi组和Intra-NS组比较,Intra-Ropi组给药后3～28 d SFI、给药后14、28 d时NCV降低(P＜0.05或0.01).给药后28 d时神经纤维粗细不一,髓鞘较薄.结论罗哌卡因神经束内给药可显著延迟大鼠损伤坐骨神经的恢复,而神经周围给药对神经恢复无影响.     

Levobupivacaine versus ropivacaine in psoas compartment block and sciatic nerve block in orthopedic surgery of the lower extremity

AIM: The aim of this study was to compare the clinical profiles of psoas block and sciatic nerve block performed with either 0.5% levobupivacaine or 0.75% ropivacaine. METHODS: With ethical committee approval and written informed consent 80 ASA physical status I-II patients, undergoing lower extremity surgery received intravenous premedication with midazolam (0.05 mg/kg) and atropine (0.01 mg/kg). Patients were randomly allocated to receive a lumbar plexus block with: Levobupivacaine Group (L) 30 ml of 0.5% levobupivacaine or Ropivacaine Group (R) 0.75% ropivacaine, and sciatic nerve block with: Group R 10 ml 0.75 ropivacaine or Group L 0.5% levobupivacaine. The onset time and duration of nerve block were evaluated. RESULTS: The motor onset time was shorter in Group L than in Group R. The motor offset time was similar in the 2 groups, the time being slightly greater for Group R. Group L presented a higher difference of resolution to motor-sensitive block compared to Group R. CONCLUSIONS: The differences between Groups L and R were characterised by: a faster motor onset time in Group L with a longer time between motor and sensitive resolution determining a lower demand for analgesic drugs postoperatively and greater support for motor control recovery.     

Glucocorticoids Prolong Rat Sciatic Nerve Blockade In Vivo from Bupivacaine Microspheres

Background: Previous work showed that incorporation of dexamethasone (0.05 weight/weight percentage) into bupivacaine microspheres prolonged blockade by eight to 13 times compared with that produced by bupivacaine microspheres alone. The determinants of dexamethasone's block-prolonging effect were examined and reported here.

Methods: Polylactic-co-glycolic acid polymer microspheres (65/35) with 75 weight/weight percentage bupivacaine were prepared. Microspheres were injected adjacent to the rat sciatic nerve, and sensory and motor blockade were assessed. A procedure was developed to test drugs for block-prolonging ability in vivo by placing test drugs in the injection fluid along with a suspension of bupivacaine microspheres.

Results: Dexamethasone alone in suspension did not produce blockade, nor did it prolong blockade induced by aqueous bupivacaine. Bupivacaine microspheres (150 mg drug/kg rat weight) produced blockade for 6 to 10 h. Dexamethasone in the suspending solution of microspheres prolonged block by up to five times. Glucocorticoids prolonged block in proportion to glucocorticoid/antiinflammatory potency. The corticosteroid antagonist cortexolone inhibited dexamethasone's blockade-prolonging action. Durations of blockade with or without dexamethasone were unaltered by hydroxyurea-induced neutrophil depletion. Microspheres were extracted from rats at time points ranging from 7 h to 7 days, and residual microsphere dry weight and bupivacaine content were similar in groups of rats injected with either bupivacaine microspheres or bupivacaine microspheres containing dexamethasone, respectively.     

Prolonged Intercostal Nerve Blockade in Sheep Using Controlled-release of Bupivacaine and Dexamethasone from Polymer Microspheres

Background: Previous work from the authors' group characterized a prolonged percutaneous blockade of the sciatic nerve in rats using bupivacaine-dexamethasone microspheres. The goals of the current study are to examine the (1) efficacy of bupivacaine microspheres with and without dexamethasone for intercostal blockade in sheep; (2) scaling of dose and duration with a 100-fold increase in body size from rats to sheep; (3) local toxicity and adverse systemic reactions to bupivacaine microspheres with and without dexamethasone.

Methods: Intercostal blocks were performed percutaneously in sedated sheep. Sensory blockade was measured at repeated time points by absent flinch response to skin pinch. Plasma bupivacaine concentrations were measured using high performance liquid chromatography. Chest wall specimens were examined by light microscopy.

Results: The duration of intercostal blockade increased with bupivacaine dose for animals receiving from 8 to 80 mg/kg of microspheres with and without dexamethasone. At each dose, microspheres containing dexamethasone had a longer duration of block than microspheres without dexamethasone. From 8 to 80 mg/kg, the mean duration of block with bupivacaine-dexamethasone microspheres increased from 4 to 13 days. Plasma concentrations of bupivacaine remained 10-fold below the convulsive EC50 concentration for sheep. Chest wall histology showed a significant granulomatous reaction around bupivacaine microspheres but not around bupivacaine-dexamethasone microspheres.     

ABSORPTION OF BUPIVACAINE, ETIDOCAINE, LIGNOCAINE AND ROPIVACAINE INTO N-HEPTANE, RAT SCIATIC NERVE, AND HUMAN EXTRADURAL AND SUBCUTANEOUS FAT

Absorption of four amide local anaesthetics, including a newexperimental agent, ropivacaine, in n-heptane, rat sciatic nerveand human extradural and subcutaneous fat was studied in vitro.The relative n-heptane/buffer (37 °C) partitioning of bupivacaine:etidocaine: lignocaine: ropivacaine was 10: 39: 1: 2.9. Theabsorption of bupivacaine and etidocaine into nerve tissue wasidentified at steady state, but in extradural and subcutaneousfat etidocaine was taken up significantly more than bupivacaine.The lowest uptake was with lignocaine, and at steady state itsmean concentrations were similar in all three tissues. Therewas a significantly higher concentration of ropivacaine thanlignocaine in all tissues. Mean tissue concentrations of bupivacainein sciatic nerve and subcutaneous fat, on the other hand, weresignificantly higher than those of ropivacaine. The ratios ofrelative mean uptake (mg g^–1), at steady state, of bupivacaine,etidocaine, lignocaine and ropivacaine were: sciatic nerve 3.3:4: 1: 1.8, extradural fat 4.1: 8.3: 1: 2.3 and subcutaneousfat 3.8: 10.6: 1: 1.9, all of which were clearly lower thanthe theoretical n-heptane/buffer partitioning ratios.     

内皮抑素对胃癌抑制作用的实验研究

目的　研究内皮抑素对胃癌生长和转移的抑制作用 ,并探讨其对胃癌细胞凋亡的影响。方法　建立人胃腺癌裸鼠原位种植转移模型。将 72只荷瘤裸鼠随机分成 4组 ,对照组 3 6只 ,治疗各组每组 12只。种植后第 1周开始皮下注射内皮抑素 ,隔天 1次 ,剂量为 0mg/kg(对照组 )、2 5mg/kg、10 0mg/kg、2 0 0mg/kg(治疗组 ) ,共用 7周。种植后第 8周处死动物 ,测量原位肿瘤体积、抑瘤率、肿瘤微血管密度 (MVD)、肿瘤细胞凋亡指数 (AI) ,观察肿瘤细胞腹膜、肝、其他脏器转移及腹水情况。结果　内皮抑素剂量为 0mg/kg、2 5mg/kg、10 0mg/kg、2 0 0mg/kg时 ,原位肿瘤体积分别为 ( 15 83±5 76)mm3、( 5 91± 3 84 )mm3、( 65 7± 4 3 1)mm3、( 1 89± 1 0 2 )mm3;抑瘤率分别为 0、62 7%、95 8%、99 9% ;MVD分别为 ( 13 70± 3 90 )、( 5 73± 2 3 6)、( 2 17± 1 2 8)、( 0 66± 0 2 5 ) ;AI分别为 ( 3 91±2 5 8) %、( 6 76± 5 0 3 ) %、( 18 92± 6 75 ) %、( 2 8 5 7± 10 3 4 ) % ;腹膜转移率分别为 87 1%、5 4 5 %、16 7%、0 ;肝转移率分别为 83 9%、2 7 3 %、8 3 %、0。治疗组与对照组相比 ,组间胃癌生长和转移的抑制作用差异有显著性意义 (t=3 1 77,P <0 0 5 ) ,且抑制作用与内皮抑素