布比卡因和罗哌卡因竖脊肌平面阻滞用于胸腔镜手术患者术后镇痛的比较

目的 比较布比卡因和罗哌卡因超声引导下竖脊肌平面阻滞用于胸腔镜手术患者术后镇痛的有效性和安全性。方法 随机将60例择期胸腔镜手术患者均分为布比卡因组（n=30）和罗哌卡因组（n=30）。全麻诱导前分别采用布比卡因或罗哌卡因行单次竖脊肌平面阻滞。观察患者阻滞范围及术后1,6,12,24,48 h静息和咳嗽疼痛视觉模拟评分（visual analogue scale,VAS）;记录术后48 h氟比洛芬酯给药次数及给药时间;观察竖脊肌平面阻滞后气胸等不良事件及术后恶心呕吐等不良反应发生情况。结果 布比卡因组阻滞范围稍广,但与罗哌卡因组比较差异无统计学意义（χ²=1.2,P>0.05）。布比卡因组术后1,6,12 h患者静息和咳嗽VAS评分低于同时点罗哌卡因组（P<0.05）,术后24,48 h静息和咳嗽VAS评分高于组内术后12 h（P<0.05）,术后48 h氟比洛芬酯使用人均次数小于罗哌卡因组（P<0.05）。2组术后第2个12 h氟比洛芬酯使用例次均高于同组术后第1个12 h（P<0.05）。2组竖脊肌平面阻滞后不良事件及术后不良反应发生情况差异无统计学意义。结论 布比卡因和罗哌卡因超声引导下单次竖脊肌平面阻滞用于胸腔镜手术患者术后镇痛,都是有效的和安全的,有效镇痛时间均仅12 h左右。比较而言,布比卡因镇痛效果更好。     

Intra-Articular Bupivacaine Reduces Postoperative Pain and Meperidine Use After Total Hip Arthroplasty: A Randomized,Double-Blind Study

One hundred patients receiving unilateral total hip arthroplasty (THA) were randomized to receive an intra-articular injection of 300 mg bupivacaine or normal saline after completion of surgery. Pain scores of the bupivacaine group were significantly lower than those of the control group the first 12 hours postoperatively (all, P < 0.001). A significantly lower dose of meperidine was used in the study group than in the control group the first 24 hours postoperatively (median, 25 vs. 45 mg, P < 0.001). Nineteen patients in the study group required meperidine the first day after surgery, as compared to 45 patients in the control group. We conclude that intra-articular injection of bupivacaine after THA reduces pain and meperidine use in the first 12 hours after surgery.     

Synthesis of nanocapsules blended polymeric hydrogel loaded with bupivacaine drug delivery system for local anesthetics and pain management

Local anesthetics are used clinically for the control of postoperative pain management. This study aimed to develop chitosan (CS) with genipin (GP) hydrogels as the hydrophilic lipid shell loaded poly(ε-caprolactone) (PC) nanocapsules as the hydrophobic polymeric core composites (CS-GP/PC) to deliver bupivacaine (BPV) for the prolongation of anesthesia and pain relief. The swelling ratio, in vitro degradation, and rheological properties enhancement of CS-GP/PC polymeric hydrogel. The incorporation of PC nanocapsules into CS-GP hydrogels was confirmed by SEM, FTIR, and XRD analysis. Scanning electron microscopy results demonstrated that the CS-GP hydrogels and CS-GP/PC polymeric hydrogels have a porous structure, the pore dimensions being non-uniform with diameters between 25 and 300 μm. The in vitro drug release profile of CS-GP/PC polymeric hydrogel has been achieved 99.2 ± 1.12% of BPV drug release in 36 h. Cellular viability was evaluated using the CCK-8 test on 3T3 fibroblast cells revealed that the obtained CS-GP/PC polymeric hydrogel with BPV exhibited no obvious cytotoxicity. The CS-GP/PC polymeric hydrogel loaded with BPV showed significant improvement in pain response compared to the control group animals for at least 7 days. When compared with BPV solution, CS-GP hydrogel and CS-GP/PC polymeric hydrogel improved the skin permeation of BPV 3-fold and 5-fold in 24 h, respectively. In vitro and in vivo results pointed out PC nanocapsules loaded CS-GP hydrogel can act as effective drug carriers, thus prolonging and enhancing the anesthetic effect of BPV. Histopathological results demonstrated the excellent biodegradability and biocompatibility of the BPV-loaded CS-GP/PC polymeric hydrogel system on 7, 14, and 21 days without neurotoxicity.

HIGHLIGHTS

• Preparation and characterization of CS-GP/PC polymeric hydrogel system.
• BPV-loaded CS-GP/PC exhibited prolonged in vitro release in PBS solution.
• Cytotoxicity of BPV-loaded CS-GP/PC polymeric hydrogel against fibroblast (3T3) cells.
• Development of CS-GP/PC a promising skin drug-delivery system for local anesthetic BPV.

     

皮内注射治疗颈肩部带状疱疹急性期疼痛及愈后的临床观察

目的 观察在颈肩部带状疱疹皮损区周围行皮内注射的止痛效果及对愈后的影响。方法 回顾性分析40例颈肩部带状疱疹神经痛患者（皮损分布区为C2～G4）的临床资料。分为两组,A组20例,在常规治疗（即给予抗病毒药、维生素类及外用炉甘石洗剂等）基础上,加用0．75％布比卡因2ml皮内注射;B组20例,只用常规输液治疗。以视觉模拟评分（VAS）和睡眠质量评分（QS）综合评定治疗效果。结果 A组VAS、QS评分治疗后均明显降低（P〈0．05）,B组VAS、QS评分、治疗后7天内降低不明显（P〉0．05）。A组治疗后VAS、QS评分明显低于B组（P〈0．05）。A组患者1年内无一例发生带状疱疹后神经痛,而B组有4例在半年后被确诊为带状疱疹后神经痛。结论 皮内布比卡因注射联合抗病毒药物治疗对缓解带状疱疹疼痛和改善睡眠质量效果显著,且简单易行,并可降低带状疱疹后神经痛的发生率。     

静脉右美托咪啶在剖宫产术中对腰麻布比卡因阻滞效果的影响

目的观察静脉右美托咪啶在腰麻剖宫产术患者中对布比卡因阻滞时间的影响。方法将择期行剖宫产术的ASAⅠ或Ⅱ级50例产妇随机分为右美托咪啶组(DEX组)和0.9%氯化钠溶液组(NS组)。蛛网膜下腔穿刺给予0.5%布比卡因8 mg,胎儿娩出10 min后,DEX组予右美托咪啶1μg/kg,10 min输完后改为0.5μg/(kg·h)持续静注,NS组予等量0.9%氯化钠溶液静注直至术毕。记录腰麻布比卡因起效时间,感觉和运动阻滞持续时间,Ramsay镇静评分,记录胎儿娩出前(T0)、娩出后10 min(T1),试验药物给药后10 min(T2)、20 min(T3)、30 min(T4)的MAP和HR。记录药物不良反应发生率和新生儿Apgar评分。结果 DEX组的感觉和运动阻滞持续时间与NS组相比均显著延长(P0.05)。DEX组的Ramsay镇静评分显著高于NS组(P0.05),DEX组T2的HR明显低于NS组(P0.05),DEX组中有6例(24%)发生心动过缓。结论在腰麻剖宫产术患者中静脉泵注右美托咪啶,可以显著延长布比卡因的感觉和运动阻滞持续时间,提供满意的镇静效果,主要不良反应为心动过缓,对血流动力学和新生儿Apgar评分无明显影响。     

腰段硬膜外腔布比卡因镇痛后反射改变与下肢运动障碍

目的探讨腰段硬膜外布比卡因止痛后脊神经反射与肌肉运动阻滞的相关差异。方法男性成年患者５０例,随机分为Ａ、Ｂ、Ｃ、Ｄ、Ｅ ５组,每组 １０例,分别在术后双盲法硬膜外注入 ０． １％０． １５％、０． ２％、０． ２５％布比卡因及生理盐水 １０ ｍｌ,注药前后记录目测类比评分（ＶＡＳ）。结果ＶＡＳ评分,Ａ、Ｂ、Ｃ、Ｄ与Ｅ组Ｐ＜０．０１;反射变化,Ａ与Ｅ组Ｐ＞０．０５,Ｂ、Ｃ、Ｄ与Ｅ组Ｐ＜０．０５或０．０１;关节运动变化：Ａ与Ｅ组Ｐ＞０．０５,Ｂ、Ｃ、Ｄ与Ｅ组Ｐ＜０．０１,各组反射与运动变化率相近,但其中反射完全消失率与运动完全消失率之比为５：１。结论布比卡因腰段硬膜外止痛出现运动神经阻滞时,脊神经反射比肌肉运动变化更为敏感,可作为临床示警性指标。     

轻密度布比卡因与重密度布比卡因用于下肢手术的临床麻醉效果对比研究

[目的]对比研究轻密度布比卡因和重密度布比卡应用于下肢手术的临床麻醉效果。[方法]选取2010年1～12月在某院因行下肢手术而实施腰麻-硬膜外联合麻醉的患者120例作为研究对象,将所有患者按照使用布比卡因的比重不同分为轻密度组和重密度组,分别向下腔蛛网膜注射轻密度和重密度布比卡因。比较两组患者的麻醉效果、麻醉时间、术中低血压发生率、BCS舒适评分及并发症情况,综合评价轻密度布比卡因和重密度布比卡因在下肢手术患者中的临床效果。[结果]两组患者麻醉效果、麻醉时间及并发症比较差异无统计学意义,P值均﹥0.05;BCS舒适度评分及低血压发生率比较,轻密度组患者较重密度组患者有明显优势,P值均﹤0.05,均具有统计学意义。[结论轻密度布比卡因和重密度布比卡因在下肢手术患者中的麻醉效果及麻醉时间方面大致相当,但使用轻密度布比卡因较重密度布比卡因在麻醉舒适度和麻醉过程中低血压发生率及舒适度比较,有明显优势。     

Successful resuscitation of bupivacaine‐induced cardiotoxicity in a neonate

We report a case of bupivacaine‐induced cardiotoxicity in a neonate following caudal epidural block under general anesthesia for urologic surgery. Prompt recognition of the complication allowed early intervention with both standard resuscitative measures and administration of 20% Intralipid^®, resulting in a good outcome.