甲磺酸罗比卡因与盐酸罗比卡因用于硬膜外阻滞的效应比较

目的 评价甲磺酸罗比卡因用于硬膜外阻滞的效应和安全性。方法 45例择期行下腹或下肢手术病人,随机分别接受用甲磺酸罗比卡因(8.94 mg/ml,观察组)或盐酸罗比卡因(7.5mg/ml,对照组)施行的硬膜外阻滞。观察两组在感觉阻滞、运动阻滞、镇痛和肌肉松弛方面的效果,同时观察用药前后肝肾功能变化。结果 观察组和对照组感觉阻滞平面达到T6以上的病例分别为84.3％和76％(P>0.05),Bromage≥3级的病例分别90％和92％(P>0.05)。两组感觉阻滞平面固定时间、Bromage达到最大级别时间、最大级别维持时间和运动阻滞维持时间均无显著性差异(P>0.05)。两组镇痛及肌松满意率无显著性差异。观察组术中2例发生低血压,2例发生心动过缓,而对照组仅1例发生低血压。两组术后24 h天冬氨酸氨基转移酶(AST)、天冬氨酸转氨酶(ALT)、尿素氮(BUN)和肌酐(Cr)均在正常范围。结论 甲磺酸罗比卡因与盐酸罗比卡因行硬膜外阻滞的效应基本相同,且无明显毒性。     

右美托咪定添加到罗哌卡因中对腰丛-坐骨神经阻滞及镇静的影响

目的观察右美托咪定添加到罗哌卡因中对腰丛-坐骨神经阻滞及镇静的影响。方法择期在腰丛-坐骨神经阻滞下行单侧膝关节检查、美国麻醉医师协会(American Society of Anesthesiology,ASA)分级Ⅰ~Ⅲ级的患者120例,按照数字生成的方法随机分为不使用右美托咪定(R组)、腰丛阻滞给予右美托咪定(RLD组)、坐骨神经阻滞给予右美托咪定(RSD组),腰丛-坐骨神经阻滞均给予右美托咪定(RD组),每组30例。记录腰丛和坐骨神经的感觉和运动阻滞起效时间、阻滞持续时间及患者第一次需要镇痛药的时间(镇痛时间)。记录患者麻醉前(T0)、麻醉后15分钟、30分钟、45分钟、60分钟(T1~T4)的镇静评分(Ramsay评分)、心率、血氧饱和度、平均动脉压及局麻药中毒的发生率。结果四组间腰丛-坐骨神经阻滞起效时间比较,差异无统计学意义,RLD组、RD组、RSD组和R组腰丛感觉和运动维持时间(min)分别为1008.00±104.99、800.00±97.56,922.00±149.05、732.00±139.52,768.00±108.48、602.00±84.09和742.00±129.44、612.00±109.62,差异有统计学意义(P0.01);RLD组、RD组、RSD组和R组坐骨神经阻滞感觉和运动维持时间分别为1006.00±117.58、810.00±105.41,932.00±144.18、744.00±136.09),738.00±120.16、582.00±96.04和708.00±126.45、548.00±111.12,差异有统计学意义(P0.01)。RLD、RSD及RD组在T1~T4点的Ramsay评分高于R组,心率低于R组(P0.05)。RLD组、RD组、RSD组和R组镇痛持续时间分别为1004.00±135.48、918.00±83.60、898.00±131.34和808.00±1 19.72,差异有统计学意义(P0.01)。无局麻药中毒发生。结论右美托咪定能随着剂量的增加而增强罗哌卡因腰丛-坐骨神经阻滞效果。右美托咪定能起到镇静作用,同时导致患者心率下降。     

Postoperative extradural analgesia with morphine and ropivacaine. A double-blind comparison between placebo and ropivacaine 10 mg/h or 16 mg/h

BACKGROUND: Some controversy exists in the literature on the benefit of epidurals compared to patient-controlled intravenous analgesia (PCA). Also, the dose of ropivacaine for epidural analgesia when combined with morphine remains uncertain. The aim of this study was to compare the epidural vs. PCA technique and high-dose vs. low-dose ropivacaine combined with morphine during knee replacement surgery. METHODS: In this prospective, randomized, double-blind study, postoperative pain relief with a combination of epidural ropivacaine (Group L: 10 mg h-1, Group H: 16 mg h-1) and morphine (0.16 mg h-1) was evaluated in 30 patients. A placebo group (Group PL) of 15 patients having PCA morphine served as the control. Visual analog pain (VAS), morphine consumption, sensory and motor block and side-effects were recorded during 48 h. RESULTS: VAS scores at rest were significantly lower in Groups L and H compared to Group PL. On movement, Group H had lower VAS scores than Group PL during 3-27 h (P<0.05) and Group L during 4-9 h (P<0.05), while Group L had lower a VAS than Group PL during 9-18 h (P<0.05). Morphine consumption after 48 h was greater in Group PL (64.6+/-36.3 mg) vs. Group L (23.3+/-33.9 mg) (P<0.001) and Group H (4.3+/-9.6 mg) (P<0.0001). Mild motor block was seen in Group H in 20% and 14% patients at 24 h and 48 h, respectively, but time to mobilization was similar between the groups. Pruritus was more common in the ropivacaine groups (P<0.05). CONCLUSION: Lumbar epidural analgesia using a combination of ropivacaine (16 mg h-1) and morphine (0.16 mg h-1) provides superior analgesia compared to the PCA technique or ropivacaine (10 mg h-1) and morphine (0.16 mg h-1). Although this resulted in a mild motor block during the first 12 h, patient mobilization was similar in all groups.     

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.     

不同浓度罗哌卡因超声引导下喉上神经阻滞 对支撑喉镜下会厌囊肿切除术的影响

目的 观察在超声引导下不同浓度的盐酸罗哌卡因喉上神经阻滞对会厌囊肿切除术患者的影响。 方法 选取2019 年9 月—2019 年11 月南京医科大学附属淮安第一医院收治的行支撑喉镜下会厌囊肿切除术 的会厌囊肿患者60 例。随机分为对照组、正常浓度组和低浓度组。对照组实施静脉全身麻醉（以下简称全 麻）,正常浓度组采用盐酸罗哌卡因（0.5%）在超声引导下行双侧喉上神经阻滞联合静脉全麻,低浓度组采用 低浓度盐酸罗哌卡因（0.25%）在超声引导下行双侧喉上神经阻滞联合静脉全麻。结果 正常浓度组、低浓 度组置入喉镜前（T0）、脑电双频普指数（BIS）值在40 ～ 60 时（T2）的丙泊酚泵注速率、瑞芬太尼泵注速 率较对照组低（P <0.05）。正常浓度组、低浓度组T0、置入喉镜即刻（T1）的心率（HR）、平均脉动压（MAP） 和BIS 最大波动值较对照组低（P <0.05）。正常浓度组、低浓度组拔管后即刻、拔管后6 h 的VAS 评分较 对照组低（P <0.05）。低浓度组拔管后有并发症的患者数较正常浓度组低,满意度较正常浓度组、对照组高 （P <0.05）。结论 0.25% 罗哌卡因神经阻滞能更好地保持术中血流动力学平稳,有效减轻会厌囊肿患者术后 疼痛,同时减轻术后并发症,实现患者的舒适化医疗和快速康复。     

多区域浸润麻醉减轻腹腔镜胆囊切除术后早期症状

目的探讨躯体、内脏局部浸润麻醉对择期腹腔镜胆囊切除术后疼痛、恶心症状的影响.方法随机将50例病人分为对照组和实验组,在门静脉周围和腹膜内分别浸润生理盐水66ml和罗吡卡因66ml;术后3h记录疼痛和恶心的程度、部位及所补充的哌替啶用量.结果罗吡卡因局部浸润可减轻术后3h的切口疼痛和恶心症状,但对腹内和肩部疼痛无明显效果;且术后3h所补充的哌替啶的用量显著减少.结论躯体、内脏局部浸润麻醉可减轻术后3h的切口疼痛、恶心及哌替啶用量.     

多瑞吉联合罗哌卡因用于腹腔镜胆囊切除术后镇痛的临床研究

目的 研究多瑞吉联合罗哌卡因局部浸润用于腹腔镜胆囊切除术后镇痛的效能和安全性.方法 择期全麻腹腔镜胆囊切除手术患者120例,均分为3组.罗哌组(A组):缝合切口前向胆囊床喷洒及切口局部浸润0.5%罗哌卡因;多瑞吉组(B组):入手术室时胸前贴多瑞吉贴膜;联合组(C组):入手术室时胸前贴多瑞吉,缝合切口前向胆囊床喷洒及切口局部浸润0.5%罗哌卡因.术中3组均采用气管插管控制呼吸异丙酚、芬太尼静脉麻醉,术后持续监测血氧饱和度、呼吸、血压、心电图,进行VAS评分、Ramsay评分,观察有无恶心、呕吐、瘙痒、眩晕、呼吸抑制等副反应.结果 镇痛效果:A组术后6 h内、B组术后6～48 h内镇痛效果满意,C组在术后48 h内镇痛效果满意;呼吸影响:3组病例均未出现血氧饱和度低于90%;副反应:恶心、呕吐发生率3组相似.瘙痒、眩晕发生率B、C组略高于A组,但无统计学差异(P＞0.05).结论 多瑞吉联合罗哌卡因局部浸润用于腹腔镜胆囊切除术术后镇痛安全有效.     

罗哌卡因与布比卡因用于硬膜外阻滞的临床对比观察

目的：将新型酰胺类局麻药罗哌卡因药效学与布比卡因进行比较。方法：选择行择期下肢手术病人40例,随机分成四组进行硬膜外麻醉,分别在硬膜外注入0．75％罗哌卡因（n=10例）,0．5％罗哌卡因（n=10例）和0．75％布比卡因（n=10例）,0．5％布比卡因（n=10例）15－18ml。分别观察感觉阻滞起效,最大运动阻滞,感觉、运动恢复时间及最高阻滞平面,最大Bromage评分及术中不良反应的情况。结果：罗哌卡因起效快,产生的麻醉平面广,镇痛、运动阻滞效果好。术中有低血压、心率减慢等副作用发生。结论：罗哌卡因应用于临床麻醉有可靠的麻醉性能及安全性,利用其感觉运动神经分离作用,利于病人术后早期活动,具有良好的临床应用前景。     

病人自控硬膜外镇痛用于经尿道前列腺电切术术后镇痛的临床观察

目的:观察硬膜外自控镇痛(PCEA)用于经尿道前列腺电切术术后镇痛作用。方法:选择经尿道前列腺电切术(T组)病人36人,随机分为3组,各12例。TΙ组术后给于单次剂量的吗啡和罗哌卡因;TⅡ组给于一次剂量罗哌卡因后接0.1%罗哌卡因硬膜外泵;TⅢ组给于一次剂量后接0.15%罗哌卡因硬膜外泵。术后观察0、1、4、8、24、36h病人心率、血压变化,同时记录有效按压硬膜外泵次数及视觉模拟评分(VAS评分)、不良反应等。结果:在术后0、1、4、8、24h,TΙ、TⅡ和TⅢ组VAS评分无显著性差异(P>0.05),36h后TΙ组的VAS评分要显著高于TⅡ、TⅢ组(P<0.05),TⅡ、TⅢ组VAS评分则无显著性差异。结论:不同浓度的罗哌卡因PCEA均能缓解术后膀胱痉挛痛,但以TⅢ组效果最好。     

布托啡诺对罗哌卡因腋路臂丛神经阻滞效果影响的临床研究

目的探讨布托啡诺联合罗哌卡因行臂丛神经阻滞的麻醉和镇痛的效果。方法60例需臂丛神经阻滞患者随机分威三组，A组局麻药0.5％罗哌卡因30ml，B组局麻药0.5％罗哌卡因30ml加布托啡诺1mg，C组局麻药0.5％罗哌卡固30ml加静脉注射布托啡诺1mg，记录感觉和运动起效和持续时间、镇痛持续时间、血流动力学指标和并发症。结果感觉阻滞时间和镇痛时间B组长于A、C组，运动阻滞和麻醉起赦时间三组无区别。结论臂丛神经阻滞0.5％罗哌卡因30ml加布托啡诺1mg比单独0.5%罗哌卡因30ml延长感觉阻滞时间和镇痛时间。