Pre-incisional epidural ropivacaine, sufentanil, clonidine, and (S)+-ketamine does not provide pre-emptive analgesia in patients undergoing major pancreatic surgery

BACKGROUND: The concept of pre-emptive analgesia remains controversial. This prospective, randomized, and double-blind study compared epidural administration of ropivacaine 2 mg ml(-1), sufentanil 0.5 microg ml(-1), clonidine 3 microg ml(-1), and S(+)-ketamine 0.25 mg ml(-1) (study solution) given before incision with the same combination started at the end of the operation. METHODS: After testing the stability of the solution using high performance liquid chromatography (HPLC) and examining 12 patients for possible side-effects in comparison with the epidural infusion of ropivacaine 2 mg ml(-1) and sufentanil 0.5 microg ml(-1), 30 patients undergoing major pancreatic surgery were recruited into the study. Before induction of anaesthesia, an epidural catheter was inserted (TH6-8). Patients in Group 1 received a bolus of 8 ml followed by a continuous infusion (8 ml h(-1)) of the study solution before induction of anaesthesia. In Group 2, patients received the same volume of saline before operation, the study solution was started at the end of surgery. After operation, the infusion was maintained for at least 96 h using a patient-controlled epidural analgesia (PCEA) pump in both groups. Patients were evaluated up to the seventh postoperative day for pain and side-effects. RESULTS: Visual analogue scale (VAS) values at rest were as follows: G1 vs G2: 24 h, 19 (sd 23) vs 6 (13); 48 h, 4 (10) vs 11 (21); and 72 h, 12 (22) vs 13 (21). VAS values during coughing and mobilization were also comparable. Total volume of epidural infusion was 904 (114) ml in G1 vs 892 (154) ml in G2. The incidence of side-effects (nausea, vomiting, and motor block) was low and not different between the groups. CONCLUSIONS: Pre-incisional epidural analgesic infusion did not provide pre-emptive analgesia compared with administration started at the end of surgery, but both groups had low pain scores.     

盐酸氨溴索与地塞米松在促胎肺成熟中的临床观察

目的:探讨产前应用盐酸氨溴索与地塞米松在促胎肺成熟中的疗效观察。方法:回顾性分析2005～2010年我院160例早产分娩的孕妇,随机分为两组,即治疗组和对照组,治疗组80例(产前28～34周应用盐酸氨溴索30mg/次,每天两次,5天),b组80例产前用地塞米松8mg/次,每天两次,连用3天,对比产后早产儿呼吸窘迫综合征的发病率。结果:盐酸氨溴索组降低早产儿呼吸窘迫综合征率明显优于地塞米松组,结论:产前应用盐酸氨溴索可以明显促胎肺成熟,降低早产儿呼吸窘迫综合征。提高早产儿存活率及生存质量。     

Early peristalsis following epidural analgesia during abdominal surgery in an extremely low birth weight infant

The inhibiting effect of opioids on intestinal motility is a cause of particular concern in extremely low birth weight (ELBW; birth weight <1000 g) infants with decreased peristalsis. An ELBW infant (birth weight 740 g) born after 26 + 1 week of gestation had an uneventful clinical course during the first few days of life. Sudden deterioration occurred on day 8 with metabolic acidosis, hyperglycemia and frequent apnea with secondary bradycardia. A chest X ray demonstrated the presence of air beneath the diaphragm. Intestinal perforation was suspected and the infant was taken to theater for laparotomy. For pain management, a 22 G epidural catheter was inserted via the caudal approach and threaded to a mid-thoracic level. Epidural ropivacaine was administered intraoperatively and for 48 h postoperatively. The infant was extubated on the following day. Opioids were not required or given at any stage during or after surgery. Peristalsis was present on auscultation as early as 3 h after surgery, the first stool was passed on the same day. Enteral nutrition was resumed early and tolerated well, full enteral feeding was rapidly achieved. Our case shows that the technique of caudal anesthesia is feasible in ELBW infants. We speculate that intestinal motility and establishment of full enteral feedings may be achieved earlier by epidural ropivacaine in cases of abdominal surgery in ELBW infants.     

Effect of epinephrine on epidural, intrathecal, and plasma pharmacokinetics of ropivacaine and bupivacaine in sheep

BACKGROUND: Local vasoconstriction induced by epinephrine added to epidural local anaesthetics has been shown to improve their quality and duration of action in several clinical reports. There are several assumptions on the mechanisms. This study was designed to evaluate the influence of epinephrine on transmeningeal uptake of epidurally administered ropivacaine and bupivacaine by measuring local anaesthetic concentrations in the epidural and intrathecal spaces and in plasma. METHODS: Ropivacaine (50 mg) and bupivacaine (30 mg) were administered epidurally in sheep with and without epinephrine (75 microg). A microdialysis technique was used to simultaneously measure epidural and intrathecal drug concentrations. Resulting dialysate and plasma concentrations were used to calculate pharmacokinetic parameters for ropivacaine and bupivacaine. RESULTS: Co-administration of epinephrine decreased epidural clearance for ropivacaine [0.6 (sd 0.1) vs 0.4 (0.1) ml min(-1)] but not significantly for bupivacaine [1.2 (0.4) vs 0.8 (0.3) ml min(-1)]. The resultant increase in epidural area under the concentration-time curves (31% for ropivacaine and 52% for bupivacaine) was also observed in the intrathecal space (21% increase for ropivacaine and 37% for bupivacaine). There was no significant influence of epinephrine on ropivacaine plasma pharmacokinetics. Plasma Cmax for bupivacaine was decreased. CONCLUSIONS: These results show that epinephrine decreases the clearance and distribution processes involved in epidural disposition of ropivacaine and bupivacaine, leading to an increased uptake into the intrathecal space with an apparent more pronounced effect for bupivacaine.     

罗哌卡因腰麻复合喷他佐辛镇静对老年患者呼吸功能的影响

目的 研究罗哌卡因腰麻复合喷他佐辛镇静对行下腹部以下手术老年患者呼吸功能的影响,同时观察低流量鼻导管吸氧对其氧合程度的影响.方法 选择65周岁以上行下腹部以下手术的老年患者40例,随机均分为罗哌卡因组（R组）及罗哌卡因复合喷他佐辛组（RP组）,2组均以0.5%盐酸罗哌卡因2.5 ml行L2～3间隙单次腰麻,转平卧位后RP组静脉注射喷他佐辛0.5 mg/kg.比较2组患者各时段心率（HR）、平均动脉压（MAP）、脉搏氧饱和度（SpO2）、氧分压（PO2）变化,评估2组患者镇静程度及麻醉满意度.结果 与T1时段相比,T2时段R组患者SpO2、PO2下降幅度轻微,RP组下降幅度明显（P〈0.05）,T3时段2组患者SpO2、PO2均明显上升并维持于较高水平（P〈0.05）.与R组比较,RP组患者的镇静程度、麻醉满意度高（P〈0.05）.结论 喷他佐辛0.5 mg/kg结合低流量鼻导管吸氧可较安全地用于老年患者腰麻后的辅助镇静,镇静程度、术者及患者满意度高.     

CLINICAL STUDY OF PATIENT-CONTROLLED EPIDURAL ANALGESIA WITH TETRACAINE HYDROCHLORIDE AFTER PULMONARY LOBECTOMY

Objective. To investigate the efficacy and safety of tetracaine hydrochloride in patient-controlled epidural analgesia (PCEA) after pulmonary lobectomy.Methods. Forty-three patients scheduled for elective pulmonary lobectomy under general anesthesia were randomly allocated into either tetracaine group (22 patients) or ropivacaine group (21 patients) . In the tetracaine group, 0. 15% tetracaine was used for postoperative PCEA, while 0. 3% ropivacaine was used in the ropivacaine group. The duration of postoperative analgesia was 48 h. The PCEA included a bolus of 6 ml with a lockout time of 1 h. Postoperative pain score was measured by visual analogue scale (VAS). Forced expired volume at the 1st second (FEV1.0), forced vital capacity (FVC), FEV1.0/ FVC and peak expired flow (PEF) were measured preoperatively and daily after surgery. Hemodynamics were monitored and recorded before and after each administration of local anesthetics during the period of the study.Results. VAS scores in both groups decreased     

罗哌卡因用于分娩镇痛的临床观察

目的：探讨相同浓度罗哌卡因或布比卡因用于硬膜外分娩镇痛的可行性。方法：72例育龄初产妇随机分为3组，A组（n=24),0.20%罗哌卡因；B组（n=24)0.20%布比卡因；C组（n=24)为对照组。采用双盲法进行视觉模拟疼痛评分（VAS）和行走功能评定。记录各组产妇的血压、脉搏、心电、血氧饱和度、胎心率（FHR）、产程长短、分娩方式、催产素用量以及新生儿Apgar评分和脐静脉血气分析。结果：A、B两组产妇均获得良好的镇痛效果，A组产妇100％能下床行走，B组75％产妇能下床行走，两组比较差异显著（P＜0．05）；3组产妇产程、分娩方式及新生儿Apgar评分均无差异（P＞0．05）。结论：罗哌卡因用于分娩镇痛优于布比卡因，且对母体和新生儿无不良影响。     

Ropivacaine 7.5 mg/ml for elective Caesarean section. A clinical and pharmacokinetic comparison of 150 mg and 187.5 mg

Background: The new, long-acting local anaesthetic ropivacaine has shown less systemic toxicity than bupivacaine and a concentration of 7.5 mg/ml can therefore be used for epidural anaesthesia in Caesarean section. The present pilot study was undertaken to find indications for an optimal dosage by comparing the clinical effects, quality of anaesthesia and pharmacokinetics of ropivacaine 150 mg (lower dose=LD) vs 187.5 mg (higher dose=HD) for women undergoing elective Caesarean section under epidural anaesthesia.
Methods: Sixteen full-term women scheduled for elective Caesarean section in two equal-sized consecutive groups received 20 or 25 ml ropivacaine epidurally in this non-randomised, open study. Study parameters included sensory and motor blockade, circulatory response, intraoperative pain and discomfort, neonatal evaluation and pharmacokinetic determinations.
Results: Block height varied between T5 and T2 in the LD group, whereas the HD group produced 4 unnecessarily high blocks (C8 in 3 women and C7 in 1 woman). Surgical anaesthesia was excellent in both groups. Circulatory stability was pronounced in the LD group (no ephedrine given), while 4 women required ephedrine in the HD group. Neonatal outcome as judged by Apgar scores, umbilical blood gas determinations and NACS scores were excellent in both groups. The plasma concentration-time profiles indicated linearity in the concentration range studied, with similar clearance values to those reported previously. Pla-cental drug equilibrium was rapid; however, the foetal drug exposure depended on intrauterine exposure time.
Conclusions: 20–25 ml ropivacaine 7.5 mg/ml produced very satisfactory conditions for elective Caesarean section under epidural anaesthesia. In this small population, 150 mg ropivacaine seemed optimal, while 187.5 mg produced unnecessarily extended block height in 50% of the women.     

盐酸普萘洛尔透皮吸收膜剂的研制

用离体大鼠皮肤为渗透屏障，研究了盐酸普萘洛尔在杜促灵、油酸、Ａｚｏｎｅ作用下的透皮效果．在盐酸普萘洛尔的饱和水溶液中促进效果大小依次为５０ｇ／ＬＡｚｏｎｅ，１００ｇ／Ｌ杜促灵、２００ｇ／Ｌ．杜促灵、５０ｇ／Ｌ杜促灵、５０ｇ／Ｌ油酸，并且杜促灵的滞后时间比Ａｚｏｎｅ短．在聚乙烯醇为成膜材料，１００ｇ／Ｌ杜促灵为促进剂制成的膜剂用于家兔皮肤进行药物动力学研究．结果表明，盐酸普萘洛尔膜剂透皮给药后以零级方式吸收进入血液循环．     

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。