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。     

Does the Use of an Intra-Articular Local Anesthetic Injection During Total Hip Arthroplasty Reduce Patient Reported Pain Scores or Patient Opioid Consumption?

BackgroundDuring primary total hip arthroplasty (THA), some surgeons use an intra-articular injection (IAI) containing 200 mg ropivacaine to target postoperative pain. There is no clear consensus on the efficacy of an IAI alone. The purpose of this study is to evaluate the effect of a 200 mg ropivacaine IAI on pain scores, opioid consumption, and mobility for primary THA patients.MethodsWe retrospectively reviewed 571 patients who underwent primary THA at a single institution. Patients were grouped according to those who received a 200 mg ropivacaine IAI and those who did not. Primary outcome measures for this study included pain scores, morphine milligram equivalents (MMEs) dosed, distance of ambulation achieved, and time to ambulation.ResultsThe intervention group reported higher average pain scores with activity than the control group (P = .024). The intervention group also required higher MMEs. When striated by hour, a statistically significant uptick in pain started at 16 hours (P = .0009) and persisted to 28 hours (P = .032) in patients receiving a 200 mg ropivacaine IAI. This correlated with an increase in MMEs seen at hour 24 through 32 (P = .003 to P = .012). Level of ambulation, time to ambulation, and distance ambulated did not differ between groups. An IAI of 200 mg ropivacaine also appeared to lead to higher pain scores and higher opioid doses in males.ConclusionThe IAI does not appear to reduce postoperative pain scores or MMEs dosed for THA patients. More research is needed to look at the utilization and efficacy of intra-articular ropivacaine, especially focusing on functional outcomes and gender differences.     

Optimizing Spinal Anesthesia in Same-Day Discharge Knee Arthroplasty Patients: Mepivacaine Versus Ropivacaine

BackgroundShort-acting spinal anesthetics are playing an increasing role in same-day discharge total joint arthroplasty though their direct comparison remains to be studied. Therefore, this study aims to compare two formulations of spinal anesthesia regarding time to discharge following knee arthroplasty surgery.MethodsA retrospective study was performed on 207 patients who underwent unicompartmental knee arthroplasty (UKA, n = 172) and total knee arthroplasty (TKA, n = 35) from May 2018 to December 2020 at a single institution and were discharged the same day. Two formulations of the spinal anesthetic were routinely administered in this population: 1) mepivacaine 1.5% 3-4 mL (n = 184) and 2) ropivacaine 0.5% 2.3-2.7 mL (n = 23). Discharge times were subsequently compared between mepivacaine and ropivacaine spinal anesthesia for each surgical procedure and between surgical procedures.ResultsThere was no significant difference in discharge times between patients receiving mepivacaine versus ropivacaine for UKA (202 minutes [range = 54-449] versus 218 minutes [range = 175-385], P = .45) or TKA (193 minutes [range = 68-384] versus 196 minutes [range = 68-412], P = .93). Similarly, no difference was found in discharge times between UKA and TKA patients receiving mepivacaine (P = .68) or ropivacaine (P = .51).ConclusionThere was no significant difference in discharge times between anesthetic agents among knee surgery patients. Therefore, either agent may be recommended for same-day discharge.     

自控硬膜外分娩镇痛对产程和母婴预后的影响

目的 研究罗哌卡因联合芬太尼于潜伏期即行硬膜外分娩镇痛的有效性及对母婴预后的影响.方法 回顾性分析2008年1月-2010年12月期间在该院妇产科分娩的1 800例初产妇,其中600例自愿接受罗哌卡因联合芬太尼自控硬膜外镇痛的600例产妇为镇痛组,条件类似却未行镇痛的1 200例为对照组,记录两组产妇的镇痛效果、各产程时间、催产素使用情况、分娩方式、产后出血量、新生儿Apgar评分以及不良反应;测定分娩过程中规律宫缩时（T1）、宫口开全时（T2）、胎儿娩出时（T3）、胎盘娩出后30 min（T4）时的空腹血糖（FPG）、空腹胰岛素（FINS）并计算出胰岛素抵抗指数HOMA-IR.结果 所有产程阶段镇痛组的VAS评分均显著低于对照组;镇痛组潜伏期及活跃期时间均较对照组缩短,第二产程时间较对照组长,差异具有统计学意义（P＜0.05）;两组在第三产程时间以及总产程时间上无明显差异（P＞0.05）;镇痛组阴道分娩率、催产素使用率高于对照组;两组新生儿Apgar评分及胎儿窘迫率无显著差别;镇痛组可以减轻胰岛素抵抗程度和血糖升高程度.结论 罗哌卡因联合芬太尼于潜伏期用于PCEA可降低剖宫产率,提高顺产率,减轻胰岛素抵抗程度和血糖升高程度,且不增加母婴并发症,是一种安全、有效、值得大范围推广的分娩镇痛方法     

Local anaesthetic agents

Local anaesthetics are weak bases and consist of a lipophilic aromatic ring, a link and a hydrophilic amine. The chemistry of the link classifies them as amides or esters. They act by blocking the sodium ionophore, especially in the activated state of the channel, and frequency dependence can be shown. The speed of onset is related to dose and proportion of drug in the unionized lipid-soluble form, which in turn is determined by the pK_a and the ambient pH. Local anaesthetic agents, being weak bases, are bound in the plasma to α1-acid glycoproteins, influencing duration of action. Esters undergo hydrolysis by esterases in the plasma. Amides are subject to phase I and II hepatic cytochrome P450 metabolism. The development of the S-enantiomers, levobupivacaine and ropivacaine, has not been without some controversy with regards to therapeutic benefits when assessed by clinical potency models such as the minimum local analgesic concentration (MLAC). Drugs derived from biological toxins that target and bind to the sodium ionophore are gaining acceptance for use as analgesics in chronic pain.     

小剂量罗呱卡因复合舒芬太尼蛛网膜下腔麻醉用于剖宫产的临床观察

目的探讨小剂量罗呱卡因复合舒芬太尼蛛网膜下腔麻醉用于剖宫产的临床效果。方法通过对2012年2月至2013年10月在我院进行剖宫产的90例产妇,随机分为对照组和实验组,每组均为45例产妇。对照组产妇仅给予小剂量罗呱卡因进行麻醉,实验组产妇给予小剂量罗呱卡因复合舒芬太尼进行麻醉。观察比较两组产妇的麻醉效果,产妇麻醉效果的满意度及不良反应发生情况。结果实验组产妇麻醉剂起效时间较对照组产妇明显降低,具有显著差异(P<0.05);实验组产妇的总满意度较对照组患者明显提高,具有显著性差异(P<0.05);实验组患者的不良反应发生率较对照组患者明显降低,具有显著性差异(P<0.05)。结论针对剖宫产产妇采用小剂量罗呱卡因复合舒芬太尼,具有显著的麻醉效果,提高患者的满意度,降低不良反应的发生率。小剂量罗呱卡因复合舒芬太尼对蛛网膜下腔麻醉剖宫产具有十分重要的临床意义,值得推广应用。     

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。     

硬膜外可行走分娩镇痛最适时间的研究

目的:观察罗哌卡因与芬太尼的混合液用于硬膜外可行走分娩镇痛的效果,探讨镇痛最适时间。方法:200例初产妇随机分为5组:A组(n=40)宫口扩张小于2cm时行镇痛;B组(n=40)宫口扩张至3cm时行镇痛;C组(n=40)宫口扩张至4cm时行镇痛;D组(n=40)宫口扩张至5cm或以上时行镇痛;E组(n=40)为对照组。镇痛组均应用0.12%罗哌卡因加芬太尼2μg/m l混合液镇痛。比较各组的镇痛效果、运动功能的评分、产妇的生命体征、胎心率(FHR)、产程时间、分娩方式、助产率、催产素用量以及新生儿A pgar评分、产后出血量等。结果:ABCD各组产妇均获得良好的镇痛效果,与E组比较均有极显著性差异(P<0.01)。各组的产程时间、分娩方式、助产率、催产素用量及新生儿A pgar评分、NACS评分、产后出血量无明显差异(P>0.05)。结论:硬膜外可行走分娩镇痛最适时间应根据产妇意愿而决定。     

盐酸罗哌卡因对胃癌MGC-803细胞增殖和凋亡的作用

目的:探讨盐酸罗哌卡因对人胃癌MGC-803细胞增殖和凋亡的影响。方法:细胞计数试剂盒（CCK-8）检测盐酸罗哌卡因对MGC-803细胞增殖能力的影响,并确定盐酸罗哌卡因的用药浓度,流式细胞术检测盐酸罗哌卡因对MGC-803细胞周期的影响,Annexin V-FITC/PI法检测盐酸罗哌卡因对MGC-803细胞凋亡的影响,蛋白免疫印迹法（Western blot）检测盐酸罗哌卡因对MGC-803细胞中B细胞淋巴瘤/白血病-2（Bcl-2）、Bcl-2相关X蛋白（Bax）和剪切的含半胱氨酸的天冬氨酸蛋白水解酶3（Cleaved Caspase-3）蛋白表达水平。结果:随着盐酸罗哌卡因用药浓度的升高,MGC-803细胞增殖能力逐渐降低,根据CCK-8实验结果分别筛选出浓度为10、50 μg/ml和100 μg/ml的盐酸罗哌卡因用于后续实验。盐酸罗哌卡因能够明显阻滞细胞周期于G2期,诱导细胞凋亡,抑制Bcl-2蛋白表达,促进Bax和Cleaved Caspase-3蛋白表达。结论:盐酸罗哌卡因能够抑制胃癌MGC-803细胞增殖,阻碍MGC-803细胞周期进程,诱导细胞凋亡,该过程可能与下调Bcl-2蛋白表达,上调Bax和Cleaved Caspase-3蛋白表达有关。     

盐酸罗哌卡因复合氢吗啡酮腰椎麻醉在剖宫产手术中的应用

目的 探讨盐酸罗哌卡因复合氢吗啡酮腰椎麻醉在剖宫产手术中的价值.方法 选择剖宫产产妇80例为研究对象,按照随机数字表法分为观察组和对照组,每组40例.对照组采用盐酸罗哌卡因腰椎麻醉,观察组采用盐酸罗哌卡因复合氢吗啡酮腰椎麻醉.比较2组产妇围手术期指标(手术时间、娩出时间、麻醉剂量、输液量、产后出血量)和麻醉效果,比较2...