不同低浓度罗哌卡因低位硬膜外镇痛对运动神经阻滞的临床观察

目的 观察不同低浓度罗哌卡因（ropivacaine,Rop）低位硬膜外镇痛对运动神经的阻滞作用。探讨罗哌卡因低位硬膜外镇痛的最佳药物浓度。方法 随机选择我院67例下腹部择期手术患者，术后随机分为5个治疗组（A、B、C、D、E）和一个对照组（F），3h后硬膜外腔用药。前5组使用不同浓度罗哌卡因（A：0.1%;B:0.15%;C:0.2%;D:0.25%;E:0.3%），F组使用0.9%生理盐水。注药前后20分钟分别观察、记录以下项目：1.视觉模拟评分（Visual analogue scale,VAS）；2.阻滞区运动神经反射；3. 下肢指令运动。结果 不同低浓度罗哌卡因均有程度不同的术后镇痛作用。对运动神经的阻滞作用A、B、C三组与对照组无显著性差异（P＞0.05），而D、E两组有显著性差异（P＜0.05）。结论 选择浓度为0.2%的罗哌卡因低位硬膜外镇痛既可以有效地发挥术后镇痛作用，又最大程度地减少了对运动神经的阻滞作用，有利患者术后恢复。

Motor-blocking effects of ropivacaine at different low concentrations as epidural anesthetics on patients after lower abdominal surgery

Objective To compare the motor blocking effects of ropivacaine at different low concentrations as postoperative epidural anesthetics on patients after lower abdominal surgery.Methods Randomly selected 67 patients undergoing lower abdominal surgery and divided into 6 groups:5 treated groups(A 0.1%Rop;B 0.1%5%Rop;C 0 2%Rop;D 0.25%Rop;E 0.3%Rop)and a control group(F 0.9%NS).Epidural infusions were demonstrated 3h after operation.Observed and recorded visual analogue scale(VAS),reflex of the motor nerve and action of legs 20 minutes before and after infusuion.Compare the differences between each treated group and control group.Results 5 treated groups showed different but reliable effects on postoperative pain relief.Contrast to group D and E,group A?B and C have no significant difference between control group on motor block.Conclusion 0.2% ropivacaine has reliable function of postoperative pain relief while the effect of motor blocking is not significant than the control.We concluded 0 2% ropivacaine is best as postoperative epidural anesthetics.