腹式子宫切除术后甲磺酸罗哌卡因与盐酸罗哌卡因硬膜外病人自控镇痛的比较

目的比较腹式子宫切除术后甲磺酸罗哌卡因与盐酸罗哌卡因硬膜外病人自控镇痛(PCEA)的效果。方法44例腹式子宫切除术病人随机分为两组(n=22):对照组应用0.75%盐酸罗哌卡因连续硬膜外麻醉,术后应用0.2%盐酸罗哌卡因作PCEA;试验组应用0.894%甲磺酸罗哌卡因连续硬膜外麻醉,术后应用0.237%甲磺酸罗哌卡因作PCEA。采用视觉模拟评分法(VAS)评价病人静卧时与咳嗽时的疼痛程度,以修正的Bromage评分法评价病人运动阻滞程度,记录镇痛质量、PCEA 情况和不良反应发生情况。结果两组病人术后VAS评分、镇痛质量、运动阻滞程度及不良反应的发生率比较差异无统计学意义(P>0.05),试验组镇痛泵有效按压次数少于对照组(P<0.05),除PCEA开始-4 h外,试验组病人其余时间段用药量均少于对照组(P<0.05)。结论0.237%甲磺酸罗哌卡因可用于腹式子宫切除术后PCEA,其镇痛效果和安全性与0.2%盐酸罗哌卡因相似。

A comparison of ropivacaine mesylate and ropivacaine hydrochloride for patient-controlled epidural analgesia after transabdominal hysterectomy

Objective To compare the effect of ropivacaine mesylate with ropivacaine HC1 for patient-controlled epidural analgesia ( PCEA) after transabdominal hysterectomy. Methods Forty-four ASA 1 or D patients aged 18-65 yrs weighing 45-80 kg undergoing elective abdominal hysterectomy performed under epidural anesthesia with either 0.75% ropivacaine HO (control group, n = 22) or 0.894% ropivacaine mesylate (study group, n= 22) . An epidural catheter was placed at L2,3 and advanced 3 cm into the epidural space. After operation PCEA was performed with 0.2% ropivacaine HCl ( control group) or 0.237 % ropivacaine mesylate (study group) respectively. Postoperative pain was assessed using VAS (0-10, 0 = no pain, 10 = worst pain) . Motor blockade was assessed using the Bromage scoring system. The patients' satisfaction level and adverse events were also recorded. Results There were no significant differences in VAS scores, motor blockade and incidence of adverse events between the two groups. The number of effective pressing in study group was significantly less than that in control group. Starting from 4h after operation the drug consumption in study group was significantly less than that in control group. Conclusion 0.237 % ropivacaine mesylate can be used for PCEA after transabdominal hysterectomy as safely as 0.2% ropivacaine HCl.