不同局部麻醉药硬膜外阻滞麻醉行隆乳术的效果

目的观察隆乳手术中不同局部麻醉药混合液行硬膜外阻滞的麻醉效果及并发症.方法 120例行乳房假体置入术患者分为4组,以T4～T5棘突间隙为硬膜外穿刺点,分别注入含1 %利多卡因及0.375 %罗哌卡因、0.25 %罗哌卡因、0.25 %布比卡因的混合液及单纯1.3 %利多卡因溶液,初量13 ml,观察麻醉效果及对血流动力学的影响和并发症.结果切皮均无疼痛,脉搏氧饱和度无明显变化,血压及心率轻度降低.1 %利多卡因加0.375 %罗哌卡因、0.25 %罗哌卡因或0.25 %布比卡因混合液组的阻滞麻醉效果较好,单纯1.3 %利多卡因组效果较差.65例(54 %)患者出现鼻塞,39例(33 %)麻醉后发生心动过缓,无组间差异.结论高位硬膜外阻滞麻醉可安全、有效地应用于隆乳房手术麻醉,1 %利多卡因与0.25 %罗哌卡因或布比卡因混合液不仅阻滞麻醉效果较好,对生理功能影响也较小.

Effects of continuous high thoracic epidural anesthesia with different local anesthetic in breast augmentation

Objective To investigate the efficacy and complication of high thoracic epidural anesthesia with different local anesthetic in breast augmentation. Methods 120 consecutive healthy women were scheduled for breast augmentation under continuous thoracic epidural anesthesia with four different compound of local anesthetic. The epidural tube was placed into the intervertebral space between the fourth and fifth thoracic vertebrae. A 13 ml bolus of 1 % lidocaine and 0.375 % ropivacaine, or 1 % lidocaine and 0.25 % ropivacaine, or 1 % lidocaine and 0.25 % bupivacaine, or pure 1.3 % lidocaine was used as a primary anesthetic agent. Results All cases were successfully anesthetized. There were no significant changes in respiratory function with oxygen inhalation; Only a slightly decreased of blood pressure and heart rate were noted. The effects of epidural anesthesia with compound of 1% lidocaine and 0.375 % ropivacaine, or 1 % lidocaine and 0.25 % ropivacaine, or 1 % lidocaine and 0.25 % bupivacaine were better than that with pure 1.3 % lidocaine. Stuffy nose was noticed in 65 patients (54 %) and were effectively treated by compound furacilin nasal drops. Bradycardia happened in 39 patients (33 %) and were treated by atropine or scopolamine. Conclusions This study reveals that thoracic epidural anesthesia is effective and safe for breast augmentation. The block effects of compound of 1 % lidocaine and 0.25 % ropivacaine, or 1 % lidocaine and 0.25 % bupivacaine are more significant, and interference for physiologic state is less.