甲磺酸罗比卡因腰麻在膝关节镜检术中的应用

目的:探讨甲磺酸罗比卡因腰麻用于膝关节镜检术的安全性与有效性。方法:选择择期行膝关节镜检术ASA～级的患者40例,随机分为两组,甲磺酸罗比卡因(R)组、布比卡因(B)组,每组20例。局麻药的配方分别为R组1.192%甲磺酸罗比卡因重比重液2.4mL,B组0.75%布比卡因重比重液2.4mL,两组均取L3～4间隙行蛛网膜下隙阻滞穿刺,待脑脊液出现后注入局麻药,观察记录两组痛觉阻滞起效时间、痛觉阻滞的最大范围及平面固定时间、痛觉阻滞维持时间。采用改良的Bromage分级评定运动阻滞,记录运动阻滞起效时间、最大运动阻滞分级及时间、完全阻滞的患者数、运动阻滞的持续时间、自主排尿时间及术后尿潴留的发生率,连续记录给药后5、10、15、30、60min时的血压、心率及麻黄素和阿托品的追加使用情况、同时记录不良反应和并发症的发生情况。结果:与B组相比,R组痛觉阻滞起效慢,最高阻滞平面较低但持续时间较长,R组运动阻滞起效慢但持续时间短,自主排尿时间早,血流动力学稳定,不良反应少。结论:1.192%甲磺酸罗比卡因重比重液以其血流动力学稳定、不良反应少可安全用于腰麻的实施。

The application of subarachnoid block with ropivacaine mesylate and bupivacaine during arthroscopy

Objective:To investigate the safety and efficacy of subarachnoid block with ropivacaine mesylate and bupivacaine during arthroscopy.Methods:Forty grade ASA Ⅰ～Ⅱ patients electively undergoing arthroscopy with subarachnoid block were randomely divided into two groups ropivacaine(group R),bupivacaine(group B),patients in both of the groups received 2.4 mL hyperbaric solution of ropivacaine mesylate and bupivacaine respectively after cerebral spinal fluide occurred.The onset time of sensory and motor block were evaluated as well as the maximum extent and duration of the sensory and motor block.Particularly,use bromage method to evaluate the rank and recovery of motor block,meanwhile,pulse rate,blood pressure,time to mobilization and urine,adverse events and other complications such as nausea and vomiting were also recorded.Results:The onset of sensory and motor block is slower in group R than that in group B and there are statistical difference between two groups.The extent of sensory block is narrower in group R than that in group B and there are statistical difference between two groups.moreover,Patients in group R mobilized sooner than patients in groups B and there were significant difference in adverse events(bradycardia P<0.01,nausea and vomiting P<0.05)between two groups.The number of patients who needs ephedrine and atropine in group B is more than that in group R.Conclusion:Subarachnoid block with ropivacaine mesylate is safe and effective due to less adverse effect on haemodynamics and rapid recovery from motor block.Therefore,it is suggested that ropivacaine mesylate can be used in subarachnoid block.