剖宫产术后患者左旋布比卡因、罗哌卡因与布比卡因混合芬太尼硬膜外镇痛的效应

Patient-controlled epidural analgesia with levobupivacaine versus ropivacaine and racemic bupivacaine after cesarean section

目的 比较左旋布比卡因、罗哌卡因和布比卡因复合芬太尼用于剖宫产术后硬膜外镇痛的效果和副作用。方法 采用随机双盲法,将51例择期行剖宫产术的足月、单胎孕妇分为三组:左旋布比卡因组(L组)、罗哌卡因组(R组)和布比卡因组(B组),每组17例。术后分别采用0.125％左旋布比卡因、0.2％罗哌卡因及0.125％布比卡因复合小剂量芬太尼(2μg·ml-1)行病人自控硬膜外镇痛(PCEA)。观察各组术后48 h内镇痛效果、运动阻滞程度变化以及恶心呕吐、尿潴留等副作用的发生率。结果 三组产妇术后视觉模拟评分、改良Bromage评分比较差异均无显著性(P>0.05)。三组产妇对PCEA的非常满意率差异无显著性(L组88.2％,R组76.5％,B组81.3％,P>0.05)。三组不良反应发生率及排气时间差异无显著性(P>0.05)。结论 0.125％左旋布比卡因混合芬太尼(2μg·ml-1)用于产科术后硬膜外镇痛可获得满意的镇痛效果且无明显毒副作用。

Objective To compare levobupivacaine with ropivacaine and racemic bupivacaine for patient-controlled epidural analgesia (PCEA) after cesarean section with respect to their relative efficay and side effects. Methods Fifty-one ASA Ⅰ-Ⅱ full-term nulliparous women aged 22-38 yrs, weighing 60-85 kg undergoing elective cesarean section under epidural anesthesia were enrolled in this prospective, randomized, double-blind study. Epidural puncture was performed at L2-3 interspace and a catheter was advanced 3-4 cm in the epidural space. Cesarean section was performed under epidural anesthesia with a mixture of 1% lidocaine and 0.25% tetracaine. After operation the patients were randomized to receive 0.125% levobupivacaine (group L, n = 17) or 2% ropivacaine (group R, n = 17) or 0.125% bupivacaine (group B, n = 17) for PCEA. The PCEA solutions in the 3 groups contained fentanyl 2 μg·ml-1 . PCEA pump was set with a 6 ml bolus dose and a 15-min lock-out interval. Intramuscular pethidine was available for rescue analgesia if required. The visual analog scale (VAS) score, high satisfaction rate, the ratio of the number of attempts calculated ( D1) to the number of successfully delivered doses ( D2), modified Bromage Motor Scale score, cardiovascular variables and side effects were recorded at regular intervals after operation. Results The three groups were comparable with respect to demographic data, efficacy of analgesia, motor blockade and side effects. There was no significant difference in D1 /D2 and high satisfaction rate [88.2% (L group); 76.5% (R group); 81.3% (B group) P > 0.05] between group L and other two groups.Conclusion PCEA with 0.125% levobupivacaine containing fentanyl 2 μg·ml-1 provides adequate pain relief after cesarean section with recovery of motor function similar to that with 0.2% ropivacaine and 0.125% racemic bupivacaine.