布比卡因、左旋布比卡因和罗哌卡因在下腹部手术中硬膜外阻滞效果比较

The anesthetic effects reactions of epidural bupivacaine,levobupivacaine and ropivacaine for underbelly surgery

目的比较布比卡因、左旋布比卡因和罗哌卡因3种局麻药用于下腹部手术硬膜外阻滞的麻醉效果与不良反应。方法将在硬膜外阻滞下行下腹部手术的90例患者随机分为3组。硬膜外穿刺置管成功后,先给试验量含1:200000的肾上腺素的2%利多卡因3ml,再分别给予浓度均为0.5%的布比卡因、左旋布比卡因和罗哌卡因中的一种,分次给药。记录各组的感觉和运动阻滞的起效、时效及不良反应。结果 3组均有较好的麻醉镇痛,但有一些肌松不满意的病例。罗哌卡因组的感觉阻滞起效、时效较其他两组长,但尚无统计学差异;其运动阻滞起效与时效和运动阻滞程度均不及其他两组,且有统计学差异(P<0.05)。3组均未发生严重不良反应。结论硬膜外0.5%的布比卡因、左旋布比卡因和罗哌卡因应用下腹部手术均有较好的麻醉镇痛效果,但罗哌卡因的阻滞起效与时效和运动阻滞程度均不及其他两药。

Objective To study the anesthetic effects and adverse reactions of epidural bupivacaine, levobupivacaine and ropivacaine for underbelly surgery. Methods Ninety patients scheduled for underbelly surgery under epidural block were assigned to receive one of the three local anesthetics. After the test dose of 2% lidocaine 3ml containing epinephrine 1:200 000,one of the three local anesthetics with concentration 0.5% and total dose 14ml were given for three times. The onset and duration of action of sense and motion block and adverse reactins were recorded. Results Fine analgesic effects were obtained in all the three groups, but there were some cases with unsatisfied muscle relaxation. Compared to bupivacagine and levobupivacaine groups, the onset time and duration of action of sense block in ropivacaine group were longer, but no significant difference was found, but the onset time and duration of action of motion block were shorter and extent of motion block were deeper with significant differences (P<0.05). No severe adverse reaction happened in three groups. Conclusion Epidural 0.5% bupicavaine,levobupivacaine or ropivacaine could cause good analgesic effects, but the motion block of ropivacaine is inferior to that of levobupivacaine or ropivacaine.