左旋布比卡因与布比卡因单侧蛛网膜下隙阻滞特征的比较

Comparison of the block characteristics of levobupivacaine vs bupivacaine for unilateral spinal block

目的比较左旋布比卡因与布比卡因轻比重单侧蛛网膜下隙阻滞(单侧腰麻)的阻滞特征(痛觉和运动阻滞起效时间及持效时间,阻滞平面固定时间和持效时间)。方法下肢手术60例,随机等分为两组,患侧向上侧卧,L3￣4腰硬联合阻滞。对照组用0.75%布比卡因(B)0.8ml(6mg),加注射用水稀释至2ml后单次注射,注速1ml/15s,注药后保持原位15min后仰卧。实验组用0.75%左旋布比卡因(LB),其他与对照组完全相同。结果①两组比较,阻滞特征的6项指标中除运动阻滞持效时间LB组较短有显著性差异(P<0.05)外,其余指标无显著性差异(P>0.05)。②两组的阻滞前后平均动脉压和心率的变化均无显著性差异(P>0.05)。③两组的单侧阻滞率均为100%,且单侧阻滞均完善。结论LB和B单侧腰麻的阻滞特征除运动阻滞持效时间LB较短外基本一致,对循环的干扰均较轻,二者应可任选。

Objective To compare the block characteristics of levobupivacaine and bupivacaine for hypobaric unilateral spinal block. Methods Sixty patients undergoing hypobaric unilateral spinal block for lower extremity operations were randomized into 2 equal groups, In one group the patients were asked to lie on the uncompromised side for slow injection of hypobaric bupivacaine solution （0.75% 6 mg, diluted to 2 ml with distilled water） at the rate of 1 ml/15 s through a 27-gauge needle. The patients maintained their position for 15 min before shifting to a supine position. In the other group levobupivacaine was used instead. Results Statistical study showed that the block characteristics were of no significant difference between the 2 groups （P〉0.05） except that the duration of motor block was shorter in levobupivacaine group than in bupivacaine group （P〈0.05）. Blood pressure or heart rate showed no significant difference between the two groups during operation. Conclusion The block characteristics of hypobaric unilateral spinal block with levobupivacaine or bupivacaine are similar and their effect on circulatory function is slight. Levobupivacaine provides an option in case bupivacaine is not available.