0.15%左旋布比卡因用于下肢术后镇痛的临床观察

A Comparison Study of Epidural Analgesia with 0.15% Levobupivacaine and 0.15% Bupivacaine After low Extremity Operation

目的:观察0.15%左旋布比卡因用于下肢手术病人术后硬膜外镇痛的临床效应。方法:60例择期下肢手术病人随机分为2组,LBUP组和BUP组,每组30例。手术结束采用持续硬膜外输注镇痛,LBUP组采用0.15%左旋布比卡因加吗啡0.1mg/m l,BUP组采用0.15%布比卡因加吗啡0.1mg/m l,输注速度均为2m l/h。观察术后48h内的VAS疼痛评分、患者对镇痛治疗总体印象评分、改良Bromage评分、术后活动能力及不良反应的发生情况。结果:两组病人在术后5个时段VAS疼痛评分、镇痛结束时对疼痛的总体评估、镇痛后4h改良Bromage评分及不良反应发生情况,组间比较并无显著性差异(P>0.05);镇痛8h后LBUP组及BUP组分别有2例病人Bromage评分=2,至镇痛后16h恢复;术后24h LBUP组及BUP组分别有12例(40%)及11例(36.7%)的病人可以短时间行走,无显著性差异(P>0.05)。结论:0.15%左旋布比卡因与0.15%布比卡因用于下肢手术后持续硬膜外输注镇痛,均可获得满意的镇痛效果,两种药物的镇痛疗效没有差别。

Objective： To research the efficacy of epidural analgesia with 0.15% levobupivacaine and 0.15% b upivacaine after low extremity operations. Methods： 60 ASA Ⅰ～Ⅱ patients undergoing low extremity operation under epidural analgesia were randomly divided into two groups, 30 cases in each groups. After operation, patients in group LBUP were given continuous epidural infusion at a rate of 2ml/h with 0.15% levobupivacaine combined with morphine 0. 1 mg/ml, and in group BUP with 0. 15% bupivacaine combined with morphine 0. 1 mg/ml. The VAS score, patients＇ overall impression of treatment, modified Bromage motor scale score, and severity of side effects after operation were recorded. Result： There was no significant difference in VAS score at 4h, 8h, 16h, 24h, 48h, and patients＇ overall impression of treatment at 48h, and modified Bromage motor scale score at 4h, and severity of side effects after operation （ P 〉0.05 ）. But there were two persons in group LBUP and group BUP respective whose modified Bromage motor scale score was two at 8h and recovered at 16h after operation. On the first postoperative day, there was no significant difference in percent of patients who were ambulatory for a little time between group LBUP and group BUP （40% vs 36.7% ,P 〉0.051. Conclusion： Postoperative epidural infusion with 0. 15% levobupivacaine or 0. 15% bupivacaine can provide effective analgesia. The clinic efficacy of 0. 15% levobupivacaine and 0.15% bupivacaine was same.