左布比卡因在腰-硬联合麻醉中的应用

Application of levobupivacaine in combined spinal-epidural anesthesia

目的:研究左布比卡因重比重液用于腰-硬联合麻醉的有效性和安全性。方法:80例拟行下肢手术病人,随机分为左布比卡因组和布比卡因组,每组40例,均行腰一硬联合麻醉。2组腰麻用药分别为0．5％左布比卡因重比重液或0．5％布比卡因重比重液,均为3 mL。记录2组感觉阻滞、运动阻滞情况和麻醉各时点血压心率变化及不良反应。结果:2组均获得满意的麻醉效果。左布比卡因组和布比卡因组的运动阻滞起效时间为(162±s 26)s和(143±27)s,P<0．0l;最大运动阻滞时间分别为(21±4)min和(18±4)min,P<0．01。运动阻滞恢复时间左布比卡因组(195±72)min,布比卡因组(218±78)min, P>0．05,感觉阻滞起效时间、程度、阻滞平面2组相似,均无严重不良反应。结论:腰-硬联合麻醉时,左布比卡因重比重液作为腰麻用药,效果好、安全。

AIM： To determine the clinical efficiency and safety of hyperbaric levobupivacaine mixsolution in combined spinal-epidural anesthesia （CSEA）. METHODS： Eighty patients scheduled for lower limb surgery were randomly divided into bupivacaine and levobupivacaine groups with 40 patients in each. All patients were undergone CSEA, with patients in the levobupivacaine and bupivacaine groups allocated to receive spinal hyperbaric mix-solution of 0.5 % levobupivacaine 3 mL and 0.5 % bupivacaine 3 mL, respectively. The level and duration of sensory anesthesia were recorded bilaterally by a pinprick test, and motor block in limb was assessed with a modified Bromage scale; and together with observation of hemodynamic changes and adverse reactions. RESULTS： Each group demonstrated perfect quality of anesthesia. The periods of minimal and maximum motor block in levobupivacaine group （ （ 162 ± s 26） s, （21 ± 4） min） were higher than those in bupivacaine group （（143 ± 27） s, （18 ± 4） rain）, P 〈 0.01. The periods of motor recession in levobupivacaine and bupivacaine group were （195 ± 72） rain and （218 ± 78） rain, with no significant difference （P〉 0.05）. In addition, the time required for reaching maximum sensor block and the level of sensory anesthesia were similar in the two groups. No serious adverse reactions occurred in both groups. CONCLUSION： Hyperbaric levobupivacaine is safe and effective for CSEA.