左旋布比卡因和罗哌卡因对周围神经的毒性作用及其临床意义

L-bupivacaine-and ropivacaine-induced neurotoxicity in peripheral nerve and its clinical significance

神经损伤为区域神经阻滞的常见并发症，尽管新型酰胺类长效局麻药左旋布比卡因、罗哌卡因的应用增多，布比卡因逐渐减少，但目前尚无充分证据表明此类并发症发生率下降。因而此文将按下述纲领进行阐述：①左旋布比卡因和罗哌卡因与暂时性神经病学综合征（transient neurological syndrome，TNS）；②左旋布比卡因和罗哌卡因与马尾神经综合征（cauda equinea syndrome，CES）；③左旋布比卡因和罗哌卡因与周围神经毒性损伤；④预先存在神经病理学改变时左旋布比卡因和罗哌卡因与周围神经毒性损伤；⑤左旋布比卡因和罗哌卡因与肌肉毒性损伤。以供临床麻醉处理及疼痛治疗参考。

The common complication in regional anesthesia is nerve injury. Even though we have used more L-bupivacaine or ropivacaine and less bupivacaine in recent years, the incidence of this complication has been not reduced. This article discusses the transient neurological syndrome （TNS）, cauda equinea syndrome （CES）, peripheral nerve toxicity reaction, exacerbated neurotoxicity by preexisting neuropathologic change in peripheral nerve, muscle toxicity induced by L-bupivacaine and ropivacaine