罗哌卡因与利多-布比卡因在眼科手术中作为球后麻醉剂的对比

Comparison of ropivacaine with bupivacaine and lidocaine in retrobulbar anesthesia for ophthalmic surgery

目的探讨罗哌卡因在眼科手术中作为局麻药物的应用价值。方法收集2011年2月至2011年9月120例择期行眼部手术的住院患者，男73例，女47例。年龄16～71岁，平均（43．39±5．37）岁。随机分为1％罗哌卡因组，2％利多卡因＋0．75％布比卡因组，每组各60例，两组注射剂量均为3．5ml。评估各组患者镇痛、运动阻滞效果及两种药物毒副反应。结果麻醉满意所需时间，利多-布比组（5±3）min，罗哌卡因组（6±2）min（P=0．18）。术中口头评估有无疼痛，罗哌卡因组2例（3％），利多-布比组8例（13％）（P=0．048）。术后于1h、3h、6h口头评估有无疼痛，各时间点差异均有统计学意义，对比术中60min、90min、120min、150min显微镜下角膜水肿情况，两组各时间点均有显著差异。术后第一天，非眼压高或血糖波动所引起，发生不同程度恶心呕吐，罗哌卡因组7例（12％），利多-布比组24例（50％）（P〈0．01）。对比罗哌卡因组和利多-布比组的疼痛视觉模拟评分（VAS）、对运动及感觉阻滞程度比较无统计学意义。结论两组麻醉剂应用于临床眼科手术时，术中球后麻醉起效时间相似，罗哌卡因组术中发生角膜水肿少、镇痛效果好，用于体质较差患者，术后较少有恶心呕吐发生，用于术后镇痛时间长。

Objective To evaluate the efficiency of ropivacaine in retrobulbar anesthesia. Meth- ods A total of 120 patients undergoing elective ophthalmic surgery were selected from the depart- ment of ophthalmology of the First Affiliated Hospital of Zhengzhou University （73 men and 47 women age 16-71 years old, mean age 43.39±5.37 years old）, were randomly allocated to receive 1% ropivacaine or 0.75% bupivacaine - 2%lidocaine. The dose of two groups was 3.5mi. Time required for onset of surgical anesthesia, quality of intraoperative and postoperative analgesia and analgesic consumption were recorded. Results Surgical block was achieved after 5-3 min in the lido-bupivacaine group and after 6±3 min in the ropivacaine group （P =0.18）. Either during surgery or postoperative, the assessment of oral pain revealed significant difference. During surgery, comparison of corneal edema at 60min, 90min, 120min, 150min, the results showed significant difference. On postoperative day 1, 7 （12%） patients in the ropivacaine group reported varying degrees nausea and vomiting, compared with 24 （40%） patients in the lido-bupivacaine group （P 〈0.01）. Conclusions Ropivacaine has an onset similar to that of the lidocaine-bupivacaine mixture, has less corneal toxicity, causes less patients happening nausea and vomiting than bupivacaine and provides a better quality of intraoperative and postoperative analgesia.