蛛网膜下腔注射左旋布比卡因与布比卡因运动阻滞效应的比较

The comparison of motor block effects between subarachnoid injection of levobupivacaine and bupivacaine

目的比较患者蛛网膜下腔注射左旋布比卡因与布比卡因的运动神经阻滞效应。方法择期腰硬联合麻醉下拟行泌尿外科腔镜手术患者60例，年龄18～64岁，ASA分级I或Ⅱ级，按随机数字表法分为0．5％左旋布比卡因组和0．5％布比卡因组（n=30），按照序贯法进行试验，阻滞有效，则下一例患者采用低一级剂量，阻滞无效，则下一例患者采用高一级剂量，初始剂量均为4mg，剂量梯度1mg，阻滞有效的标准：蛛网膜下腔给药后5或10min任一下肢的运动神经阻滞评分〉0分。采用序贯法计算蛛网膜下腔注射左旋布比卡因或布比卡因运动神经阻滞的半数有效剂量（ED50）。结果患者蛛网膜下腔注射左旋布比卡因和布比卡因运动神经阻滞的ED50及其95％置信区间分别为6．68（6．27，7．13）mg和5．06（4．56，5．47）mg，效力比为0．76。结论患者蛛网膜下腔注射左旋布比卡因运动神经阻滞效力小于布比卡因。

Objective To compare the ED50values for motor block with subarachnoid injection of levobupivacaine and bupivacaine. Methods Sixty patients aged 18 - 64 years old who were undergone the elective urological surgery with combined spinal-epi- dural（CSE） anesthesia were enrolled in this study. The patients were randomized divided into two groups. The patients received the spinal injection of 0. 5 % levobupivacaine （ group I, n = 30 ） or 0. 5 % bupivacaine （ group II , n = 30 ）. By using a sequential technique, varying doses of levobupivacaine or bupivacaine were administered. The efficacy of the studied drug was assessed by using a modified Bromage scale and the hip motor function scale at 5 min or 10 min. ED50was estimated by the up-and-down method. Results The motor block ED50 for the group I was 6. 68 mg （ 95 % CI 6. 27 - 7. 13 ） and for the group II was 5.06 mg （ 95 % Cl 4. 56 - 5.47 ）. The relative motor blocking potency ratios were 0. 76. Conclusion The EDs0for motor block of subarachnoid injection of levobupivacaine was lower than that of bupivacaine.