罗哌卡因在乳腺手术中的应用

Effect of different concentration ropivacaine in breast operation

目的 :观察罗哌卡因麻醉在乳腺手术中应用的可行性。方法 :选择ASAⅠ～Ⅱ级 30例乳腺手术患者 ,随机分为 3组 ,Ⅰ组 :2 .5g/L罗哌卡因组 (n =10 ) ;Ⅱ组 :3.75g/L罗哌卡因组 (n =10 ) ;Ⅲ组 :5g/L罗哌卡因组 (n =10 )。硬膜外穿刺成功后 ,注入 10g/L利多卡因 5ml,观察 5min。分别注入不同浓度罗哌卡因 10～ 15ml,2 0min后平面不满意者追加 5～ 10ml。连续记录给药时、给药后 15min、45min时血压、心率、xO2 。麻醉中患者不吸氧。结果 :麻醉平面出现时间 :Ⅰ组为 15min ,Ⅱ组为 10～ 15min ,Ⅲ组为 10min。镇痛效果 :极满意 :Ⅰ组 1例 ,Ⅱ组 3例 ,Ⅲ组 6例 ;满意 :Ⅰ组 2例 ,Ⅱ组 3例 ,Ⅲ组 3例 ;不满意 :Ⅰ组 7例 ,Ⅱ组 4例 ,Ⅲ组 1例。 3组患者均无不良反应。结论 :2 .5g/L罗哌卡因不适用于乳腺手术 ,3.75g/L罗哌卡因适用于乳房单切或区段切除的患者 ,5 .0g/L罗哌卡因用于乳腺手术镇痛完善、完全有效、且副作用少。

Aim: To observe feasibility of ropivacaine being used in breast operation.Methods: Thirty patients(ASA Ⅰ～Ⅱ) undergoing breast operation were randomly divided into 3 groups.Group Ⅰ,Ⅱ and Ⅲ were given ropivacaine 2.5 g/L,3.75 g/L,5.0 g/L.After epidural anesthesia,3 groups were all given 10 g/L lidocaine 5 ml as a test dose and observed for 5 min,then injected different concentration ropivacaine 10～15 ml,respectively.After 20 min patients with dissatisfactory analgesia level were given additional ropivacaine 5～10 ml. p MA , f H and x O 2 were recorded at injection,15 min,and 45 min after injection.Patients were not supplied O 2 during operation procedure.Results: The time block level occurred:Group Ⅰ,15 min,Group Ⅱ,10～15 min,Group Ⅲ,10 min.Analgesia effects:very satisfactory:one case in group Ⅰ,3 in group Ⅱ,6 in group Ⅲ; satisfactory:two in group Ⅰ,3 in group Ⅱ,3 in group Ⅲ;dissatisfactory:seven in group Ⅰ,4 in group Ⅱ,1 in group Ⅲ.No adverse reaction occurred in 3 groups.Conclusion: 2.5 g/L ropivacaine is not suitable for mammary gland operation.3.75 g/L ropivacaine can be used in regional breast surgery.5.0 g/L ropivacaine is suitable and safe for breast operation with satisfactory analgesia and fewer adverse reactions.