罗哌卡因腰椎-硬膜外联合麻醉用于妇科手术的探讨

Application of spinal-epidural combination anesthesia with ropicavaine in gynecologic operation

目的 探讨罗哌卡因腰椎 -硬膜外联合麻醉用于妇科手术的安全有效性及合适剂量。方法 择期妇科手术 60例 ,ASAⅠ～Ⅱ级 ,用一次性腰椎 -硬膜外联合穿刺包在L1 - 2 间隙穿刺。随机分成 3组 :Ⅰ组 ,布比卡因 1 1 .35mg(n=2 0 ) ;Ⅱ组 ,罗哌卡因 1 0mg(n =2 0 ) ;Ⅲ组 ,罗哌卡因 1 5mg(n =2 0 )。术中酌情追加 2 %利多卡因以改善肌松。观察感觉与运动阻滞时间、镇痛和腹壁肌松质量、Bromage评分及副作用。结果 Ⅰ ,Ⅲ组感觉阻滞起效时间、阻滞完善时间无差异 (P >0 0 5) ,Ⅱ组阻滞完善时间较其他两组时间长 (P <0 0 5) ,运动阻滞时间亦长 (P <0 0 5) ,Ⅰ ,Ⅲ组运动阻滞起效时间无差异 (P >0 0 5) ,运动恢复时间Ⅱ ,Ⅲ组要短于Ⅰ组 ,差异有显著性 (P <0 0 5) ,镇痛和腹壁肌松质量Ⅰ组和Ⅲ组均优于Ⅱ组 (P <0 0 5)。观察中无严重副作用。结论 适量罗哌卡因腰椎 -硬膜外联合麻醉用于妇科手术 ,1 5mg是安全有效剂量 ,镇痛、肌松满意 。

Objective To evaluate the clinical safety and efficacy of spinal-epidural combination anesthesia with ropicavaine and its appropriate dose in gynecologic operation. Methods Sixty patients undergoing gynecologic operation with ASA class Ⅰ～Ⅱ were randomly divided into three groups: group I ( n= 20) with injection of bupivacaine 11. 35 mg , group Ⅱ ( n= 20) with ropivacaine 10 mg, and group Ⅲ ( n= 20)with ropivacaine 15 mg. These agents were injected into L 2-3 inter space with spinal-epidural combination anesthesia kit. If necessary, 2% lidocaine will added for improving abdominal muscle relaxation. The time of sensory and motor block, Bromage scale of abdominal muscle relaxation and analgesia and side effects were recorded. Results The start time and satisfactory time of sensory block was not significantly different between group Ⅰ and group Ⅲ( P >0 05). The duration of sensory block and motor block in group Ⅱ was longer than that of others. The duration of motor block in group Ⅰ and Ⅲ was similar ( P > 0 05 ). The recovery time of motor block in group Ⅱ and Ⅲ was less than that in group Ⅰ( P <0 05). The quality of abdominal muscle relaxation and analgesia of group Ⅱ and Ⅲ was better than that in group Ⅰ( P <0 05). No serious side effects in the period of operation were recorded. Conclusion Spinal-epidural combination anesthesia with appropriate dose of ropivacaine in gynecologic operation was safe and effective, with good abdominal muscle relaxation and rapid recovery of postoperative motor.