高龄患者PFNA术等剂量罗哌卡因与左布比卡因腰丛神经阻滞的效果比较

Comparison of the effect of an equal dose of ropivacaine and levobupivacaine on lumbar plexus block in aged patients undergoing PFNA

目的探讨高龄患者股骨近端髓内钉(proximal femoral nail antirotation,PFNA)术等剂量罗哌卡因与左布比卡因腰丛神经阻滞的效果比较。方法选择行择期单侧PFNA手术患者60例,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级为Ⅰ和Ⅱ级,年龄65~95岁,采用随机数字表法分为2组,每组30例。2组均在超声联合神经刺激器引导下行腰丛神经阻滞,L组选用0.375%罗哌卡因25 mL,B组选用0.375%左布比卡因25 mL,比较2组感觉阻滞起效及感觉阻滞持续时间、运动阻滞起效及运动阻滞持续时间,术后6,12,24,48 h静息VAS评分、术后48 h内镇痛泵使用情况及不良反应发生情况。结果L组感觉阻滞持续时间和运动阻滞持续时间明显短于B组(P<0.05)。2组各时点静息VAS评分均呈先升高后降低趋势,B组升高幅度明显小于L组,组间、时点间、组间·时点间交互作用差异均有统计学意义(P<0.05)。L组首次镇痛泵按压时间明显短于B组(P<0.05)。结论等剂量罗哌卡因与左布比卡因腰丛神经阻滞用于高龄患者PFNA术均具有良好的麻醉镇痛效果,阻滞起效时间相近,但罗哌卡因阻滞持续时间较左布比卡因短,更有利于患者早期活动,促进术后更快恢复,安全性更好,值得推广。

Objective To compare the effect of an equal dose of ropivacaine and levobupivacaine on lumbar plexus block in aged patients undergoing PFNA.Methods A total of 60 patients undergoing elective unilateral PFNA surgery were enrolled.Inclusion criteria were American Society of Anesthesiologists(ASA)medical status ofⅠorⅡand age of 65 to 95 years.The patients were divided into group L(n=30)and group B(n=30)by random number table.Both group underwent the lumbar plexus block guided by ultrasound combined with nerve stimulator,and group L and group B were injected with 25 mL of 0.375%ropivacaine and 25 mL of 0.375%levobupivacaine respectively.The onset time of sensory block and motor block,duration of sensory block and motor block,resting VAS values at 6 h,12 h,24 h and 48 h after surgery were compared for patients in each group,and analgesia pump use within 48 h after operation and the incidence of adverse reactions were recorded.Results The duration of sensory block and motor block was significantly shorter in group L than in group B(P<0.05).The VAS scores of all two groups were increased initially and then decreased,and the increase in group B was significantly less than that in group L.The differences of interaction betweengroups,time points and time points between groups were statistically significant(P<0.05).The time of first pressing analgesia pump was significantly shorter in group L than in group B(P<0.05).Conclusion An equal dose of ropivacaine and levobupivacaine has a good analgesic effect on lumbar plexus block for elderly patients undergoing PFNA,and the block onset time is similar,however,duration of ropivacaine block is shorter than that of levobupivacaine,which is more conducive to the early activities of patientsand faster recovery after surgery,with better safety.Therefore,it is worthy of popularization.