罗哌卡因联合镇痛药蛛网膜下隙阻滞用于剖宫产术

Intrathecal Ropivacaine with Analgsics for Cesarean Section

目的:比较不同剂量罗哌卡因以及与芬太尼或吗啡联合用于蛛网膜下隙阻滞,对剖宫产患者阻滞效果、血压、心率和不良反应的影响。方法:选择急诊剖宫产患者60例,随机分成四组,每组15例。经侧卧位L_(2～3)间隙穿刺行阻滞麻醉。A组:罗哌卡因10mg,B组:罗吡卡因7.5mg+芬太尼25μg,C组:罗吡卡因7.5mg+吗啡0.2mg,D组:罗吡卡因5mg+芬太厄25μg。用针刺法测感觉阻滞平面,用改良Bromage法测运动阻滞,术后随访并记录开始出现切口疼痛的时间,以及头痛,恶心、呕吐等并发症。结果:A组的感觉阻滞平面上界为T_(2～6),高于其他组(P<0.05),下肢运动完全阻滞百分率明显大于其他组,差异有显著性(P<0.05),但A组感觉阻滞时间与B组相比没有差异(P>0.05)。四组中,C组感觉阻滞持续时间最长,与其他组比较差异有显著性(P<0.05),运动阻滞时间与B组比较没有差异(P>0.05),明显比A组短(P<0.05)。在D组中,有66.7％的患者因感觉阻滞平面不完善,需在硬膜外导管内注入局麻药。血流动力学的影响以A组最为明显,在注药后的5min,血压、心率显著降低,与基础值比较,差异有意义(P<0.05)。术后恶心、呕吐发生率C组最高,与其他组比较,差异有显著性(P<0.05);四组患者术后均无头痛症状。结论:罗吡卡因加入芬太尼25μg,能减少局麻药的用量。

Objective: To compare the effects different dose of ropivacaine and ropivacaine with fentanyl or morphine on hemodynamic, sensory and motor block and side - effect in spinal anesthesia for cesarean section. Methods: After approval by our hospital ethics committee, 60 patients with ASA physical status I and E scheduled to undergo emergency cesarean section for delivery were enrolled in the study. A 25 gauge spinal needle was inserted at the L-2-3 interspace through epidural needle. Patients were randomly allocated into one of the four groups: Group A (n = 15) received 10 mg ropivacaine, Group B (n = 15) received 7.5 mg ropivacaine with 25 fig fentanyl, Group C ( n = 15) received 7.5 mg ropivacaine with 0. 2mg morphine, Group D (n = 15) received 5 mg ropivacaine with 25 fig fentanyl. The level and duration of sensory block were measured by using a pinprick test, and motor block in the lower limbs were assessed with a modified Bromage scale. On postoperative days, patients were interviewed in person to identify side- effects. Results: Most complete blockage was obtained in Group A comparable to other groups: highest upper limit of sensory block and perfect motor block (P<0.05): but the duration of sensory block was insignificantly difference with Group B (P,0. 05). Group C produced longest duration of sensory block among the four groups, and the time of motor recovery was not different with group B, but shorter than group A. In Group D, about 66.6% patients required another dose of epidural anesthesia, for unsatifactied sensory block level. Group A produced significant lower blood pressure than basic level (P <0.05) after injection. The incidence of postoperative vomiting in Group A was the highest among the four groups. No headache or other sign of transients radicular irritation were noted. Conclusion: Intrathecal ropivacaine 7.5 mg with 25fig fentanyl may intensify and increase the sensory blockage without increasing the intensity of motor block and postoperation vomiting.