0.2%左旋布比卡因与罗哌卡因持续硬膜外泵注镇痛效应的比较

A comparison of efficacy of continuous epidural infusion of 0.2% levobupivacaine and 0.2% ropivacaine for postoperative pain relief

目的 研究0.2％左旋布比卡因(LBUP)硬膜外持续泵注的镇痛效应,并与0.2％罗哌卡因(ROP)比较。方法 60例妇科下腹部择期手术ASA Ⅰ-Ⅱ级病人随机分为两组,LBUP组(L组)和ROP组(R组),每组30例。术毕采用双泵法镇痛,一泵持续泵注0.2％ LBUP或0.2％ ROP 4ml/h;另一泵病人硬膜外自控镇痛(PCA)0.01％吗啡2ml/次,锁定时间为10min。结果 两组的镇痛效果均满意,术后24h VAS评分L组略低、BCS及Ramsey镇静评分两组基本相似,L组和R组分别有7例(23％)和5例(17％)未按压PCA泵,两组24h吗啡需求量分别为(0.6±0.4)mg、(0.7±0.6)mg。下肢运动完全恢复时间L组(7.8±2.8)h长于R组(5.9±2.5)h,P<0.05,术后4h时Bromage评分分别为1.3±0.9和1.1±1.0。结论 硬膜外0.2％LBUP 4ml/h + 吗啡硬膜外PCA术后镇痛效果满意,同等浓度的LBUP阻滞效果比ROP强。

Objective To investigate the analgesic efficacy and safety of continuous epidural infusion of 0.2% levobupivacaine in patients after lower abdominal surgery.Methods Sixty ASA Ⅰ - Ⅱ patients undergoing lower abdominal gynecologic operation under epidural anesthesia were randomly divided into two groups : group L levobupivacaine (n = 30) and group R ropivacaine ( n = 30) . An epidural catheter was placed at L2-3 . After operation the catheter was connected through a 3-way Stopcock to a Graseby 9 500 infusion pump for continuous infusion of 0.2% levobupivacaine or 0.2% ropivacaine at a rate of 4 ml·h-1 and a Graseby 3300 infusion pump for PCEA with 0.01% morphine (bolus dose = 2ml, lockout interval = 10 min, total dose limit = 16 ml·4 h-1) (1) VAS score (0 = no pain, 100 = severe pain). (2) the ratio of the number of attempts calculated (D1) to the number of successfully delivered doses (D2) (D1/D2), (3) modified Bromage Motor scale score, (4) Bruggmann comfort scale (BCS), (5) Ramsay sedation score and (6) the severity of side effects were recorded 0, 2,4, 8, 12, 20 and 24h after operation.Results The demographic data (age, body weight, height) and duration of operation were comparable between the two groups. The analgesia was satisfactory in both groups. VAS scores were significantly lower in levobupivacaine group than that in ropivacaine group at 8 and 24 h after operation ( P < 0.05). There was no significant difference in BCS and Ramsay score between the two groups. There were 7 patients in group L (23%) and 5 patients in group R (17% ) in whom no PCEA was used. The time required for recovery of motor function was significantly longer in group L (7.8 ±2.8h) than that in group R (5.9 ± 2.5h). The Bromage score was higher in group L (1.3 ± 0.9) than that in group R (1.1 ± 1.0) at 4h after operation.Conclusion Background epidural infusion of 0.2% levobupivacaine + PCEA with 0.01% morphine is satisfactory for postoperative analgesia. The motor block produced by 0.2% levobupivacaine is more intense than by 0.2 % ropivacaine.