Anti-inflammatory efficiency of levobupivacaine in an experimental colitis model

AIM:To investigate the efficiency of levobupivacaine in treating experimentally induced colitis in rats.METHODS:Colitis was induced by trinitrobenzene sulfonic acid and ethanol in 30 rats under general anesthesia,and 10 rats were used as a sham group.Subsequent to induction of colitis,rats were divided into three groups;budesonide group received 0.1 mg/kg budesonide,levobupivacaine group received 10 mg/kg levobupivacaine and saline group received 1 mL saline solution via rectal route for 7 d.In the sham group,only routine rectal catheterization was performed without use of any material.At the end of 7 d,laparotomy and total colectomy were performed for histopathological ex-amination in all rats and blood samples were drawn for measurement of tumor necrosis factor(TNF)-αand interleukin(IL)-6 following cardiac puncture.Macroscopic and microscopic evaluations of the specimens were performed by a pathologist blinded to group assignment of the rats.RESULTS:Weight loss(P=0.016)and macroscopic examination scores(P=0.001)were significantly higher in saline group than others.Histopathological scoring was comparable between all colitis groups(P=0.350).There was no significant difference in TNF-αlevels and IL-6 levels(P=0.150).CONCLUSION:The significant improvement in macroscopic scores suggests that levobupivacaine may have topical anti-inflammatory effects in an experimental colitis model;however,this finding was not supported by microscopic findings.

Comparison of a Standard Dose with a Low Dose of Levobupivacaine in Spinal Anesthesia for Caesarean Section

Obstetric anesthesia carries great responsibilities because there are two patients, the mother and the fetus. The purpose of the present study is to compare two doses of Levobupivacaine for spinal anesthesia at elective cesarean section, to determine the best dose that can give mother and fetal hemodynamic stability and a fast anesthesia recovery after the surgery. Method: We conducted a prospective randomized comparative study in 56 patients undergoing cesarean section with spinal dose of Levobupivacaine 6 mg (22 patients) and 10 mg (34 patients), both groups combined with 25 μg of fentanyl. The two doses of local anesthetic were compared with regard to sensory and motor blockade, the need for supplementation epidural, the severity of hypotension and other complications. Result: The 6 mg of levobupivacaine group presents no difference in the incidence of hypotension, bradycardia, nauseas or vomiting compared with the 10 mg of levobupivacaine group, but presents higher incidence of supplementary analgesia and lower mother satisfaction. Conclusions: The combination of 6 mg of levobupivacaine with 25 μg of fentanyl on spinal anesthesia can be an option for short time cesarean section, buy doesn’t present a superior profile in side effects over the 10 mg of levobupivacaine with 25 μg of fentanyl combination with worst maternal satisfaction.

Comparison between 0.06% and 0.1% Levobupivacaine Combined with 2 μg/mL of Fentanyl for Epidural Labor Analgesia

Purpose: Levobupivacaine is thought to be a good alternative to bupivacaine for epidural labor analgesia because of its pharmacologic profile. However, the optimal concentration of levobupivacaine for labor analgesia has not been adequately studied. The objective of this retrospective study was to compare the analgesic effect of levobupivacaine between 0.06% and 0.1% both combined with 2 μg/mL of fentanyl. Methods: Primiparous women (ASA I, II) who delivered their babies to our hospital using combined spinal epidural analgesia and patient-controlled epidural analgesia between August 1, 2011 and September 30, 2011 were included into this retrospective study. The analgesic solution for epidural administration was 0.06% levobupivacaine with 2 μg/mL of fentanyl between August 1 and 31, and 0.1% levobupivacaine with 2 μg/mL of fentanyl between September 1 and 30. Their anesthetic and obstetric charts were reviewed to compare obstetric outcome, anesthetic intervention, and patients’ satisfaction. Results: There were 46 women fulfilling the inclusion criteria: 23 women in 0.06% group, and 23 women in 0.1% group. The number of patients who needed more than 3 requests for one actual bolus was significantly higher in the 0.06% group (P 0.05). Conclusion: Our results revealed that 0.06% levobupivacaine combined with 2 μg/mL fentanyl does not provide sufficient analgesic effects for epidural labor analgesia. It seems that levobupivacaine has not been adequately studied after its withdrawal from the US market. Further studies should be conducted to determine the optimal concentration of levobupivacaine for epidural labor analgesia.

Laparoscopic-assisted instillation of epinephrine and levobupivacaine enables cornual excision and anatomical reconstruction in unruptured cornual pregnancy

The objective of this report is to describe the possible use of intramiometrial vasoconstrictive agents for laparoscopic management of interstitial pregnancy and the consequences in anatomical results and reproductive outcomes. Cornual resection can be performed by laparoscopy, but the high vascularization of this area may result in profuse bleeding and laparoscopic suturing under these conditions might be impossible for the majority of the surgeons. We present a case that describes the possible use of intramiometrial instillation of a solution of diluted epinephrine and levobupivacaine under laparoscopic guidance that permitted a bloodless cornual excision with complete reconstruction. Vasoactive agents might have potentially serious cardiovascular side effects and the correct election of the active principle and the dosage is essential to reduce the risk of the surgery and obtain good anatomical results and reproductive outcomes. In conclusion, unruptured interstitial pregnancies can be managed successfully with intramyometrial instillation of epinephrine and bupivacaine. This simple technique is particularly attractive as it facilitates anatomical reconstruction of the cornual area, gives enough time to perform a complete suture of the defect and reduces the risk of laparotomic conversion.

Comparison between intrathecal hyperbaric bupivacaine and levobupivacaine for ambulatory knee arthroscopy

AIM: To compare the effect of hyperbaric levobupivacaine and bupivacaine on the quality of the block, patient satisfaction, and discharge time in patients undergoing arthroscopic knee surgery under unilateral spinal anesthesia.METHODS: One hundred and thirty-two patients, American Society of Anaesthesiologists Ⅰ or Ⅱ, scheduled for elective ambulatory knee arthroscopy were randomly assigned to four double-blind groups. To achieve a unilateral spinal block, Group BF received 5 mg of hyperbaric bupivacaine plus 20 μg of fentanyl intrathecally, Group LF received 5 mg of hyperbaric levobupivacaine plus 20 μg of fentanyl intrathecally, Group B received 5 mg of hyperbaric bupivacaine intrathecally, and Group L received 5 mg of hyperbaric levobupivacaine intrathecally. The level and duration of the sensory block, the intensity and duration of the motor block, the time to first analgesic requirement, and the time elapsed until the patient's discharge were recorded. Hemodynamic values and adverse effects were also recorded. RESULTS: The duration of time needed to reach the T12 dermatome level was significantly longer in Group L [7(3-20) min] than in Group B [6(3-12) min](P = 0.006). The maximum sensory level reached on the side undergoing the operation was significantly higher in Group BF than in Group B(P < 0.05). The intensity of the motor blockade was greater in Group BF than in Group LF and L. Complete recovery from motor blockade occurred earlier in Groups LF [75(45-165) min] and L [63(35-120) min] than in Group BF [115(60-180) min](P < 0.05). The length of time needed for the sensory block to regress to the level of S2 was shorter in Group L(154 ± 50) than in Group BF(192 ± 66)(P < 0.05). The quality of the block was significantly lower in Group L than in Groups BF, LF and B(P = 0.012, P = 0.003, and P < 0.001, respectively). The time elapsed until Visual Analog Scale ≥ 4 was significantly shorter in Group L(110 ± 48) than in Groups BF(200 ± 60), LF(156 ± 61) and B(162 ± 52)(P < 0.05). The time elapsed until the patient's discharge was shorter in Groups B(244 ± 54) and L(229 ± 55) than in Group BF(288 ± 64)(P = 0.021 and P = 0.001, respectively). There were no differences among the groups regarding hemodynamic parameters and adverse events, except for pruritus. The occurrence of pruritus was significantly more frequent in Groups BF and LF than in other groups. CONCLUSION: In conclusion, 5 mg of hyperbaric bupivacaine and 5 mg of hyperbaric levobupivacaine plus 20 μg of fentanyl provided a better spinal anesthesia than 5 mg of hyperbaric levobupivacaine alone.

A Comparison of Spinal Anesthesia with Levobupivacaine and Hyperbaric Bupivacaine for Cesarean Sections:A Randomized Trial

Purpose: Levobupivacaine showed a lower risk of cardiovascular and central nervous system (CNS) toxicity than bupivacaine which is the most popular local anesthetic agent in obstetric practice. The aim of this study was to investigate the clinical efficacy of levobupivacaine compared with hyperbaric bupivacaine for spinal anesthesia for cesarean section. Methods: 60 pregnant women in ASA I - II group scheduled to have elective cesarean operation were allocated into the study. Patients were randomly divided into two groups. The combinations 10 mg levobupivacaine (0.5%) + fentanyl (15 μcg) for Group LF (n = 30) patients, 10 mg hyperbaric bupivacaine (0.5%) + fentanyl (15 μcg) for BF (n = 30) patients were intrathecally administrated a total of 2.3 cc. Sensory and motor block characteristics of the groups were assessed with pinprick and Bromage scale;observed hemodynamic changes and side effects were recorded. Results: The time to reach maximum dermatome for the sensory block, time to regression by two dermatomes and time to regress to T12 dermatome was found to be significantly long in Group BF. It was observed that in Group BF, the evolution of the motor block was faster and lasted longer. Whereas hypotension, bradycardia and nausea were less in Group LF, the need for ephedrine was higher in Group BF (p < 0.05). Conclusion: Since motor block time is shorter, and side effects like hypotension, bradycardia and nausea are less, the combination of levobupivacaine + fentanyl can be a good alternative in cesarean sections.

Effects of levobupivacaine and bupivacaine on rat myometrium

Objective: To study the effect of levobupivacaine and bupivacaine on the contractility of isolated uterine muscle strips from pregnant and non-pregnant female rats. Methods: Full-thick myometrial strips were prepared from 18- to 21-day pregnant (n=8) and non-pregnant rats (n=7). After contractions became regular, strips were exposed to cumulative concentrations of the two drugs from 10?8 to 10?4 mol/L, amplitude and frequency of the uterine contraction was recorded. Results: Two local anesthetics caused a concentration dependent inhibition on contractility of myometrial strips from pregnant and non-pregnant rats. In the myometrium from non-pregnant rats, ?logIC50 of levobupivacaine and bupivacaine were 4.85 and 4.25 respectively. In the myo- metrium from pregnant rats, similar concentrations of levobupivacaine and bupivacaine were observed, ?logIC50 were 2.7 and 2.9 respectively. Levobupivacaine produced an increase in amplitude of contractions, while bupivacaine showed an increased trend in frequency. Conclusion: These results demonstrate that levobupivacaine and bupivacaine may inhibit myometrium contractility. The inhibitory effect of levobupivacaine or bupivacaine is not enhanced by gestation in rat. Levobupivacaine may have more positive influence than bupivacaine in pregnant myometrium.

左旋布比卡因联合右美托咪定行头皮神经阻滞对开颅手术患者镇痛效果的研究

目的探讨左旋布比卡因联合右美托咪定行头皮神经阻滞(SNB)对开颅手术患者镇痛的有效性。方法选取2021年2月至2023年2月浙江省丽水市中心医院收治的210例行开颅手术患者为研究对象,根据用药方法将其分为左旋布比卡因联合右美托咪定SNB复合全身麻醉组(LD组)70例,左旋布比卡因SNB复合全身麻醉(L组)70例,与常规全身麻醉组(G组)70例。比较3组的术后疼痛情况、血流动力学、应激水平和不良反应。结果3组术后各时间段视觉模拟评分(VAS)比较,L组、LD组均低于G组,且LD组低于L组(P<0.05)。与术前(T0)比较,3组切皮即刻(T1)、切皮后5 min(T2)、缝皮结束即刻(T3)及苏醒拔管时(T4)平均动脉压、心率均出现明显波动(P<0.05);L组、LD组T1、T2、T3、T4平均动脉压、心率波动幅度较G组小(P<0.05),LD组T1、T2、T3、T4平均动脉压、心率波动幅度较L组小(P<0.05)。3组应激反应指标比较,L组、LD组苏醒拔管时、术后24 h去甲肾上腺素(NE)、皮质醇(Cor)、肾上腺素(EP)水平较G组低(P<0.05);LD组苏醒拔管时、术后24 h EP、NE、Cor水平较L组低(P<0.05)。3组总不良反应发生率比较(26%、13%与14%),差异无统计学意义(χ^(2)=4.790,P=0.091)。结论左旋布比卡因联合右美托咪定行SNB可缓解开颅手术患者术后疼痛,减轻机体应激水平,改善血流动力学,且安全性较高。

Comparison of bupivacaine, ropivacaine and levobupivacaine with sufentanil for patient-controlled epidural analgesia during labor： a randomized clinical trial

Ropivacaine and levobupivacaine have been introduced into obstetric analgesic practice with the proposed advantages of causing less motor block and toxicity compared with bupivacaine. However, it is still controversial whether both anesthetics are associated with any clinical benefit relative to bupivacaine for labor analgesia. This study aimed to compare the analgesic efficacy, motor block and side effects of bupivacaine, ropivacaine and levobupivacaine at lower concentrations for patient-controlled epidural labor analgesia. Methods Four hundred and fifty nulliparous parturients were enrolled in this randomized clinical trial. A concentration of 0.05%, 0.075%, 0.1%, 0.125% or 0.15% of either bupivacaine （Group B）, ropivacaine （Group R） or levobupivacaine （Group L） with sufentanil 0.5 ug/ml was epidurally administered by patient-controlled analgesia mode. Effective analgesia was defined as a visual analogue scale score was 〈30 mm. The relative median potency for each local anesthetic was calculated using a probit regression model. Parturients demographics, sensory and motor blockade, obstetric data, maternal side effects, hourly volumes of local anesthetic used, and others were also noted. Results There were no significant differences among groups in the numbers of effective analgesia, pain scores, hourly local anesthetic amount used, sensory and motor blockade, labor duration and mode of delivery, side effects and maternal satisfaction （P 〉0.05）. The relative median potency was bupivacaine/ropivacaine： 0.828 （0.602-1.091）, bupivacaine/levobupivacaine： 0.845 （0.617-1.12）, ropivacaine/levobupivacaine： 1.021 （0.774-1.354）, respectively. However, a significantly less number of effective analgesia and higher hourly local anesthetic use were observed in the concentration of 0.05% than those of 〉0.1% within each group （P 〈0.05）. Conclusions Using patient-controlled epidural analgesia, lower concentrations of bupivacaine, ropivacaine and levobupivacaine with s＇ufentanil produce similar analgesia and motor block and safety for labor analgesia. The analgesic efficacy mainly depends on the concentration rather than the type of anesthetics.

超声引导下胸神经阻滞与左布比卡因、地塞米松胸椎旁阻滞对改良根治性乳房切除术后的镇痛效果比较

目的比较胸椎旁阻滞(TPVB)和胸神经阻滞(PecSⅡ)对改良根治性乳房切除术(MRM)的镇痛效果。方法选取2019年1月至2021年2月接受单侧改良的根治性乳房切除术(MRM)并具有完整随访记录的女性患者200例,按照随机抽签法分为观察组和对照组,其中接受胸神经阻滞(PecSII)镇痛患者(观察组)100例,接受胸椎旁椎体阻滞(TPVB)镇痛患者(对照组)100例。比较2组镇痛持续时间和总镇痛需求,数字评分休息时(NRS-R)和运动时(NRS-M)的评分。结果观察组的镇痛持续时间明显高于对照组,差异有统计学意义(P<0.05);观察组的24 h吗啡用量吗啡抢救剂量明显低于对照组,差异有统计学意义(P<0.05);观察组术后NRS-R的2 h、4 h、6 h、10 h评分明显低于对照组,差异有统计学意义(P<0.05);观察组术后NRS-M的2 h、4 h、6 h、10h评分明显低于对照组,差异有统计学意义(P<0.05)。结论在接受MRM的患者中,0.25%左旋布比卡因和4 mg地塞米松在PecSⅡ阻滞中提供较TPVB更长的镇痛持续时间,且未见明显不良反应。

甲磺酸罗哌卡因与左旋布比卡因在疝囊高位结扎术超声引导腹横肌平面阻滞中的应用

目的探讨甲磺酸罗哌卡因与左旋布比卡因在疝囊高位结扎术超声引导腹横肌平面阻滞中的应用效果。方法回顾性分析2022年4月—2023年4月甘肃省妇幼保健院85例疝囊高位结扎术患儿的临床资料,根据不同麻醉用药方案将进行分组,对照组42例患儿给予左旋布比卡因超声引导腹横肌平面阻滞,研究组43例患儿给予甲磺酸罗哌卡因超声引导腹横肌平面阻滞。对比两组患儿血流动力学指标、麻醉恢复相关指标、瑞芬太尼用量与住院时间、镇痛效果及不良反应发生率。结果两组患儿在麻醉诱导前、插入喉罩后、手术开始时及移除喉罩时的平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)水平比较,差异无统计学意义(P>0.05)。两组患儿恢复自主呼吸时间、苏醒时间、定向力恢复时间、拔管时间、麻醉恢复室停留时间比较,差异无统计学意义(P>0.05);研究组患儿瑞芬太尼用量较对照组高,差异有统计学意义(P<0.05),两组住院时间相比,差异无统计学意义(P>0.05);术后即刻及术后24 h时两组患儿儿童疼痛行为量表(The Face,Legs,Activity,Cry,Consolability Behavioral Tool,FLACC)评分相比,差异无统计学意义(P>0.05),研究组术后4 h及12 h时FLACC评分(1.71±0.29)分、(1.45±0.35)分较对照组(1.58±0.23)分、(1.18±0.39分)高,差异有统计学意义(t=2.286、3.361,P<0.05)。结论在疝囊高位结扎术超声引导腹横肌平面阻滞麻醉中甲磺酸罗哌卡因与左旋布比卡因的镇痛效果和安全性都比较明显,但是后者镇痛效果更优。

罗哌卡因、左旋布比卡因与布比卡因低位硬膜外麻醉的比较

目的比较罗哌卡因、左旋布比卡因与布比卡因低位硬膜外麻醉的临床效果。方法60例行下腹部手术病人,随机分成三组,每组20例。Ⅰ组:0.5%罗哌卡因;Ⅱ组:0.5%左旋布比卡因;Ⅲ组:0.5%布比卡因。行连续低位硬膜外麻醉。观察感觉阻滞起效时间、感觉阻滞平面上界、运动阻滞起效时间、运动阻滞程度及麻醉质量。结果Ⅰ、Ⅱ和Ⅲ组首次局麻药用量分别为(14.38±1.57)、(14.75±0.50)和(13.80±1.30)ml。Ⅰ组运动阻滞起效时间比Ⅲ组长(P<0.05),Ⅰ组Bromage评分为1分的例数多于Ⅲ组(P<0.05)。与Ⅲ组比较,Ⅰ、Ⅱ组感觉阻滞起效时间、感觉阻滞平面上界差异均无统计学意义。Ⅲ组SBP在感觉阻滞平面达上界及运动阻滞起效时有明显降低(P<0.05)。结论0.5%罗哌卡因、左旋布比卡因或布比卡因连续硬膜外麻醉均可产生良好的感觉和运动阻滞,三种药物药效学相似。

右旋美托咪啶对左旋布比卡因妇科手术患者腰段硬膜外麻醉效果的影响

目的观察右旋美托咪啶对左旋布比卡因妇科手术腰段硬膜外麻醉的影响。方法妇科择期子宫肌瘤手术(ASAⅠ～Ⅱ级)60例,随机均分为左旋布比卡因硬膜外麻醉组(L组)和左旋布比卡因+右旋美托咪啶硬膜外麻醉组(LD组)。L组常规消毒穿刺后硬膜外注入0.75%左旋布比卡因15 mL+生理盐水2 mL,LD组注入0.75%左旋布比卡因15 mL+右旋美托咪啶1.0μg/kg(2 mL)。记录年龄、身高、体重、ASA级、手术时间、失血量和输液量等一般情况;评估感觉阻滞和运动阻滞效果;监测和记录硬膜外给药前(0)、硬膜外给药后5、10、20、30和60 min MAP、HR、SpO2和BIS值及低血压、心动过缓、恶心、呕吐和寒战等不良反应;从术中疼痛程度、腹肌松弛度和牵拉反应3方面评估麻醉效果。结果两组感觉阻滞起效时间、最高感觉阻滞时间、运动阻滞起效时间组间比较差异无统计学意义(P>0.05)。LD组感觉阻滞维持时间和运动阻滞恢复时间大于L组(P<0.01),最大运动阻滞时间短于L组(P<0.05),20和30 min最大运动阻滞评分高于L组(P<0.05)。与L组比较,LD组疼痛程度和牵拉反应程度降低(P<0.01)。与基础值比较,L组和LD组BIS值于20 min后降低(P<0.05,P<0.01),LD组BIS值于20 min后低于L组(P<0.01)。与基础值比较,L组和LD组MAP分别于硬膜外注药后20和10min时降低(P<0.05,P<0.01),LD组HR于硬膜外注药10 min后降低(P<0.05);与L组比较,LD组MAP和HR于硬膜外注药10 min后降低(P<0.05)。LD组寒战发生例次低于L组(P<0.01)。结论左旋布比卡因混合右旋美托咪啶1.0μg/kg感觉阻滞和运动阻滞维持时间延长,运动阻滞和镇痛作用增强,麻醉效果更加完善。

三种不同局麻药腰麻最大运动阻滞效应的比较

目的采用序贯试验评估罗哌卡因、左旋布比卡因和布比卡因鞘内注射后达到Bro-mage3级的半数有效剂量(ED50),比较三种局麻药腰麻的运动阻滞效应。方法腰-硬联合麻醉(CSEA)下择期行妇科手术患者99例,随机分为罗哌卡因组、左旋布比卡因组和布比卡因组,分别鞘内注射0.5%等比重罗哌卡因、左旋布比卡因或布比卡因,起始剂量均为7mg,剂量变化梯度为1mg,鞘内注药后25min内双下肢改良Bromage达到3级为有效。结果罗哌卡因组腰麻产生最大运动阻滞的ED50为9.62mg,95%可信区间(CI)为9.16～10.09mg;左旋布比卡因组的ED50为9.55mg,95%CI为9.01～10.11mg;布比卡因组的ED50为6.08mg,95%CI为5.39～6.80mg。罗哌卡因最大运动阻滞相对效价比是布比卡因的0.63倍(95%CI0.56～0.73)。结论罗哌卡因和左旋布比卡因腰麻的运动阻滞效应明显低于布比卡因,而罗哌卡因与左旋布比卡因无明显差异。

国产盐酸左旋布比卡因用于蛛网膜下腔阻滞的实验研究

目的观察不同浓度国产盐酸左旋布比卡因注入犬蛛网膜下腔后对脊髓、脊神经根及脑脊液(CFS)的影响。方法健康杂种犬18只,随机分为生理盐水2ml(A)组、0.5%左旋布比卡因2ml(B)组和0.75%左旋布比卡因2ml(C)组,每组各6只。动物基础麻醉后行L3-4间隙穿刺,见CSF后注入上述各组药物。分别于注药前和注药后1、2、3h测定CFS中氧分压(PO2)及乳酸(Lac)值。3h后处死动物取L1～L2段脊髓及神经根组织,用透射电镜观察脊髓及神经根组织超微结构的改变,检测脊髓组织中Ca2+、MDA含量和SOD活力的变化。结果注药前、后CFS中PO2及Lac值组间比较差异无显著性(P>0.05);脊髓组织中Ca2+、MDA含量及SOD活力组间比较差异无显著性(P>0.05);A组脊髓及神经根组织的早期超微结构基本正常,神经元胞质内线粒体和内质网结构完整清晰,有髓神经纤维的髓鞘完整;B、C组神经元胞质接近正常,多数线粒体、内质网结构完整,有髓神经纤维的板层结构基本正常。结论临床常用浓度和剂量的盐酸左旋布比卡因用于犬蛛网膜下腔阻滞对脊髓、神经根和脑脊液无明显影响。

参附注射液对三种局麻药中枢及心脏毒性的影响

目的 比较布比卡因、罗比卡因和左旋布比卡因的毒性,并探讨参附注射液对其中枢 及心脏毒性作用的影响。方法 60只雄性SD大鼠,随机分为三组(n=20):布比卡因组(B组)、罗比 卡因组(R组)和左旋布比卡因组(L组),每组再分为对照和参附两个亚组(每组n=10)。对照组实 验前30min大鼠腹腔注射生理盐水10ml/kg,参附组大鼠腹腔注射参附注射液10ml/kg。所有动物 股静脉置管用于泵注相应的局麻药,B组为0.5%布比卡因,R组为0.5%罗比卡因,L组为0.5%左 旋布比卡因,速度均为2ml·kg-1·min-1,并记录大鼠出现抽搐、心律失常和心跳停止的时间及局 麻药用量。结果 局麻药中毒出现抽搐、心律失常及心跳停止时R组和L组的局麻药用量大于B组 (P<0.01),R组的局麻药用量大于L组(P<0.01)。参附注射液处理后B组的中毒剂量明显大于 用生理盐水处理后的动物(出现抽搐、心律失常和心跳停止时P值分别是0.001,0.007和0.015),但 其对R和L组的中毒剂量无明显影响。结论 罗比卡因和左旋布比卡因的毒性确实低于布比卡因, 预先给予参附注射液可明显减轻布比卡因对大鼠的中枢及心脏毒性,但对罗比卡因和左旋布比卡因 的全身毒性反应无明显作用。

左旋布比卡因腰-硬联合阻滞在下肢手术的应用

目的探讨0.75%左旋布比卡因用于蛛网膜下隙阻滞的临床效果及安全性。方法随机选择ASAⅠ～Ⅱ级的40例骨科下肢手术患者(股骨干及髋关节大手术的患者),随机均分成两组:L组腰麻用药为0.75%左旋布比卡因15mg,容量为2.5ml;B组腰麻用药为0.75%布比卡因,剂量及容量同L组。术中必要时经硬膜外导管注入2%利多卡因。术中监测BP、HR、SpO2、RR的变化并观察围术期不良反应的发生。结果两组最高阻滞平面及到达时间、麻醉持续时间、肌松效果及达到最大肌松效果时间差异均无显著意义。两组均无神经系统的不良反应。结论0.75%左旋布比卡因用于腰-硬联合麻醉骨科下肢手术安全有效,效果与0.75%布比卡因相比差异无显著意义。

不同剂量左布比卡因腰麻在剖宫产术中麻醉效果评价

目的:研究不同剂量左布比卡因腰麻在剖宫产术中麻醉效果。方法:选择ASA1～2级剖宫产妇90例,年龄23～36岁,体重55～90kg,身高150～175cm,随机、双盲分成3组,每组30例,均采用腰硬联合麻醉,L2～3椎间隙穿刺,穿刺成功后蛛网膜下腔分别注入0.75%左布比卡因(加10%葡萄糖至2mL),A组(7.5mg)、B组(10mg)、C组(12.5mg),3组注药时间均为1mL/5s。给药后用针刺法测定感觉阻滞平面,给药15min后阻滞平面未达T6水平者经硬膜外分次酌情追加2%利多卡因。麻醉期连续监测BP、HR、ECG和SPO2,观察并记录给药后15min麻醉平面、麻醉效果、并发症的发生率及新生儿1min和5min的Apgar评分。结果:在麻醉效果、并发症的发生率及新生儿1min和5min的Apgar评分等方面B、C两组与A组比较无显著性差异(P>0.05);在麻醉平面,B、C两组与A组比较有显著性差异(P<0.05)。结论:左布比卡因B组(10mg)和C组(12.5mg)腰麻在剖宫产术中麻醉效果是有效的、安全的。

相同浓度的左旋布比卡因、罗比卡因与布比卡因硬膜外腔给药用于剖宫产术时效性的比较

目的比较左旋布比卡因、罗比卡因和布比卡因用于硬膜外麻醉剖宫产术的阻滞效果、母婴安全和药物不良反应。方法采用随机双盲法,将48例择期剖宫产手术的足月单胎产妇分为三组:0.5%左旋布比卡因组(L组)17例、0.5%罗比卡因组(R组)15例和0.5%布比卡因组(B组)16例。记录硬膜外腔给药后产妇的感觉阻滞和运动阻滞的起效和持续时间、肌松满意程度、麻醉质量评价、恶心和呕吐等不良反应及术中心率、血压、脉搏血氧饱和度和新生儿1 min和5 min Apgar评分。结果产妇的一般情况、新生儿的Apgar评分组间无显著性差异;三组术中低血压及其他不良事件(恶心和呕吐)的发生率无显著性差异;各组的麻醉质量(术中的疼痛评分和肌松满意度)基本一致;感觉阻滞起效和维持时间组间无显著性差异,运动阻滞改良Bromage评分为1分的起效时间和持续时间组间有显著性差异。结论常用量0.5%左旋布比卡因、罗比卡因和布比卡因用于剖宫产手术的硬膜外麻醉时具有相似的麻醉效能和安全性。

术前应用帕瑞昔布钠复合局部浸润麻醉对腹腔镜手术后镇痛的影响

目的探讨术前应用帕瑞昔布钠复合0.5%左旋布比卡因局部浸润麻醉对腹腔镜手术后镇痛的影响。方法择期腹腔镜手术患者66例,随机分为两组,帕瑞昔布钠复合0.5%左旋布比卡因局部浸润麻醉组(P组)和生理盐水(C组);观察苏醒拔管后、术后1、2、4、6、12、24h疼痛数字(NRS)评分和舒适(BCS)评分,如NRS评分大于4分静脉给予地佐辛5mg/次,直至评分小于3分,记录术后24h内地佐辛、首次补救镇痛药的时间和满意率,以及恶心、呕吐、呼吸抑制不良反应。结果最终P组32例,C组31例患者纳入分析。与C组比较,术后4、6、12和24hP组NRS评分明显降低、BCS评分明显升高(P<0.05)。与C组比较,术后24h内P组地佐辛用量明显减少、首次补救镇痛药时间明显延长、满意率明显提高(P<0.01)。两组术后恶心、呕吐和呼吸抑制发生率差异无统计学意义。结论腹腔镜手术前应用帕瑞昔布钠复合0.5%左旋布比卡因局部浸润麻醉能有效抑制患者术后疼痛,提高患者术后满意度,且降低不良反应的发生率,安全性高,是该类手术术后疼痛干预有效的方法。