罗哌卡因或2%甲哌卡因用于下肢周围神经阻滞。意大利麻醉、镇痛与重症监护学会骨科麻醉研究组。

Ropivacaine or 2% mepivacaine for lower limb peripheral nerve blocks. Study Group on Orthopedic Anesthesia of the Italian Society of Anesthesia, Analgesia, and Intensive Care.

作者信息

Casati A, Fanelli G, Borghi B, Torri G

机构信息

University of Milan, Italy.

出版信息

Anesthesiology. 1999 Apr;90(4):1047-52. doi: 10.1097/00000542-199904000-00018.

DOI:10.1097/00000542-199904000-00018

PMID:10201676

Abstract

BACKGROUND

Intra- and postoperative clinical properties of sciatic-femoral nerve block performed with either ropivacaine at different concentrations or mepivacaine have been evaluated in a multicenter, randomized, blinded study.

METHODS

Adult patients scheduled for foot and ankle surgery were randomized to receive combined sciatic-femoral nerve block with 225 mg of either 0.5% (n = 83), 0.75% (n = 87), or 1% (n = 86) ropivacaine, or with 500 mg of 2% mepivacaine (n = 84). A thigh tourniquet was used in all patients. Onset time, adequacy of surgical anesthesia, time to offset of nerve block, and time until first postoperative requirement for pain medication were evaluated by a blinded observer.

RESULTS

The adequacy of nerve block was similar in the four treatment groups (the ratios between adequate:inadequate: failed blocks were 74:9:0 with 0.5% ropivacaine, 74:13:0 with 0.75% ropivacaine, 78:8:0 with 1% ropivacaine, and 72:12:0 with 2% mepivacaine). The onset of the block was slower with 0.5% ropivacaine than with other anesthetic solutions (P < 0.001). Regardless of the concentration, ropivacaine produced a longer motor blockade (10.5+/-3.8 h, 10.3+/-4.3 h, and 10.2+/-5.1 h with 0.5%, 0.75%, and 1% ropivacaine, respectively) than with mepivacaine (4.3+/-2.6 h; P < 0.001). The duration of postoperative analgesia was shorter after mepivacaine (5.1+/-2.7 h) than after ropivacaine (12.2+/-4.1 h, 14.3+/-5 h, and 14.5+/-3.4 h, with 0.5%, 0.75%, or 1% ropivacaine, respectively; P < 0.001). Pain relief after 0.5% ropivacaine was 14% shorter than 0.75% or 1% ropivacaine (P < 0.05). During the first 24 h after surgery, 30-37% of patients receiving ropivacaine required no analgesics compared with 10% of those receiving mepivacaine (P < 0.001).

CONCLUSIONS

This study suggests that 0.75% ropivacaine is the most suitable choice of local anesthetic for combined sciatic-femoral nerve block, providing an onset similar to mepivacaine and prolonged postoperative analgesia.

摘要

背景

在一项多中心、随机、双盲研究中，已对使用不同浓度罗哌卡因或甲哌卡因进行坐骨-股神经阻滞的术中和术后临床特性进行了评估。

方法

计划进行足踝手术的成年患者被随机分为四组，分别接受联合坐骨-股神经阻滞，其中一组使用225mg的0.5%罗哌卡因（n = 83），一组使用225mg的0.75%罗哌卡因（n = 87），一组使用225mg的1%罗哌卡因（n = 86），另一组使用500mg的2%甲哌卡因（n = 84）。所有患者均使用大腿止血带。由一位盲法观察者评估起效时间、手术麻醉的充分性、神经阻滞消退时间以及术后首次需要使用止痛药物的时间。

结果

四个治疗组的神经阻滞充分性相似（0.5%罗哌卡因组充分:不充分:失败的阻滞比例为74:9:0，0.75%罗哌卡因组为74:13:0，1%罗哌卡因组为78:8:0，2%甲哌卡因组为72:12:0）。0.5%罗哌卡因的阻滞起效比其他麻醉溶液慢（P < 0.001）。无论浓度如何，罗哌卡因产生的运动阻滞时间（0.5%罗哌卡因组为10.5±3.8小时，0.75%罗哌卡因组为10.3±4.3小时，1%罗哌卡因组为10.2±5.1小时）均长于甲哌卡因组（4.3±2.6小时；P < 0.001）。甲哌卡因术后镇痛持续时间（5.1±2.7小时）短于罗哌卡因（0.5%罗哌卡因组为12.2±4.1小时，0.75%罗哌卡因组为14.3±5小时，1%罗哌卡因组为14.5±3.4小时；P < 0.001）。0.5%罗哌卡因后的疼痛缓解比0.75%或1%罗哌卡因短14%（P < 0.05）。术后24小时内，接受罗哌卡因的患者中有30 - 37%不需要使用镇痛药，而接受甲哌卡因的患者中这一比例为10%（P < 0.001）。