Koinig H, Krenn C G, Glaser C, Marhofer P, Wildling E, Brunner M, Wallner T, Grabner C, Klimscha W, Semsroth M
Department of Anesthesia and General Intensive Care A, University of Vienna, Austria. Herbert
Anesthesiology. 1999 May;90(5):1339-44. doi: 10.1097/00000542-199905000-00018.
Ropivacaine, a new local anesthetic, is less cardiotoxic in adults and is less likely to cause motor blockade than is bupivacaine. The authors evaluated the clinical effectiveness and hemodynamic effects of ropivacaine compared with bupivacaine and the pharmacokinetics of ropivacaine when given for caudal blocks in 56 children 4.1 +/- 1.2 yr old (mean +/- SD).
Patients scheduled for inguinal hernia repair were randomly given a caudal injection (0.75 ml/kg) of ropivacaine, 0.25% (R0.25 group); ropivacaine, 0.5% (R0.5 group); or bupivacaine, 0.25% (B0.25 group). Postoperative measurements included the duration of analgesia, which was our primary outcome variable, and hemodynamic and respiratory monitoring for 4 h in the recovery room. Thereafter, analgesic requirements for the following 24 h were assessed by an independent observer on the ward using an observational pain-discomfort scale, which gives a cumulative score from 5 to 15 to estimate the quality of analgesia by assessment of behavioral objective parameters. Plasma levels of ropivacaine were measured before the procedure was started and 5, 10, 15, 20, 25, 30, and 45 min and 1, 2, 4, 6, 8, and 24 h after caudal block.
A significantly longer (P < 0.0001) duration of analgesia (median [range]) was observed in the R0.5 group (1,440 [335-1,440] min), whereas the R0.25 group (208 [175-340] min) and the B0.25 group (220 [100-390] min) were comparable. All groups showed a significant decrease in mean arterial blood pressure and heart rate from baseline values, but differences between groups were not observed.
Ropivacaine is well tolerated and provides effective analgesia when given for caudal blockade in small children for inguinal hernia repair.
罗哌卡因是一种新型局部麻醉药，在成人中具有较低的心脏毒性，且与布比卡因相比，引起运动阻滞的可能性更小。作者对56名年龄为4.1±1.2岁（均值±标准差）的儿童在进行骶管阻滞时，比较了罗哌卡因与布比卡因的临床有效性和血流动力学效应以及罗哌卡因的药代动力学。
计划进行腹股沟疝修补术的患者被随机给予骶管注射（0.75 ml/kg）：0.25%罗哌卡因（R0.25组）；0.5%罗哌卡因（R0.5组）；或0.25%布比卡因（B0.25组）。术后测量包括镇痛持续时间（这是我们的主要观察变量）以及在恢复室进行4小时的血流动力学和呼吸监测。此后，由病房的独立观察者使用观察性疼痛 - 不适量表评估接下来24小时的镇痛需求，该量表通过评估行为客观参数给出5至15的累积分数以估计镇痛质量。在手术开始前以及骶管阻滞后5、10、15、20、25、30和45分钟以及1、2、4、6、8和24小时测量罗哌卡因的血浆水平。
R0.5组观察到显著更长（P < 0.0001）的镇痛持续时间（中位数[范围]）为1440[335 - 1440]分钟，而R0.25组（208[175 - 340]分钟）和B0.25组（220[100 - 390]分钟）相当。所有组的平均动脉血压和心率均较基线值显著降低，但组间差异未观察到。
罗哌卡因耐受性良好，在小儿腹股沟疝修补术进行骶管阻滞时可提供有效的镇痛。
