Bertini L, Tagariello V, Mancini S, Ciaschi A, Posteraro C M, Di Benedetto P, Martini O
Department of Anesthesia, Centro Traumatologico Ortopedico, Rome, Italy.
Reg Anesth Pain Med. 1999 Nov-Dec;24(6):514-8. doi: 10.1016/s1098-7339(99)90041-x.
Although ropivacaine has been extensively studied for epidural anesthesia, very few reports exist on brachial plexus block. We therefore decided to investigate the clinical features of axillary brachial plexus anesthesia with two different concentrations of ropivacaine (0.5% and 0.75%) and to compare the results with those obtained with 0.5% bupivacaine.
Three groups of patients were randomized and prospectively studied. They received, in a double-blind fashion, 32 mL of the local anesthetic solution into the midaxilla, by a nerve-stimulator technique. Onset time in each of the stimulated nerves was recorded both for the sensory and motor block. Peak time (ready to surgery), rate of supplemental blocks, need for intraoperative opioids, duration of sensory and motor block, postoperative analgesic requirements, and patient satisfaction were also recorded.
The rate of complete sensory and motor block observed with both ropivacaine groups was higher at 10, 15, and 20 minutes postinjection (P < .001). The mean peak time was shorter with ropivacaine than with bupivacaine (R50 = 16.37 minutes, R75 = 14.7 minutes, B = 22.3 minutes, P < .05). The quality of the anesthesia was higher with ropivacaine, as measured by the intraoperative needs for opioids and the overall patient's satisfaction (P < .05). No significant differences were noted with all the other studied parameters.
Ropivacaine showed advantages over bupivacaine for axillary brachial plexus block. Because no statistical differences were found between the two ropivacaine groups, we therefore conclude that 0.75% does not add benefit and that 0.5% ropivacaine should be used to perform axillary brachial plexus blocks.
尽管罗哌卡因已被广泛用于硬膜外麻醉研究，但关于臂丛神经阻滞的报道却很少。因此，我们决定研究两种不同浓度（0.5%和0.75%）罗哌卡因用于腋路臂丛神经麻醉的临床特征，并与0.5%布比卡因的麻醉效果进行比较。
将三组患者随机分组并进行前瞻性研究。采用神经刺激器技术，以双盲方式将32毫升局部麻醉药注入腋窝中部。记录每条受刺激神经的感觉和运动阻滞起效时间。还记录了达到高峰时间（准备手术）、追加阻滞率、术中阿片类药物需求、感觉和运动阻滞持续时间、术后镇痛需求以及患者满意度。
在注射后10、15和20分钟时，两个罗哌卡因组观察到的完全感觉和运动阻滞率更高（P <.001）。罗哌卡因组的平均达到高峰时间比布比卡因组短（R50 = 16.37分钟，R75 = 14.7分钟，B = 22.3分钟，P <.05）。根据术中阿片类药物需求和患者总体满意度衡量，罗哌卡因的麻醉质量更高（P <.05）。在所有其他研究参数方面未发现显著差异。
在腋路臂丛神经阻滞方面，罗哌卡因比布比卡因具有优势。由于两个罗哌卡因组之间未发现统计学差异，因此我们得出结论，0.75%的罗哌卡因并无额外益处，可以使用0.5%的罗哌卡因进行腋路臂丛神经阻滞。
