Burke D, Henderson D J, Simpson A M, Faccenda K A, Morrison L M, McGrady E M, McLeod G A, Bannister J
Ninewells Hospital and Medical School, Dundee, UK.
Br J Anaesth. 1999 Nov;83(5):750-5. doi: 10.1093/bja/83.5.750.
We have compared the efficacy of 0.25% S(-)-bupivacaine with 0.25% RS-bupivacaine in providing epidural analgesia for labour in a randomized, multicentre, double-blind study. Analgesia was initiated with 10 ml of the study solution and maintained with 10-ml top-ups. We studied 137 women and treatments were found to be equivalent for onset, duration and quality of block. Median onset of pain relief was 12 min for both drugs and median duration was 49 (range 3-129) min and 51 (7-157) min for S(-)-bupivacaine and RS bupivacaine, respectively. The estimated treatment difference for duration of pain relief was -4 (90% CI -13, 6) min. Thirty patients failed to achieve pain relief after the first injection (20 patients after S(-)-bupivacaine and 10 after RS-bupivacaine; P = 0.039). However, median duration of pain relief from the first top-up was 82 (range 3-164) min for S(-)-bupivacaine and 76 (22-221) min for RS-bupivacaine. There were no significant differences in the quality of analgesia, as assessed by the investigators. There were no significant differences in the extent of sensory block, percentage of patients with motor block or incidence of adverse events.
在一项随机、多中心、双盲研究中，我们比较了0.25% S(-)-布比卡因与0.25%消旋布比卡因用于分娩硬膜外镇痛的效果。用10 ml研究溶液开始镇痛，并通过10 ml追加剂量维持。我们研究了137名女性，发现两种药物在阻滞起效时间、持续时间和质量方面相当。两种药物的疼痛缓解中位起效时间均为12分钟，S(-)-布比卡因和消旋布比卡因的疼痛缓解中位持续时间分别为49（3 - 129）分钟和51（7 - 157）分钟。疼痛缓解持续时间的估计治疗差异为-4（90%CI -13, 6）分钟。30名患者在首次注射后未实现疼痛缓解（S(-)-布比卡因后20例，消旋布比卡因后10例；P = 0.039）。然而，S(-)-布比卡因首次追加剂量后的疼痛缓解中位持续时间为82（3 - 164）分钟，消旋布比卡因则为76（22 - 221）分钟。研究者评估的镇痛质量无显著差异。感觉阻滞范围、运动阻滞患者百分比或不良事件发生率也无显著差异。
