Fayman Moshe, Beeton Anthony, Potgieter Estelle, Becker Piet J
Rosebank Clinic, 14 Sturdee Avenue, Suite 17, PO Box 1708, Parklands 2121, Johannesburg, South Africa.
Aesthetic Plast Surg. 2003 Mar-Apr;27(2):100-3. doi: 10.1007/s00266-003-0117-7.
Local anesthesia infiltration has been established as a preferred method of perioperative analgesia in many cosmetic operations. In an attempt to maximize the risk-benefit ratio of local anesthesia, a study was conducted to compare efficacy of two local anaesthetic agents. Bupivacaine was compared to ropivacaine in a bilaterally symmetrical breast surgery model. A local anaesthetic solution containing either bupivacaine or ropivacaine was infiltrated into each of the breasts of 15 patients undergoing either breast augmentation or breast reduction. Both surgeon and patient were blinded to the nature of local anaesthetic agent injected. Patients were requested to score their pain at 1, 2, 6, and 10 hours after surgery on a visual analog scale. The results were analyzed statistically using a cross-sectional time-series regression model employing the random effects option of the xtreg command from Strata Release 6 statistical software. We found that overall analgesia achieved with bupivacaine and ropivacaine infiltrations was not statistically different. The use of a higher dose of ropivacaine is likely to have removed the clinical advantage noted for the bupivacaine group. There was, however, a statistical and clinical difference in the efficacy of local anaesthetic infiltration of both agents in breast augmentation patients as compared to breast reduction patients, local anaesthetic being less effective in patients who had submuscular breast augmentation than in patients who had breast reduction. In view of these findings, it appears reasonable to recommend the use of ropivacaine in high-dose infiltration breast analgesia, as it is reported to be less cardiotoxic than bupivacaine. Serious attention needs also to be given to the adequacy of field infiltration of local anesthesia in submuscular breast augmentation.
局部麻醉浸润已成为许多整形手术围手术期镇痛的首选方法。为了使局部麻醉的风险效益比最大化，开展了一项研究以比较两种局部麻醉剂的疗效。在双侧对称乳房手术模型中，将布比卡因与罗哌卡因进行了比较。将含有布比卡因或罗哌卡因的局部麻醉溶液浸润到15例行隆乳术或缩乳术患者的每侧乳房中。外科医生和患者均对所注射局部麻醉剂的性质不知情。要求患者在术后1小时、2小时、6小时和10小时使用视觉模拟评分法对疼痛进行评分。使用Stata Release 6统计软件的xtreg命令中的随机效应选项，通过横断面时间序列回归模型对结果进行统计学分析。我们发现，布比卡因和罗哌卡因浸润所实现的总体镇痛效果在统计学上无差异。使用更高剂量的罗哌卡因可能消除了布比卡因组所显示的临床优势。然而，与缩乳术患者相比，两种药物在隆乳术患者局部麻醉浸润效果方面存在统计学和临床差异，局部麻醉在肌下隆乳术患者中的效果不如缩乳术患者。鉴于这些发现，推荐在高剂量浸润乳房镇痛中使用罗哌卡因似乎是合理的，因为据报道其心脏毒性低于布比卡因。对于肌下隆乳术中局部麻醉的术野浸润充分性也需要给予高度关注。
