Du Huaiqing, Xu Xing, Yao Tong, Wu Xinmin
Department of Anesthesiology, Peking University First Hospital, Beijing 100034, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2003 Dec 18;35(6):642-4.
To compare the anesthetic and analgesic efficacy of ropivacaine and bupivacaine and their side reactions in combined spinal-epidural anesthesia (CSEA) and postoperative analgesia in pediatric surgery.
Fifty children for lower abdominal surgery, aged 6-14 years, were randomly assigned to receive either ropivacaine (Group R, n=25) or bupivacaine (Group B, n=25) for CSEA. Spinal injection for Group R was a mixture of 1.5 ml of 10 g x L(-1) ropivacaine, 0.5 ml distilled water and 1ml of 100 g x L(-1) dextrose. The injection for Group B was the same as that for Group R except 0.5 ml of 7.5 g x L(-1) bupivacaine. The terminal concentrations of anesthetics were 5 g x L(-1) for the two groups. The injection volume was calculated as: ml=(age x 0.2 + weight x 0.5) divided by 2. When operations prolonged to 1.5 h, epidural infusion at the rate of 1 mg x (kg(-1) x h(-1)) started with 2.5 g x L(-1) ropivacaine for Group R and 2.5 g x L(-1) bupivacaine for Group B. The observed variables were the changes in blood pressure, heart rate, SpO(2), block level, visual analogue scores, and motor block. Epidural postoperative analgesia was performed for Group R with 100 ml of 0.75 g x L(-1) ropivacaine to which 100 mg tramadol and 5 mg were added, and for Group B with 100 ml of 0.75 g/L(-1) bupivacaine instead. Backgroup infusion was 3 ml x h(-1) for the children aged 6-9 years or 4 ml x h(-1) for the children aged 10-14 years, bolus was 2 ml controlled by children or their parents when necessary, and locktime was 15 min. The observed variables were the efficacy of postoperative analgesia, recession of motor block of legs, and the incidence of headache, nausea and vomiting, leg numbness, and urinary retention within 24 h after operation.
There was no significant difference between the two groups in block level. Motor block was much milder in Group R than that in Group B during operation, and recessed faster after operation. Only one case of nausea occurred in each group, and one case of urinary retention in Group B without statistical significance.
Either ropivacaine or bupivacaine can be satisfactorily used in CSEA for analgesia during and after operation. However, ropivacaine has a weaker motor block than bupivacaine, which benefits early walking after operation and recovery of bowl movement.
比较罗哌卡因和布比卡因在小儿外科腰麻 - 硬膜外联合麻醉（CSEA）及术后镇痛中的麻醉和镇痛效果及其不良反应。
选取50例6 - 14岁行下腹部手术的儿童，随机分为罗哌卡因组（R组，n = 25）和布比卡因组（B组，n = 25）接受CSEA。R组腰麻注射用药为1.5 ml 10 g/L罗哌卡因、0.5 ml蒸馏水和1 ml 100 g/L葡萄糖的混合液。B组注射用药与R组相同，只是将0.5 ml 7.5 g/L布比卡因代替罗哌卡因。两组局麻药终浓度均为5 g/L。注射量计算公式为：ml =（年龄×0.2 +体重×0.5）÷2。当手术延长至1.5 h时，R组以1 mg/（kg·h）的速率开始硬膜外输注2.5 g/L罗哌卡因，B组输注2.5 g/L布比卡因。观察指标为血压、心率、SpO₂、阻滞平面、视觉模拟评分及运动阻滞的变化。R组术后硬膜外镇痛采用100 ml含0.75 g/L罗哌卡因并加入100 mg曲马多和5 mg某药（原文此处5 mg后药物名称缺失）的混合液，B组则采用100 ml 0.75 g/L布比卡因。6 - 9岁儿童背景输注速度为3 ml/h，10 - 14岁儿童为4 ml/h，必要时由儿童或其家长控制给予2 ml负荷量，锁定时间为15 min。观察指标为术后镇痛效果、下肢运动阻滞消退情况以及术后24 h内头痛、恶心呕吐、下肢麻木和尿潴留的发生率。
两组阻滞平面无显著差异。术中R组运动阻滞比B组轻得多，术后消退更快。每组仅1例出现恶心，B组1例出现尿潴留，但差异无统计学意义。
罗哌卡因和布比卡因均可满意地用于小儿外科CSEA术中及术后镇痛。然而，罗哌卡因运动阻滞作用比布比卡因弱，这有利于术后早期行走及胃肠功能恢复。
