Kampe Sandra, Tausch Brigitte, Paul Matthias, Kasper Stefan-Mario, Bauer Klaus, Diefenbach Christoph, Kiencke Peter
Department of Anaesthesiology, University of Cologne, Joseph-Stelzmann-Strasse 9, 50931 Cologne, Germany.
Curr Med Res Opin. 2004 Jan;20(1):7-12. doi: 10.1185/030079903125002649.
To determine cardiovascular effects and neonatal outcome of ropivacaine 0.75% and bupivacaine 0.5% for elective epidural caesarean section.
Healthy pregnant women, scheduled for elective caesarean section, were enrolled in this randomised, double-blind study. Epidural block was obtained with 20-30 ml of ropivacaine 0.75% (Group R) or bupivacaine 0.5% (Group B) and surgery did not commence until anaesthesia was achieved bilaterally to T6.
Maternal heart rate and blood pressure were assessed before the main dose of local anaesthetic and at 5-min intervals until 35 min. Neonatal umbilical pH and Apgar scores were determined after delivery. Ten, twenty and thirty minutes after the main dose, sensory and motor block characteristics were determined. Quality of analgesia was assessed by the anaesthetist, surgeon and the patient. Adverse events were recorded.
Sixty-two patients were enrolled and the data of 60 of them were eligible for analysis: 31 in Group R and 29 in Group B. The area under the curve (AUC) for maternal heart rate decreased significantly less in Group B than in Group R (p = 0.038). Twenty-five and thirty minutes after administration of the main local anaesthetic dose, heart rate decreased significantly less in Group B than in Group R (p = 0.006 and p = 0.007). There was no difference in AUC for maternal blood pressure (p = 0.32). Repeated measurement analysis showed no difference between groups in motor block (p = 0.78) and in spread of the sensory block (lower level: p = 0.83, upper level: p = 0.88). There was no statistical difference in neonatal umbilical pH (p = 0.22) and Apgar score (p = 0.59). Multiple linear regression analysis showed a significant influence of maternal body mass index on neonatal pH (p = 0.004), but not of maternal blood pressure (p = 0.323), nor of maternal heart rate (p = 0.12). The quality of analgesia and incidence of adverse events were similar in both groups.
Both drugs produced equally satisfactory epidural block. Although ropivacaine 0.75% resulted in a greater decrease of maternal heart rate, this effect did not influence neonatal well-being. Both ropivacaine 0.75% and bupivacaine 0.5% can therefore be recommended for epidural anaesthesia in elective caesarean section.
确定0.75%罗哌卡因和0.5%布比卡因用于择期硬膜外剖宫产的心血管效应及新生儿结局。
本随机、双盲研究纳入计划行择期剖宫产的健康孕妇。采用20 - 30 ml的0.75%罗哌卡因（R组）或0.5%布比卡因（B组）进行硬膜外阻滞，直至双侧麻醉平面达到T6才开始手术。
在给予主要局麻药物前及之后每隔5分钟评估产妇心率和血压，直至35分钟。分娩后测定新生儿脐动脉血pH值和阿氏评分。在给予主要剂量后10、20和30分钟，测定感觉和运动阻滞特征。由麻醉医生、外科医生及患者评估镇痛质量。记录不良事件。
共纳入62例患者，其中60例患者的数据符合分析要求：R组31例，B组29例。B组产妇心率曲线下面积（AUC）下降幅度显著小于R组（p = 0.038）。给予主要局麻药物剂量后25分钟和30分钟，B组心率下降幅度显著小于R组（p = 0.006和p = 0.007）。产妇血压的AUC无差异（p = 0.32）。重复测量分析显示两组间运动阻滞（p = 0.78）及感觉阻滞范围（下限：p = 0.83，上限：p = 0.88）无差异。新生儿脐动脉血pH值（p = 0.22）和阿氏评分（p = 0.59）无统计学差异。多元线性回归分析显示产妇体重指数对新生儿pH值有显著影响（p = 0.004），但对产妇血压（p = 0.323）和心率（p = 0.12）无影响。两组镇痛质量及不良事件发生率相似。
两种药物产生的硬膜外阻滞效果同样令人满意。虽然0.75%罗哌卡因使产妇心率下降幅度更大，但该效应并未影响新生儿健康。因此，0.75%罗哌卡因和0.5%布比卡因均可推荐用于择期剖宫产的硬膜外麻醉。
