Gioia Luigi, Fanelli Guido, Casati Andrea, Nuti Umberto, Mennella Roberta, Scarioni Monica, Cerchierini Elisa, Sciascia Angela, Garassino Alessandra, Torri Giorgio, Fasce Francesco, Bolognesi Gianluigi
Department of Anesthesiology, Vita-Salute University of Milano and IRCCS H. San Raffaele, Milan, Italy.
J Clin Anesth. 2004 May;16(3):184-8. doi: 10.1016/j.jclinane.2003.07.004.
To evaluate the efficacy of three different concentrations of ropivacaine (0.5%, 0.75%, and 1%) together with a single concentration of hyaluronidase administered for peribulbar block.
Prospective, randomized, double-blind study.
Anesthesia department of a university teaching hospital.
68 ASA physical status I, II, and III patients undergoing elective cataract surgery.
Patients were randomly allocated to receive peribulbar block with 6.5 mL of either 0.5% (Group Ropi-5; n = 22), 0.75% (Group Ropi-7.5; n = 22), or 1% ropivacaine (Group Ropi-10; n = 24). In all patients, 0.5 mL of hyaluronidase was added to the local anesthetic solution.
A larger proportion of patients in Groups Ropi-7.5 (82%) and Ropi-10 (83%) showed complete motor block 15 minutes after injection compared with Group Ropi-5 (55%;p = 0.05, andp = 0.03, respectively). Hypotension (reduction of systolic blood pressure by 30% or more from baseline) was observed in two Group Ropi-5 patients (9%), and two Group Ropi-7.5 patients (9%;p = 0.31), whereas bradycardia (reduction in heart rate < or = 50 bpm) was observed in one Group Ropi-5 patient (4%), and three Group Ropi-10 patients (12%;p = 0.18). Seven hours after surgery, a smaller proportion of Group Ropi-10 patients (64%) showed complete recovery of sensory function as compared with both Group Ropi-5 (94%) and Group Ropi-7.5 (90%;p = 0.03 and p = 0.03, respectively). Complete recovery of motor function 1 hour after surgery was more frequent in Group Ropi-5 (37%) than in Group Ropi-7.5 (5%) or Group Ropi-10 (9%;p = 0.05 and p = 0.05, respectively); however, no other differences in recovery of motor function were observed at any other observation times, with complete recovery in all patients 7 hours after surgery.
While confirming that ropivacaine is a good option for peribulbar anesthesia, this study demonstrated that the use of 0.75% or 1% concentrations are preferred in that they produce quick and deep sensory and motor block of the operated eye. If recovery of normal motor function is important after surgery, the 0.75% concentration probably represents the best compromise.
评估三种不同浓度的罗哌卡因（0.5%、0.75%和1%）联合单一浓度的透明质酸酶用于球周阻滞的疗效。
前瞻性、随机、双盲研究。
一所大学教学医院的麻醉科。
68例美国麻醉医师协会（ASA）身体状况为I、II和III级的择期白内障手术患者。
患者被随机分配接受球周阻滞，分别注射6.5 mL的0.5%罗哌卡因（罗哌卡因-5组；n = 22）、0.75%罗哌卡因（罗哌卡因-7.5组；n = 22）或1%罗哌卡因（罗哌卡因-10组；n = 24）。所有患者的局部麻醉溶液中均添加0.5 mL透明质酸酶。
与罗哌卡因-5组（55%）相比，罗哌卡因-7.5组（82%）和罗哌卡因-10组（83%）中有更大比例的患者在注射后15分钟出现完全运动阻滞（分别为p = 0.05和p = 0.03）。罗哌卡因-5组有2例患者（9%）出现低血压（收缩压较基线降低30%或更多），罗哌卡因-7.5组有2例患者（9%；p = 0.31）；而罗哌卡因-5组有1例患者（4%）出现心动过缓（心率降低至≤50次/分钟），罗哌卡因-10组有3例患者（12%；p = 0.18）。术后7小时，与罗哌卡因-5组（94%）和罗哌卡因-7.5组（90%）相比，罗哌卡因-10组中感觉功能完全恢复的患者比例较小（64%；分别为p = 0.03和p = 0.03）。术后1小时，罗哌卡因-5组（37%）运动功能完全恢复的情况比罗哌卡因-7.5组（5%）或罗哌卡因-10组（9%）更常见（分别为p = 0.05和p = 0.05）；然而，在其他观察时间点未观察到运动功能恢复的其他差异，所有患者在术后7小时均完全恢复。
本研究证实罗哌卡因是球周麻醉的良好选择，同时表明使用0.75%或1%浓度更佳，因为它们能快速产生手术眼的深度感觉和运动阻滞。如果术后正常运动功能的恢复很重要，0.75%的浓度可能是最佳折衷方案。
