Cappelleri Gianluca, Aldegheri Giorgio, Danelli Giorgio, Marchetti Chiara, Nuzzi Massimiliano, Iannandrea Gabriella, Casati Andrea
Department of Anesthesiology, Vita-Salute University of Milan, IRCCS H San Raffaele, Via Olgettina 60, 20132 Milano, Italy.
Anesth Analg. 2005 Jul;101(1):77-82, table of contents. doi: 10.1213/01.ANE.0000155265.79673.56.
To compare unilateral spinal block produced with small doses of hyperbaric ropivacaine with that produced by 2 doses of hyperbaric levobupivacaine, we randomly allocated 91 ASA physical status I-II outpatients undergoing knee arthroscopy to receive unilateral spinal anesthesia with 7.5 mg of hyperbaric ropivacaine 0.5% (group Ropi-7.5, n = 31) or either 7.5 mg (group Levo-7.5, n = 30) or 5 mg (group Levo-5, n = 30) of hyperbaric levobupivacaine 0.5%. Spinal anesthesia was performed at the L3-4 interspace using a 25-gauge Whitacre spinal needle. The lateral decubitus position was maintained for 15 min after injection. Strictly unilateral sensory block was present in 73%, 50%, and 61% of cases in groups Ropi-7.5, Levo-7.5, and Levo-5, respectively, 30 min after injection (P = 0.40), and unilateral motor block was observed in 94%, 93%, and 83% in groups Ropi-7.5, Levo-7.5, and Levo-5, respectively (P = 0.31). One patient of group Ropi-7.5 required general anesthesia to complete surgery, and fentanyl supplementation was required in one patient of group Ropi-7.5 (3%) and one patient of group Levo-5 (3%) (P = 0.42). The median (range) time for spinal block resolution was shorter in group Ropi-7.5 (135 [126-154] min] than in group Levo-7.5 (162 [148-201] min) (P = 0.04); whereas home discharge was shorter in groups Ropi-7.5 (197 [177-218] min) and Levo-5 (197 [187-251] min) as compared with group Levo-7.5 (238 [219-277] min) (P = 0.02 and P = 0.04, respectively). We conclude that 7.5 mg of 0.5% hyperbaric ropivacaine and 5 mg of 0.5% hyperbaric levobupivacaine provide adequate spinal block for outpatient knee arthroscopy, with a faster home discharge as compared with 7.5 mg of 0.5% hyperbaric levobupivacaine.
为比较小剂量高压布比卡因与2倍剂量高压左旋布比卡因产生的单侧脊髓阻滞效果，我们将91例拟行膝关节镜检查的ASA身体状况I-II级门诊患者随机分为三组，分别接受0.5% 7.5 mg高压罗哌卡因（罗哌卡因-7.5组，n = 31）或0.5% 7.5 mg（左旋布比卡因-7.5组，n = 30）或0.5% 5 mg（左旋布比卡因-5组，n = 30）高压左旋布比卡因进行单侧脊髓麻醉。使用25G Whitacre脊髓穿刺针于L3-4椎间隙进行脊髓麻醉。注射后保持侧卧位15分钟。注射后30分钟，罗哌卡因-7.5组、左旋布比卡因-7.5组和左旋布比卡因-5组分别有73%、50%和61%的病例出现严格的单侧感觉阻滞（P = 0.40），罗哌卡因-7.5组、左旋布比卡因-7.5组和左旋布比卡因-5组分别有94%、93%和83%的病例出现单侧运动阻滞（P = 0.31）。罗哌卡因-7.5组有1例患者需要全身麻醉才能完成手术，罗哌卡因-7.5组（3%）和左旋布比卡因-5组（3%）各有1例患者需要补充芬太尼（P = 0.42）。罗哌卡因-7.5组脊髓阻滞消退的中位（范围）时间（135 [126 - 154]分钟）短于左旋布比卡因-7.5组（162 [148 - 201]分钟）（P = 0.04）；与左旋布比卡因-7.5组（238 [219 - 277]分钟）相比，罗哌卡因-7.5组（197 [177 - 218]分钟）和左旋布比卡因-5组（197 [187 - 251]分钟）出院时间更短（分别为P = 0.02和P = 0.04）。我们得出结论，0.5% 7.5 mg高压罗哌卡因和0.5% 5 mg高压左旋布比卡因可为门诊膝关节镜检查提供足够的脊髓阻滞，与0.5% 7.5 mg高压左旋布比卡因相比，出院时间更快。
