Lee Y Y, Ngan Kee W D, Muchhal K, Chan C K
Department of Anaesthesiology and Operating Theatre Services, Kwong Wah Hospital, Kowloon, Hong Kong.
Acta Anaesthesiol Scand. 2005 Nov;49(10):1477-82. doi: 10.1111/j.1399-6576.2005.00864.x.
Early studies have suggested that ropivacaine causes less motor block than bupivacaine, which might be advantageous in spinal anaesthesia for short procedures. The aim of this study was to compare plain ropivacaine 10 mg and plain bupivacaine 10 mg, both with fentanyl 15 microg, for spinal anaesthesia in urological surgery.
This was a prospective randomized double-blind study. After written informed consent had been obtained, 34 ASA I-III patients scheduled for urological surgery were randomly assigned to receive intrathecal injection of either plain ropivacaine 10 mg with fentanyl 15 microg (ropivacaine group) or plain bupivacaine 10 mg with fentanyl 15 microg (bupivacaine group) using a combined spinal-epidural technique.
All patients achieved sensory block to the T10 dermatome or higher at 15 min after intrathecal injection. One patient in the ropivacaine group was excluded because of unexpectedly prolonged surgery. The primary outcome, the duration of motor block, was shorter in the ropivacaine group (median, 126 min; interquartile range, 93-162 min) compared with the bupivacaine group (median, 189 min; interquartile range, 157-234 min; difference between medians, 71 min; 95% confidence interval, 28-109 min; P = 0.003). The duration of complete motor block was also shorter in the ropivacaine group compared with the bupivacaine group. There was no difference in the onset time of motor block. The characteristics of sensory block and the haemodynamic changes were similar between the groups.
Plain ropivacaine 10 mg plus fentanyl 15 microg provided similar sensory anaesthesia, but with a shorter duration of motor block, compared with plain bupivacaine 10 mg plus fentanyl 15 microg when used for spinal anaesthesia in urological surgery.
早期研究表明，罗哌卡因引起的运动阻滞比布比卡因轻，这在短时间手术的脊髓麻醉中可能具有优势。本研究的目的是比较10毫克普通罗哌卡因和10毫克普通布比卡因分别与15微克芬太尼用于泌尿外科手术脊髓麻醉的效果。
这是一项前瞻性随机双盲研究。在获得书面知情同意后，34例计划进行泌尿外科手术的ASA I-III级患者，采用腰麻-硬膜外联合技术，随机分配接受鞘内注射10毫克普通罗哌卡因与15微克芬太尼（罗哌卡因组）或10毫克普通布比卡因与15微克芬太尼（布比卡因组）。
所有患者在鞘内注射后15分钟时感觉阻滞均达到T10皮节或更高水平。罗哌卡因组有1例患者因手术意外延长而被排除。主要观察指标运动阻滞持续时间，罗哌卡因组（中位数为126分钟；四分位间距为93-162分钟）短于布比卡因组（中位数为189分钟；四分位间距为157-234分钟；中位数差值为71分钟；95%置信区间为28-109分钟；P = 0.003）。罗哌卡因组完全运动阻滞的持续时间也短于布比卡因组。两组运动阻滞的起效时间无差异。两组感觉阻滞特征和血流动力学变化相似。
在泌尿外科手术脊髓麻醉中，10毫克普通罗哌卡因加15微克芬太尼与10毫克普通布比卡因加15微克芬太尼相比，提供了相似的感觉麻醉，但运动阻滞持续时间更短。
