Borghi B, Facchini F, Agnoletti V, Adduci A, Lambertini A, Marini E, Gallerani P, Sassoli V, Luppi M, Casati A
IRCCS Istituti Ortopedici Rizzoli, Department of Anaesthesiology, Italy.
Eur J Anaesthesiol. 2006 Dec;23(12):1005-9. doi: 10.1017/S0265021506000962. Epub 2006 Jul 7.
To compare pain relief and motor impairment of 0.25% levobupivacaine with either an equivalent (0.25%) or equipotent (0.4%) concentration of ropivacaine for continuous interscalene block after open shoulder surgery.
Seventy-two adult patients scheduled for elective major shoulder surgery received an interscalene injection of mepivacaine 1.5% 30 mL followed by 24 h patient-controlled interscalene analgesia (basal infusion rate: 5 mL h-1; incremental bolus: 2 mL; lockout period: 10 min; maximum boluses per hour: 4) with either 0.25% levobupivacaine (n = 24), 0.25% ropivacaine (n = 24) or 0.4% ropivacaine (n = 24). A blinded observer recorded the evolution of pain relief and recovery of motor block during the first 24 h. Motor function was assessed as the maximum pressure developed while squeezing a sphygmomanometer cuff with the blocked hand. The reduction from preoperative values was considered as an index of motor impairment.
No differences were reported among the three groups in the quality of postoperative analgesia. The number of incremental patient-controlled interscalene analgesia doses, total volume of local anaesthetic infused during the 24-h patient-controlled interscalene analgesia, and number of rescue ketoprofen analgesia were higher in the ropivacaine 0.25% group than in the other two groups (P = 0.0005). The hand strength recovered to >or=90% of baseline values within the first 24 h of infusion in all groups, without differences among the three groups.
When providing patient-controlled interscalene analgesia after open shoulder surgery 0.25% levobupivacaine and 0.4% ropivacaine performed equally in terms of pain relief, motor block and number of patient-controlled boluses required, while patients receiving 0.25% ropivacaine needed significantly more boluses and rescue analgesia to control their pain.
比较0.25%左旋布比卡因与同等浓度（0.25%）或等效浓度（0.4%）的罗哌卡因用于开放性肩部手术后连续肌间沟阻滞时的镇痛效果和运动功能障碍情况。
72例择期行大型肩部手术的成年患者，先接受肌间沟注射1.5%甲哌卡因30 mL，随后进行24小时患者自控肌间沟镇痛（基础输注速率：5 mL/h；追加剂量：2 mL；锁定时间：10分钟；每小时最大追加次数：4次），分别使用0.25%左旋布比卡因（n = 24）、0.25%罗哌卡因（n = 24）或0.4%罗哌卡因（n = 24）。一名盲法观察者记录前24小时内镇痛效果的变化和运动阻滞的恢复情况。运动功能通过用阻滞侧手挤压血压计袖带时产生的最大压力来评估。与术前值相比的降低幅度被视为运动功能障碍的指标。
三组术后镇痛质量无差异。0.25%罗哌卡因组患者自控肌间沟镇痛追加剂量的次数、24小时患者自控肌间沟镇痛期间输注的局部麻醉药总量以及补救性酮洛芬镇痛的次数均高于其他两组（P = 0.0005）。所有组在输注的前24小时内手部力量均恢复至基线值的≥90%，三组之间无差异。
在开放性肩部手术后提供患者自控肌间沟镇痛时，0.25%左旋布比卡因和0.4%罗哌卡因在镇痛效果、运动阻滞和所需患者自控追加剂量次数方面表现相当，而接受0.25%罗哌卡因的患者需要显著更多的追加剂量和补救性镇痛来控制疼痛。
