Dijkstra T, Reesink J A, Verdouw B C, Van der Pol W S C J M, Feberwee T, Vulto A G
Department of Hospital Pharmacy, Reinier de Graaf Groep, PO Box 5011, 2600 GA Delft, The Netherlands.
Br J Anaesth. 2008 Jan;100(1):104-8. doi: 10.1093/bja/aem332.
A local anaesthetic with fast onset and short reliable duration of anaesthesia may be preferable for out-patient lower limb surgery. Articaine is believed to act faster and to have a shorter duration of action than bupivacaine, but there are no conclusive data available. The purpose of this study was to compare articaine and bupivacaine for day-case lower limb surgery.
Eighty patients planned for day-case lower limb surgery enrolled in this study. Patients were randomized to receive hyperbaric articaine 80 mg or plain bupivacaine 15 mg intrathecally. Primary outcome variable was recovery time from motor block. Secondary outcomes were: onset of sensory and motor block, maximum spread of sensory block, time to micturition, discharge from the hospital, and complications.
The groups were comparable for the medians and the range of the maximum blocks after 30 min. Median time to complete regression of motor block was 101 min (range 80-129) for articaine compared with 307 min (range 225-350) for bupivacaine (P<0.0005). First spontaneous micturition occurred after 257 min (210-293) in the articaine group and after 350 min (304-370) in the bupivacaine group (P<0.0005). In the articaine and bupivacaine groups, patients were discharged after 300 min (273-347) and 380 min (332-431), respectively (P<0.0005). There was no significant difference in the occurrence of complications between the groups.
Spinal anaesthesia with 80 mg of hyperbaric articaine has a shorter duration than a spinal anaesthesia with 15 mg of plain bupivacaine in lower limb surgery of approximately 1 h duration.
对于门诊下肢手术而言，一种起效快且麻醉持续时间可靠的局部麻醉药可能更为适用。据信，阿替卡因的起效速度比布比卡因更快，作用持续时间更短，但尚无确凿数据。本研究的目的是比较阿替卡因和布比卡因用于日间下肢手术的效果。
80例计划行日间下肢手术的患者纳入本研究。患者被随机分为鞘内注射80mg重比重阿替卡因或15mg普通布比卡因两组。主要结局变量是运动阻滞的恢复时间。次要结局包括：感觉和运动阻滞的起效时间、感觉阻滞的最大范围、排尿时间、出院时间及并发症。
两组在30分钟后最大阻滞的中位数和范围具有可比性。阿替卡因组运动阻滞完全消退的中位时间为101分钟（范围80 - 129分钟），而布比卡因组为307分钟（范围225 - 350分钟）（P<0.0005）。阿替卡因组首次自主排尿发生在257分钟（210 - 293分钟），布比卡因组发生在350分钟（304 - 370分钟）（P<0.0005）。阿替卡因组和布比卡因组患者分别在300分钟（273 - 347分钟）和380分钟（332 - 431分钟）后出院（P<0.0005）。两组并发症的发生率无显著差异。
在持续时间约为1小时的下肢手术中，80mg重比重阿替卡因的脊髓麻醉持续时间比15mg普通布比卡因的脊髓麻醉持续时间短。
