De Cosmo G, Congedo E, Lai C, Sgreccia M, Amato A, Beccia G, Aceto P
Policlinico A. Gemelli, Department of Anaesthesia and Intensive Care, Roma, Italy.
Eur J Anaesthesiol. 2008 Dec;25(12):1020-5. doi: 10.1017/S0265021508004638. Epub 2008 Jun 9.
There are no clinical studies that compare epidural infusion of ropivacaine and levobupivacaine in patients undergoing lung surgery. The aim of this prospective, randomized double-blind study was to evaluate the efficacy and safety of two commercially available solutions of ropivacaine (0.2% w/v) and levobupivacaine (0.125% w/v) when administered by continuous epidural infusion together with sufentanil in patients undergoing lung surgery.
After obtaining informed consent, 54 patients, ASA physical status I-III undergoing lung resection, were enrolled. Patients were randomly assigned to two groups in which analgesia was performed by continuous thoracic epidural infusion of ropivacaine 0.2% w/v (Group R) or levobupivacaine 0.125% w/v (Group L) with or without sufentanil 1 microg mL(-1). After a test and a loading dose of each drug for the respective group, continuous epidural infusion, set at 5 mL h(-1), began. General anaesthesia was standardized. In the recovery room, patients were provided with intravenous morphine patient-controlled analgesia. Visual analogue scale at rest and when coughing, rescue patient-controlled analgesia morphine amount, haemodynamics, sensory and motor block, sedation, nausea and vomiting, patient satisfaction score, were evaluated within 48 h.
The two groups were similar regarding patient characteristics, quality of analgesia, level of sensory block, morphine consumption and satisfaction score. Postoperative haemodynamic profile was stable in all the patients. Minor side-effects occurred with a similar incidence. Motor block was not seen.
Equivalent volumes of ropivacaine (0.2% w/v) and levobupivacaine (0.125% w/v) provided similar static and dynamic analgesia with similar incidence of minor side-effects after thoracotomy.
尚无临床研究比较肺手术患者硬膜外输注罗哌卡因和左旋布比卡因的效果。这项前瞻性、随机双盲研究的目的是评估两种市售罗哌卡因溶液（0.2%w/v）和左旋布比卡因溶液（0.125%w/v）在肺手术患者中与舒芬太尼联合持续硬膜外输注时的有效性和安全性。
获得知情同意后，纳入54例美国麻醉医师协会（ASA）身体状况分级为I - III级且接受肺切除术的患者。患者被随机分为两组，分别通过持续胸段硬膜外输注0.2%w/v罗哌卡因（R组）或0.125%w/v左旋布比卡因（L组）进行镇痛，两组均联合或不联合1μg/mL舒芬太尼。在对各药物进行试验剂量和负荷剂量给药后，开始以5mL/h的速度持续硬膜外输注。全身麻醉标准化。在恢复室，为患者提供静脉吗啡自控镇痛。在48小时内评估静息和咳嗽时的视觉模拟评分、补救性自控镇痛吗啡用量、血流动力学、感觉和运动阻滞、镇静、恶心和呕吐、患者满意度评分。
两组在患者特征、镇痛质量、感觉阻滞水平、吗啡消耗量和满意度评分方面相似。所有患者术后血流动力学情况稳定。轻微副作用的发生率相似。未观察到运动阻滞。
等量的罗哌卡因（0.2%w/v）和左旋布比卡因（0.125%w/v）在开胸术后提供了相似的静态和动态镇痛效果，且轻微副作用的发生率相似。
