Mantouvalou M, Ralli S, Arnaoutoglou H, Tziris G, Papadopoulos G
Department of Anesthetics, Western Attica General Hospital, Greece.
Acta Anaesthesiol Belg. 2008;59(2):65-71.
This study was performed to compare the anesthetic efficacy and safety of three local anesthetic agents: racemic bupivacaine and its two isomers: ropivacaine and levobupivacaine, in patients undergoing lower abdominal surgery. One hundred-twenty patients, ASA I-III, were randomized to receive an intrathecal injection of one of three local anesthetic solutions. Group A (n = 40) received 3 ml of isobaric bupivacaine 5 mg/ml (15 mg). Group B (n = 40) received 3 ml of isobaric ropivacaine 5 mg/ml (15 mg). Group C (n = 40) received 3 ml of isobaric levobupivacaine 5 mg/ml (15 mg). The onset and duration of sensory block at dermatome level T8, maximum upper spread of sensory block, time for 2-segment regression of sensory block as well as the onset, intensity and duration of motor block were recorded, as were any adverse effects, such as bradycardia, hypotension, hypoxia, tremor, nausea and/or vomiting. Time to unassisted standing up and voluntary micturition was also recorded. The onset of motor block was significantly faster in the bupivacaine group compared with that in the ropivacaine group and almost the same of that in the levobupivacaine group (P < 0.05). Ropivacaine presented a shorter duration of both motor and sensory block than bupivacaine and levobupivacaine (P < 0.05). Bupivacaine required more often the use of a vasoactive drug (ephedrine) compared to both ropivacaine and levobupivacaine and of a sympathomimetic drug (atropine) compared to the ropivacaine group.
本研究旨在比较三种局部麻醉剂（消旋布比卡因及其两种异构体：罗哌卡因和左旋布比卡因）在接受下腹部手术患者中的麻醉效果和安全性。120例ASA I - III级患者被随机分为三组，分别接受鞘内注射三种局部麻醉溶液中的一种。A组（n = 40）接受3 ml等比重布比卡因5 mg/ml（15 mg）；B组（n = 40）接受3 ml等比重罗哌卡因5 mg/ml（15 mg）；C组（n = 40）接受3 ml等比重左旋布比卡因5 mg/ml（15 mg）。记录T8皮节水平感觉阻滞的起效时间和持续时间、感觉阻滞的最大上界扩展、感觉阻滞消退两个节段的时间以及运动阻滞的起效时间、强度和持续时间，同时记录任何不良反应，如心动过缓、低血压、低氧血症、震颤、恶心和/或呕吐。还记录了自主站立和自主排尿的时间。与罗哌卡因组相比，布比卡因组运动阻滞的起效明显更快，与左旋布比卡因组几乎相同（P < 0.05）。罗哌卡因的运动和感觉阻滞持续时间均短于布比卡因和左旋布比卡因（P < 0.05）。与罗哌卡因和左旋布比卡因相比，布比卡因更常需要使用血管活性药物（麻黄碱），与罗哌卡因组相比，布比卡因更常需要使用拟交感神经药物（阿托品）。
