剖宫产脊髓麻醉：等比重布比卡因与重比重布比卡因联合吗啡的比较研究

Spinal anesthesia for cesarean section: comparative study between isobaric and hyperbaric bupivacaine associated to morphine.

作者信息

das Neves José Francisco Nunes Pereira, Monteiro Giovani Alves, de Almeida João Rosa, Brun Ademir, Cazarin Nivaldo, Sant'Anna Roberto Silva, Duarte Evandro Soldate

机构信息

Hospital Monte Sinai, Hospital Agregado ao CET/SBA da Universidade Federal de Juiz de Fora, MG.

出版信息

Rev Bras Anestesiol. 2003 Sep;53(5):573-8.

PMID:19475310

Abstract

BACKGROUND AND OBJECTIVES

Bupivacaine preparations, plain or with glucose, are frequently used in the clinical practice. Blockade upper level is determined by local anesthetic spread in the CSF. This study aimed at comparing isobaric and hyperbaric bupivacaine in patients submitted to spinal anesthesia for Cesarean section.

METHODS

In this prospective, randomized and double-blind study 60 patients submitted to spinal anesthesia for Cesarean section were distributed in two groups: IB - (0.5% isobaric bupivacaine, 12.5 mg) and HB - (0.5% hyperbaric bupivacaine, 12.5 mg). After monitoring, venous puncture was performed followed by hydration with lactated Ringers solution. Spinal puncture was paramedially performed at L3-L4 interspace with 27G Quincke needle. Following the CSF dripping, morphine (100 microg) and bupivacaine were separately injected at the speed of 1 ml. 15 s(-1). With the patient back to supine position, two parameters were recorded: onset time (absence of sensitivity in L3) at 1-minute intervals as well as motor and sensory block after 20 minutes. All patients were kept with preanesthetic blood pressure levels until umbilical cord clamping, and if necessary, ephedrine was administered. Neonates were evaluated by Apgars score at 1 and 5 minutes. Sensory and motor blocks were also evaluated at PACU 120 minutes after local anesthetic injection.

RESULTS

Groups were homogeneous. Onset time: Group IB (1', 50") and HB (1', 33"), with no statistical difference. Motor and sensory block at twenty minutes showed no significant difference. Ephedrine consumption: IB (11.83 mg) and HB (14.17 mg), showed also no statistical difference. PACU motor block evaluation showed significant differences.

CONCLUSIONS

We concluded that 12.5 mg isobaric and hyperbaric bupivacaine associated to morphine (100 microg) in spinal anesthesia for Cesarean section in term pregnant women are effective and present similar profiles.

摘要

背景与目的

布比卡因制剂，无论是单纯制剂还是含糖制剂，在临床实践中都经常使用。麻醉平面取决于局部麻醉药在脑脊液中的扩散情况。本研究旨在比较接受剖宫产脊髓麻醉的患者使用等比重布比卡因和重比重布比卡因的效果。

方法

在这项前瞻性、随机双盲研究中，60例接受剖宫产脊髓麻醉的患者被分为两组：IB组（0.5%等比重布比卡因，12.5毫克）和HB组（0.5%重比重布比卡因，12.5毫克）。监测后，进行静脉穿刺，随后用乳酸林格氏液进行补液。在L3 - L4椎间隙旁正中用27G Quincke针进行脊髓穿刺。脑脊液滴出后，吗啡（100微克）和布比卡因分别以1毫升/15秒的速度注入。患者恢复仰卧位后，记录两个参数：每隔1分钟记录L3水平感觉消失的起效时间，以及20分钟后的运动和感觉阻滞情况。所有患者在脐带结扎前维持麻醉前血压水平，必要时给予麻黄碱。在1分钟和5分钟时通过阿氏评分对新生儿进行评估。在局部麻醉药注射后120分钟，在麻醉后恢复室（PACU）也对感觉和运动阻滞情况进行评估。