Ophthalmological Science Department, University of Rome "Sapienza", Rome, Italy.
Eur Rev Med Pharmacol Sci. 2010 Jun;14(6):539-44.
The Authors examine the employement of a new anaesthetic agent, levobupivacaine 0.50% (S - enantiomer of racemic mixture of bupivacaine), for peribulbar anaesthesia in a randomized double blind study vs. racemic bupivacaine 0.50% alone or in association with hyaluronidase 10 IU x ml(-1).
120 patients were divided into four groups of 30 each: group L (levobupivacaine 0.50%), group B (racemic bupivacaine 0.50%), group LH (levobupivacaine-hyaluronidase 10 IU x ml(-1)), group BH (racemic bupivacaine-hyaluronidase 10 IU x ml(-1)).
The onset-time (14 +/- 3.2 min vs. 13 +/- 4.8 min) and the duration of anaesthesia (195 +/- 34.2 vs. 204 +/- 37.6) were similar. The ocular akinesia was evaluated with an 8 point system: it was considered sufficient for surgery with values of less than 5 points. The association with hyaluronidase increased the spread of local anaesthetics (76.6% of group LH, 73.3% of group BH) with local anaesthetics alone (60% of group L, 56.6% of group B). Moderate hypotension (<30% baseline) was reported in 3 patients (10%) of group L, 2 (6.6%) of group B, 1 (3.3%) of group LH and 2 (6.6%) of group BH. Statistical analysis (Student-Newman-Keuls test) was significant between group L vs. BH, B vs. BH and LH vs. BH as regards onset-time of anaesthesia; between group B vs. LH, B vs. BH and L vs. LH for the duration of anaesthesia. Chi square test for the general akinesia score showed significant results in group L vs. LH (p=0.043) and B vs. LH 8P =0.018); as regards the score 0, test reported significant values between groups B vs. LH (p=0.004) and B vs. BH (p=0.017).
In conclusion levobupivacaine, a longlasting local anaesthetic with limited cardio and neurotoxicity, might be useful for vitreoretinal surgery in elderly patients, compared with general anaesthesia.
作者研究了一种新的麻醉剂左旋布比卡因 0.50%（布比卡因外消旋混合物的 S-对映体）在球周麻醉中的应用，在一项随机双盲研究中，将其与布比卡因 0.50% （单独使用或与透明质酸酶 10IU x ml(-1) 联合使用）进行比较。
120 名患者被分为 4 组，每组 30 名：L 组（左旋布比卡因 0.50%）、B 组（布比卡因 0.50%）、LH 组（左旋布比卡因-透明质酸酶 10IU x ml(-1)）、BH 组（布比卡因-透明质酸酶 10IU x ml(-1)）。
起效时间（14 +/- 3.2 分钟对 13 +/- 4.8 分钟）和麻醉持续时间（195 +/- 34.2 对 204 +/- 37.6）相似。眼部运动障碍采用 8 分制进行评估：分数小于 5 分被认为足以进行手术。与透明质酸酶联合使用可增加局部麻醉剂的扩散（LH 组 76.6%，BH 组 73.3%），而单独使用局部麻醉剂（L 组 60%，B 组 56.6%）。L 组有 3 名患者（10%）、B 组有 2 名患者（6.6%）、LH 组有 1 名患者（3.3%）和 BH 组有 2 名患者（6.6%）报告出现中度低血压（低于基线的 30%）。统计学分析（Student-Newman-Keuls 检验）显示，麻醉起效时间方面，L 组与 BH 组、B 组与 BH 组、LH 组与 BH 组之间有显著差异；麻醉持续时间方面，B 组与 LH 组、B 组与 BH 组、L 组与 LH 组之间有显著差异。总体运动障碍评分的卡方检验显示，L 组与 LH 组（p=0.043）和 B 组与 LH 组（p=0.018）之间有显著差异；在 0 分方面，B 组与 LH 组（p=0.004）和 B 组与 BH 组（p=0.017）之间有显著差异。
左旋布比卡因是一种长效局部麻醉剂，具有有限的心脏和神经毒性，可能对老年患者的玻璃体视网膜手术有用，与全身麻醉相比。
