Tijanić Milos, Burić Nikola, Jovanović Goran
Medicinski fakultet Nis, Klinika za stomatologiju Odeljenje oralne hirurgije.
Med Pregl. 2010 May-Jun;63(5-6):366-70. doi: 10.2298/mpns1006366t.
Ropivacaine is used in orthopedcs, gyneacology, surgery, ophtamology, whereas experience about its usage in dentistry is still limited. The aim of this research was to compare the anesthetic effect between local anesthetics ropivacaine and bupivacaine, in surgical disposals of chronical periapical lessions in maxilla.
The study included the patients that had indications for surgical removal of chronical periapical lessions at one of the frontal teeth of upper jaw. The total total number of examinees was 60, and they were devided in two groups. Ropivacaine chloride (0.75%) was used as a local anesthetic in one group (Naropin 0.75%; Astra Zeneca), and in the other one bupivacaine chloride (0.5%) (Vexelit 0.5%; Zdravlje). The authors applied 1.8 ml of block anesthesia for the n. infraorbitalis (intra-oral approach) as well as 0.2 ml of the local anesthetic from the palatine side for the final branches of N. nasopalatinus in order to observe the following anesthetic parameters. (I) Beginning of anesthesia was followed by the appearence of upper lip numbness. (II) Pain rating scale according to Sisk was used for the objective measurement of the anesthesia quality. (III) The pain intensity during the intervention was measured by visual analogous scale, on which the patient denoted the intensity of pain he had felt during the intervention. (IV) Duration of anesthetic effect--it is followed by soft tissues numbness.
After the ropivacaine application anesthesia effect started in 1.57 min. and after the usage of bupivacaine in 1.67 min. The mean duration of soft tissue numbness after the application of ropivacaine was 321 minutes. Bupivacaine had a shorter anesthetic effect--296.5 minutes. The quality of anesthesia after the usage of ropivacaine was assessed by the surgeons with average mark--1.76. Interventions in which this anesthetic was used were performed with minimal pain and without additional anesthesia. The quality of anesthesia after the usage of bupivacaine (3.03) was statistically much worse (p < 0.01) in comparison to ropivacaine. In visual analogous scale where patients denoted the intensity of pain during the intervention with ropivacaine the marked average value was 30.1 mm while the average value with usage of bupivacaine was 41.7 mm. The patients from the control group, where bupivacaine was used, had much stronger pain, statistically significant (p < 0.05) in comparison to the group where ropivacaine was used. Our results show that the quality of anesthesia that was attained with 0.5% bupivacaine was much worse than the quality of anesthesia after the application of 0.75% ropivacaine.
Ropivacaine has a potential to replace bupivacaine completely in cases when there is the indication for its usage in oral surgery (longlasting intervention, interventions followed by intensive postoperational pain, nerve blockade).
罗哌卡因用于骨科、妇科、外科、眼科，而其在牙科的使用经验仍有限。本研究的目的是比较局部麻醉药罗哌卡因和布比卡因在上颌慢性根尖周病变手术处理中的麻醉效果。
该研究纳入了上颌前牙之一有手术切除慢性根尖周病变指征的患者。受检者总数为60人，分为两组。一组使用氯罗哌卡因（0.75%）作为局部麻醉药（耐乐品0.75%；阿斯利康），另一组使用氯布比卡因（0.5%）（威克赛0.5%；Zdravlje）。作者采用1.8 ml眶下神经阻滞麻醉（口内入路）以及从腭侧注入0.2 ml局部麻醉药用于鼻腭神经终末支，以观察以下麻醉参数。（I）麻醉开始后观察上唇麻木的出现。（II）根据西斯克疼痛评分量表客观测量麻醉质量。（III）通过视觉模拟量表测量干预期间的疼痛强度，患者在该量表上表示其在干预期间所感受到的疼痛强度。（IV）麻醉效果持续时间——观察软组织麻木情况。
应用罗哌卡因后麻醉效果在1.57分钟开始，应用布比卡因后在1.67分钟开始。应用罗哌卡因后软组织麻木的平均持续时间为321分钟。布比卡因的麻醉效果持续时间较短——296.5分钟。外科医生对应用罗哌卡因后的麻醉质量评估平均评分为1.76分。使用这种麻醉药进行的干预操作时疼痛轻微，无需追加麻醉。与罗哌卡因相比，应用布比卡因后的麻醉质量（3.03）在统计学上差得多（p<0.01）。在视觉模拟量表上，患者表示使用罗哌卡因干预期间的疼痛强度平均评分为30.1 mm，而使用布比卡因时的平均评分为41.7 mm。使用布比卡因的对照组患者疼痛明显更强烈，与使用罗哌卡因的组相比具有统计学显著性（p<0.05）。我们的结果表明，0.5%布比卡因获得的麻醉质量比应用0.75%罗哌卡因后的麻醉质量差得多。
在口腔手术有使用指征的情况下（长时间手术、术后疼痛剧烈手术、神经阻滞），罗哌卡因有潜力完全取代布比卡因。
