2 Department of Anaesthesiology, University of Athens, School of Medicine, "Attikon" University Hospital, Athens, Greece.
Arch Med Sci. 2011 Aug;7(4):685-93. doi: 10.5114/aoms.2011.24140. Epub 2011 Sep 2.
The aim of this study was to compare the postoperative analgesic efficacy of epidural ropivacaine 0.15%, levobupivacaine 0.15% and ropivacaine 0.15% plus fentanyl 2 µg/ml, used with a patient-controlled epidural analgesia (PCEA) device after Caesarean section.
Sixty women undergoing elective Caesarean section under combined spinal-epidural anaesthesia were enrolled. Postoperatively, patients received PCEA with either ropivacaine or levobupivacaine 0.15% (basal rate 6 ml/h, bolus 5 ml/20 min), or ropivacaine 0.15% plus fentanyl 2 µg/ml (basal rate 6 ml/h, bolus 4 ml/20 min). Sympathetic and sensory level of analgesia, motor ability (Bromage 0-3), and pain scores at rest, movement and cough (VAS 0-10), haemodynamic parameters, oxygenation, side effects and total doses of local anaesthetic were documented every 6 h for 24 h. Patient satisfaction was assessed using a descriptive scale.
No significant difference was observed in pain scores at all time intervals. A significantly higher sympathetic and sensory blockade occurred with levobupivacaine and ropivacaine 0.15% compared to ropivacaine 0.15% plus fentanyl, with no significant difference in total local analgesic consumption at 24 h (p = 0.08). Rescue analgesic requirements did not differ between the groups (p = 0.8) while patients' satisfaction was significantly higher in the ropivacaine 0.15% plus fentanyl group (p = 0.02). Haemodynamics, oxygenation, nausea, pruritus and numbness did not differ between the groups.
Dilute local anaesthetic solutions provided satisfactory postoperative analgesia after Caesarean section when used with a PCEA device. The combination of ropivacaine 0.15% with fentanyl 2 µg/ml appeared superior, since it provided higher patient satisfaction with statistically equal pain scores and local anaesthetic consumption.
本研究旨在比较罗哌卡因 0.15%、左布比卡因 0.15%和罗哌卡因 0.15% 加芬太尼 2μg/ml 用于剖宫产术后患者自控硬膜外镇痛（PCEA）的术后镇痛效果。
本研究纳入了 60 例行择期剖宫产术的产妇，均接受蛛网膜下腔-硬膜外联合麻醉。术后，患者接受 PCEA 治疗，药物分别为罗哌卡因或左布比卡因 0.15%（基础输注率 6ml/h，推注量 5ml/20min）或罗哌卡因 0.15% 加芬太尼 2μg/ml（基础输注率 6ml/h，推注量 4ml/20min）。记录术后 24 小时内每 6 小时一次的感觉和运动神经阻滞程度、镇痛效果（VAS 评分 0-10）、血流动力学参数、氧合、不良反应和局部麻醉药总剂量。采用描述性量表评估患者满意度。
各组患者在各个时间点的疼痛评分均无显著差异。与罗哌卡因 0.15%相比，左布比卡因和罗哌卡因 0.15% 可显著提高交感神经和感觉神经阻滞程度，但在 24 小时内的总局部麻醉药用量无显著差异（p=0.08）。各组患者的补救性镇痛需求无显著差异（p=0.8），但罗哌卡因 0.15% 加芬太尼组患者的满意度明显更高（p=0.02）。各组患者的血流动力学、氧合、恶心、瘙痒和麻木无显著差异。
在剖宫产术后使用 PCEA 装置时，低浓度局部麻醉药溶液可提供满意的术后镇痛效果。罗哌卡因 0.15% 加芬太尼 2μg/ml 的组合似乎更优，因为它提供了更高的患者满意度，同时疼痛评分和局部麻醉药用量相当。
