Faulí A, Anglada M T, Gomar C, Sala X, López A, Pons M, Gambús P, Fábregas N
Departamento de Anestesiología, Universidad de Barcelona, Barcelona, España.
Rev Esp Anestesiol Reanim. 2012 Dec;59(10):549-55. doi: 10.1016/j.redar.2012.07.012. Epub 2012 Oct 3.
To compare 3 combinations of 0.5% levobupivacaine (L) and 1% mepivacaine (M) for popliteal block for hallux valgus surgery.
Prospective, double blind study of 120 patients undergoing unilateral hallux valgus outpatient surgery with posterior popliteal block with ultrasound-guided single injection. Patients were randomly allocated into three groups: G1: 20mL L+10mL M; G2: 10mL L+20mL M; and G3: 15mL L+15mL M. Recorded variables were: time of block, onset and reversal times for tibial and peroneal nerves block; postoperative pain until the 7(th) day by means of visual analogue scale (VAS), simple descriptive scale and the quality of nocturnal rest, complications, and patient satisfaction. ANOVA and chi2 were applied in the statistical analysis, with a P<0.05 considered significant.
Groups were homogeneous for demographic and surgical characteristics. None of the patients required intraoperative complementary analgesia or anaesthesia. Block onset was significantly longer in G1 than in G2 and G3 (39.4±14.7 versus 32.2±16.5 and 33.2±12minutes). Recovery time from sensory and motor block was significantly longer in G1 than in G2 and G3 (29.5±9.3 versus 22.2±8.2 and 24.8±7.9hours). Postoperative pain level was below VAS 30 (1-100) in the three groups; none of the patients experienced severe pain. Maximum pain level appeared at 24h postoperatively. Patient satisfaction was high and there were no complications.
Block onset time and anaesthetic efficacy was adequate in the three groups. The combination of 20mL levobupivacaine 0.5% with 10mL mepivacaine 1% provide a good alternative for a lasting postoperative analgesia.
比较0.5%左旋布比卡因（L）与1%甲哌卡因（M）的三种组合用于拇外翻手术腘窝阻滞的效果。
对120例行单侧拇外翻门诊手术且接受超声引导下单次注射腘窝后阻滞的患者进行前瞻性双盲研究。患者被随机分为三组：G1组：20mL L + 10mL M；G2组：10mL L + 20mL M；G3组：15mL L + 15mL M。记录的变量包括：阻滞时间、胫神经和腓总神经阻滞的起效及消退时间；术后第7天通过视觉模拟评分法（VAS）、简单描述性量表评估的疼痛情况、夜间休息质量、并发症及患者满意度。采用方差分析和卡方检验进行统计学分析，P < 0.05为差异有统计学意义。
三组患者的人口统计学和手术特征相似。所有患者术中均无需补充镇痛或麻醉。G1组的阻滞起效时间显著长于G2组和G3组（39.4±14.7分钟 vs 32.2±16.5分钟和33.2±12分钟）。G1组感觉和运动阻滞的恢复时间显著长于G2组和G3组（29.5±9.3小时 vs 22.2±8.2小时和24.8±7.9小时）。三组术后疼痛程度均低于VAS 30（1 - 100）；无患者经历严重疼痛。最大疼痛程度出现在术后24小时。患者满意度高，且无并发症发生。
三组的阻滞起效时间和麻醉效果均良好。0.5%左旋布比卡因20mL与1%甲哌卡因10mL的组合为术后持久镇痛提供了一个良好的选择。
