Brown D L, Carpenter R L, Thompson G E
Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington 98111.
Anesthesiology. 1990 Apr;72(4):633-6. doi: 10.1097/00000542-199004000-00010.
Ropivacaine is an amide local anesthetic structurally related to, but appearing less cardiotoxic, than bupivacaine. The authors' investigation was designed in a randomized, double-blind fashion to compare the clinical effectiveness of ropivacaine and bupivacaine in patients undergoing lower-extremity surgery. Forty-five patients were randomized to receive 20 ml of 0.5% ropivacaine or bupivacaine. Intermittent sensory (pinprick) and motor (Bromage score) measurements were made while the block was in effect, and changes in heart rate, blood pressure and amounts of additional analgesics, sedatives and other medications were also recorded. Presence of tourniquet pain and the quality of anesthesia were also assessed. One patient was excluded from analysis; thus, 22 patients each received ropivacaine or bupivacaine. No differences were found in patient or perioperative characteristics between the groups. The quality and extent of sensory and motor blockade between groups were comparable, although bupivacaine was slightly longer acting. Cardiovascular changes, incidence of tourniquet pain, and the amounts of supplemental medications necessary were also similar between groups. The authors found 0.5% ropivacaine and bupivacaine to be clinically similar in both sensory- and motor-blocking characteristics, with the exception that bupivacaine produced a blockade of slightly longer duration. Because ropivacaine is reported to be less cardiotoxic than bupivacaine in animal studies, the similarity of clinical epidural anesthesia may make ropivacaine the preferred agent.
罗哌卡因是一种酰胺类局部麻醉药，其结构与布比卡因相关，但心脏毒性似乎比布比卡因小。作者的研究采用随机、双盲方式设计，以比较罗哌卡因和布比卡因在接受下肢手术患者中的临床疗效。45例患者被随机分配接受20毫升0.5%的罗哌卡因或布比卡因。在阻滞起效时进行间歇性感觉（针刺）和运动（布罗玛杰评分）测量，并记录心率、血压以及额外镇痛药、镇静剂和其他药物的用量变化。还评估了止血带疼痛的存在情况和麻醉质量。1例患者被排除在分析之外；因此，每组22例患者分别接受了罗哌卡因或布比卡因。两组患者或围手术期特征无差异。尽管布比卡因作用时间稍长，但两组间感觉和运动阻滞的质量和范围相当。两组间心血管变化、止血带疼痛发生率以及所需补充药物的用量也相似。作者发现0.5%罗哌卡因和布比卡因在感觉和运动阻滞特征方面临床相似，只是布比卡因产生的阻滞持续时间稍长。由于在动物研究中罗哌卡因的心脏毒性比布比卡因小，临床硬膜外麻醉的相似性可能使罗哌卡因成为首选药物。
