Compagna Rita, Vigliotti Gabriele, Bianco Tommaso, Amato Maurizio, Rossi Roberto, Fappiano Francesca, Accurso Antonello, Danzi Michele, Aprea Giovanni, Amato Bruno
BMC Surg. 2013;13 Suppl 2(Suppl 2):S30. doi: 10.1186/1471-2482-13-S2-S30. Epub 2013 Oct 8.
Inguinal hernia is one of the most common diseases in the elderly. Treatment of this pathology is exclusively surgical and relies almost always on the use of local anesthesia. While in the past hernia surgery was carried out mainly by general anesthesia, in recent years there has been growing emphasis on the role of local anesthesia.
The aim of our study was to compare intra-and postoperative analgesia obtained by the use of levobupivacaine to the same obtained by bupivacaine. Bupivacaine is one of the main local anesthetics used in the intervention of inguinal hernioplasty. Levobupivacaine is an enantiomer of racemic bupivacaine with less cardiotoxicity and neurotoxicity. The study was conducted from March 2011 to March 2013. We collected data of eighty patients, male and female, aged between 65 and 86 years, who underwent inguinal hernioplasty with local anesthesia.
Evaluation of intra-operatively pain shows that minimal pain is the same in both groups. Mild pain was more frequent in the group who used levobupivacaine. Moderate pain was slightly more frequent in the group who used bupivacaine. Only one reported intense pain. Two drugs seem to have the same effect at a distance of six, twelve, eighteen and twentyfour hours. Bupivacaine shows a significantly higher number of complications, as already demonstrated by previous studies. Degree of satisfaction expressed by patients has been the same in the two groups. Levobupivacaine group has shown a greater request for paracetamol while patients who experienced bupivacaine have showed a higher request of other analgesics.
Clinical efficacy of levobupivacaine and racemic bupivacaine are actually similar, when used under local intervention of inguinal hernioplasty. In the field of ambulatorial surgery our working group prefers levobupivacaine for its fewer side effects and for its easy handling.
腹股沟疝是老年人最常见的疾病之一。这种疾病的治疗完全依靠手术，并且几乎总是依赖局部麻醉的使用。过去疝手术主要通过全身麻醉进行，近年来人们越来越重视局部麻醉的作用。
我们研究的目的是比较左旋布比卡因和布比卡因在术中及术后的镇痛效果。布比卡因是腹股沟疝修补术中使用的主要局部麻醉剂之一。左旋布比卡因是消旋布比卡因的对映体，具有较低的心脏毒性和神经毒性。该研究于2011年3月至2013年3月进行。我们收集了80例年龄在65至86岁之间、接受局部麻醉下腹股沟疝修补术的患者的数据，男女不限。
术中疼痛评估显示，两组的最小疼痛程度相同。使用左旋布比卡因的组中轻度疼痛更为常见。使用布比卡因的组中中度疼痛略为常见。仅1例报告有剧烈疼痛。在6、12、18和24小时时，两种药物似乎具有相同的效果。如先前研究所表明的，布比卡因的并发症数量明显更多。两组患者表示的满意度相同。左旋布比卡因组对扑热息痛的需求更大，而使用布比卡因的患者对其他镇痛药的需求更高。
在腹股沟疝修补术的局部干预下使用时，左旋布比卡因和消旋布比卡因的临床疗效实际上相似。在门诊手术领域，我们的工作组更倾向于使用左旋布比卡因，因为其副作用较少且易于操作。
