Department of Anaesthesia and Intensive Care, University of Foggia, Foggia, Italy.
Eur Rev Med Pharmacol Sci. 2013 Dec;17(23):3229-36.
BACKGROUND: In spinal anaesthesia for a Caesarean delivery, it is important to limit anaesthesia only at the surgical area, and to resolve fast motor block. We compared the intraoperative effectiveness, hemodynamic effects, anaesthetic recovery times and patients satisfaction after isobaric levobupivacaine (L) 0.25% versus L0.50% spinal anaesthesia during elective Caesarean deliveries performed with the Stark technique. PATIENTS AND METHODS: In this double-blinded prospective study, seventy women undergoing elective caesarean delivery were randomized to receive either intrathecal 7.5 mg Levobupivacaine 0.25% plus sufentanil 2.5 μg (Group L0.25), or intrathecal 7.5 mg L 0.50% plus sufentanil 2.5 μg (GroupControl). The onset time, duration of anaesthesia, analgesia and sensory and motor block and hemodynamic parameters were measured from the beginning of spinal anaesthesia until four hours after spinal anaesthesia (T240). RESULTS: Onset time, duration of anaesthesia and haemodynamic variations were similar in the two groups. No patients required general anesthesia to complete surgery. Motor block vanished faster in Group L0.25 as compared with GroupControl (p < .01). The cephalad spread of the 0.50% solution was higher than that of the 0.25% solution: no patient in Group L0.25 experienced paresthesia of the upper limbs vs 14% in GroupControl (p < .05). In GroupControl anaesthesia reached the dermatome T1 in 15% of cases. Maternal and surgeon satisfaction was good in every patient. CONCLUSIONS: Levobupivacaine 7.5 milligrams at 0.25% may be used as a suitable alternative to L 0.50% for spinal anaesthesia for caesarean deliveris with the Stark technique with good maternal satisfaction. In Group L0.25 a lower appearance of nausea and hypotension were observed and motor and sensitive block developed and diminished faster while no clinically significant differences in hemodynamic behavior was observed between groups.
背景:在剖宫产术的椎管内麻醉中,重要的是仅在手术区域内限制麻醉,并快速解决运动阻滞。我们比较了等比重左旋布比卡因(L)0.25%与 L0.50%椎管内麻醉用于 Stark 技术剖宫产时的术中效果、血液动力学效应、麻醉恢复时间和患者满意度。
患者和方法:在这项双盲前瞻性研究中,70 名择期剖宫产的患者随机分为鞘内注射 7.5mg 左旋布比卡因 0.25%加舒芬太尼 2.5μg(L0.25 组)或鞘内注射 7.5mg L0.50%加舒芬太尼 2.5μg(对照组)。从脊髓麻醉开始到脊髓麻醉后 4 小时(T240)测量起效时间、麻醉持续时间、镇痛和感觉及运动阻滞以及血液动力学参数。
结果:两组的起效时间、麻醉持续时间和血液动力学变化相似。没有患者需要全身麻醉来完成手术。与对照组相比,L0.25 组的运动阻滞更快消失(p <.01)。0.50%溶液的头侧扩散高于 0.25%溶液:L0.25 组无患者出现上肢感觉异常(占 0%),而对照组有 14%(p <.05)。在对照组中,麻醉达到 T1 皮节的占 15%。每位患者的产妇和外科医生满意度均良好。
结论:左旋布比卡因 7.5mg 0.25%可作为 Stark 技术剖宫产脊髓麻醉的合适替代物,具有良好的产妇满意度。在 L0.25 组中,观察到恶心和低血压的发生率较低,运动和感觉阻滞更快发展和消退,而两组之间的血液动力学行为无显著差异。
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