Chipde Ss, Banjare M, Arora Kk, Saraswat M
Department of Anesthesiology, M.G.M. Medical College and M.Y. Hospital, Indore, Madhya Pradesh, India.
Ann Med Health Sci Res. 2014 Jul;4(Suppl 2):S115-8. doi: 10.4103/2141-9248.138025.
Bupivacaine and ropivacaine are commonly used agents for caudal anesthesia in pediatric patients. Several studies have shown different motor and cardiovascular effects of two drugs.
The primary objective of this study was to evaluate the efficacy of both drugs and secondary objective was to compare motor blockade and hemodynamic effects caused by them.
This was a prospective randomized controlled study including 50 consecutive patients in the age group of 1-10 years, who underwent urogenital surgeries under general anesthesia. Caudal block was given with either bupivacaine (0.25%) 1 ml/kg (Group I) or ropivacaine (0.25%) 1 ml/kg (Group II). Heart rate (HR) and systolic blood pressure (SBP) were recorded as a baseline, before the anesthesia induction and then at 30, 60 and 90 min after incision. Pain scores were assessed post-operatively by a single observer at 30 min and then at 2, 4, 8 and 12 h with a 5-point observer pain score (OPS). Patients and observer were blinded to the medication given. The duration of absolute analgesia was defined as the time from caudal injection until the pain score was >2. Motor block was assessed by modified Bromage scale. Statistical analysis was performed with Chi-square test, Student's t-test and log-rank test. P < 0.05 were considered as significant.
HR and SBP measured at a specific time intervals showed no significant difference. All the patients had adequate intraoperative analgesia. Mean OPS were comparable between two groups. Duration of absolute analgesia was 276.8 (11) min in Group I and 284.8 (12) min for Group II. The only significant difference was the motor-block score at 2, 3 and 4 h after surgery, although the score was same 1 h post-operatively.
The efficacy of both ropivacaine and bupivacaine is almost same in terms of onset and duration of analgesia. Therefore, the motor blockade caused by ropivacaine is less; there is no significant difference in cardiovascular events.
布比卡因和罗哌卡因是儿科患者骶管麻醉常用的药物。多项研究显示了这两种药物不同的运动和心血管效应。
本研究的主要目的是评估两种药物的疗效，次要目的是比较它们引起的运动阻滞和血流动力学效应。
这是一项前瞻性随机对照研究，纳入了50例年龄在1至10岁之间、在全身麻醉下接受泌尿生殖系统手术的连续患者。骶管阻滞采用布比卡因（0.25%）1毫升/千克（第一组）或罗哌卡因（0.25%）1毫升/千克（第二组）。心率（HR）和收缩压（SBP）在麻醉诱导前作为基线记录，然后在切口后30、60和90分钟记录。术后由一名观察者在30分钟以及之后2、4、8和12小时使用5分制观察者疼痛评分（OPS）评估疼痛评分。患者和观察者对所给予的药物不知情。绝对镇痛持续时间定义为从骶管注射到疼痛评分>2的时间。运动阻滞通过改良的 Bromage 量表进行评估。采用卡方检验、学生 t 检验和对数秩检验进行统计分析。P<0.05被认为具有显著性。
在特定时间间隔测量的HR和SBP无显著差异。所有患者术中镇痛充分。两组的平均OPS相当。第一组绝对镇痛持续时间为276.8（11）分钟，第二组为284.8（12）分钟。唯一显著的差异是术后2、3和4小时的运动阻滞评分，尽管术后1小时评分相同。
罗哌卡因和布比卡因在镇痛起效和持续时间方面疗效几乎相同。因此，罗哌卡因引起的运动阻滞较小；心血管事件无显著差异。
