Goyal Ayesha, Shankaranarayan P, Ganapathi P
Department of Anesthesiology, KVG Medical College, Sullia, Dakshina Kannada, Karnataka, India.
Anesth Essays Res. 2015 Jan-Apr;9(1):57-62. doi: 10.4103/0259-1162.150169.
BACKGROUND: To date, racemic bupivacaine is the most popular local anesthetic for spinal anesthesia in parturients undergoing elective cesarean delivery. With the introduction of levobupivacaine as pure S (-) enantiomer of bupivacaine which offers advantages of lower cardiotoxicity and neurotoxicity and shorter motor block duration, its use has widely increased in India. However, very few studies have been conducted about its efficacy in obstetric anesthesia. Thus, this study was undertaken to compare the sensorial, motor block levels, and side-effects of equal doses of hyperbaric bupivacaine and levobupivacaine with intrathecal fentanyl addition in elective cesarean cases. MATERIALS AND METHODS: After approval of College Ethical Committee, 30 parturient with American Society of Anesthesiologists I-II undergoing elective cesarean section were enrolled for study with their informed consent. They were randomly divided equally to either Group BF receiving 10 mg (2 ml) hyperbaric bupivacaine and 25 mcg (0.5 ml) fentanyl, or Group LF receiving 10 mg (2 ml) isobaric levobupivacaine and 25 mcg (0.5 ml) fentanyl. Sensory and motor block characteristics of the groups were assessed with pinprick, cold swab, and Bromage scale; observed hemodynamic changes and side-effects were recorded. Effects on the neonate were observed by APGAR score at 1 and 5 min and umbilical cord blood gas analysis. RESULTS: Hemodynamic parameters like mean arterial pressure of Group BF were found to be lower. Group BF exhibited maximum motor block level whereas in Group LF, max sensorial block level and postoperative visual analog scale scores were higher. Umbilical blood gas pCO2 was slightly higher, and pO2 was marginally lower in Group BF. Onset of motor block time, time to max motor block, time to T10 sensorial block, reversal of two dermatome, the first analgesic need were similar in both groups. CONCLUSION: Intrathecal isobaric levobupivacaine-fentanyl combination is a good alternative to hyperbaric bupivacaine-fentanyl combination in cesarean surgery as it is less effective in motor block, it maintains hemodynamic stability at higher sensorial block levels.
背景：迄今为止，消旋布比卡因是择期剖宫产产妇脊髓麻醉中最常用的局部麻醉药。随着左旋布比卡因作为布比卡因的纯S（-）对映体的引入，其具有较低的心脏毒性和神经毒性以及较短的运动阻滞持续时间等优点，在印度其使用已广泛增加。然而，关于其在产科麻醉中的疗效的研究非常少。因此，本研究旨在比较等剂量的高压布比卡因和左旋布比卡因加鞘内注射芬太尼在择期剖宫产病例中的感觉、运动阻滞水平及副作用。 材料与方法：经学院伦理委员会批准，30例美国麻醉医师协会分级为I-II级的择期剖宫产产妇在获得知情同意后纳入研究。她们被随机平均分为两组，BF组接受10mg（2ml）高压布比卡因和25μg（0.5ml）芬太尼，LF组接受10mg（2ml）等比重左旋布比卡因和25μg（0.5ml）芬太尼。通过针刺、冷拭子和布罗麻量表评估两组的感觉和运动阻滞特征；记录观察到的血流动力学变化和副作用。通过1分钟和5分钟时的阿氏评分及脐血血气分析观察对新生儿的影响。 结果：发现BF组的平均动脉压等血流动力学参数较低。BF组表现出最大运动阻滞水平，而LF组的最大感觉阻滞水平和术后视觉模拟量表评分较高。BF组脐血血气pCO2略高，pO2略低。两组的运动阻滞起效时间、最大运动阻滞时间、T10感觉阻滞时间、两个皮节的恢复时间、首次镇痛需求相似。 结论：在剖宫产手术中，鞘内注射等比重左旋布比卡因-芬太尼组合是高压布比卡因-芬太尼组合的良好替代方案，因为它在运动阻滞方面效果较差，在较高感觉阻滞水平下能维持血流动力学稳定。
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