左旋布比卡因与消旋布比卡因用于连续双侧全膝关节置换术脊髓麻醉的回顾性队列研究

Chen Chee Kean, Lau Francis C S, Lee Woo Guan, Phui Vui Eng

Department of Anesthesiology and Intensive Care, Kuching Specialist Hospital, 93350 Kuching, Sarawak, Malaysia.

J Clin Anesth. 2016 Sep;33:75-80. doi: 10.1016/j.jclinane.2016.03.007. Epub 2016 Apr 29.

STUDY OBJECTIVES

To compare the anesthetic potency and safety of spinal anesthesia with higher dosages of levobupivacaine and bupivacaine in patients for bilateral sequential for total knee arthroplasty (TKA).

DESIGN

Retrospective cohort study.

SETTING

Operation theater with postoperative inpatient follow-up.

PATIENTS

The medical records of 315 patients who underwent sequential bilateral TKA were reviewed.

INTERVENTIONS

Patients who received intrathecal levobupicavaine 0.5% were compared with patients who received hyperbaric bupivacaine 0.5% with fentanyl 25 μg for spinal anesthesia.

MEASUREMENTS

The primary outcome was the use of rescue analgesia (systemic opioids, conversion to general anesthesia) during surgery for both groups. Secondary outcomes included adverse effects of local anesthetics (hypotension and bradycardia) during surgery and morbidity related to spinal anesthesia (postoperative nausea, vomiting, and bleeding) during hospital stay.

MAIN RESULTS

One hundred fifty patients who received intrathecal levobupivacaine 0.5% (group L) were compared with 90 patients given hyperbaric bupivacaine 0.5% with fentanyl 25 μg (group B). The mean volume of levobupivacaine administered was 5.8 mL (range, 5.0-6.0 mL), and that of bupivacaine was 3.8 mL (range, 3.5-4.0 mL). Both groups achieved similar maximal sensory level of block (T6). The time to maximal height of sensory block was significantly shorter in group B than group L, 18.2 ± 4.5 vs 23.9 ± 3.8 minutes (P< .001). The time to motor block of Bromage 3 was also shorter in group B (8.7 ± 4.1 minutes) than group L (16.0 ± 4.5 minutes) (P< .001). Patients in group B required more anesthetic supplement than group L (P< .001). Hypotension and postoperative bleeding were significantly less common in group L than group B.

CONCLUSION

Levobupivacaine at a higher dosage provided longer duration of spinal anesthesia with better safety profile in sequential bilateral TKA.

研究目的

比较在双侧全膝关节置换术（TKA）患者中，较高剂量左旋布比卡因和布比卡因腰麻的麻醉效能和安全性。

设计

回顾性队列研究。

地点

有术后住院患者随访的手术室。

患者

回顾了315例行序贯双侧TKA患者的病历。

干预措施

将接受0.5%鞘内左旋布比卡因的患者与接受0.5%高压布比卡因加25μg芬太尼进行腰麻的患者进行比较。

测量指标

主要结局是两组手术期间使用补救性镇痛（全身使用阿片类药物、转为全身麻醉）的情况。次要结局包括手术期间局部麻醉药的不良反应（低血压和心动过缓）以及住院期间与腰麻相关的并发症（术后恶心、呕吐和出血）。

主要结果

150例接受0.5%鞘内左旋布比卡因的患者（L组）与90例接受0.5%高压布比卡因加25μg芬太尼的患者（B组）进行比较。左旋布比卡因的平均给药量为5.8 mL（范围5.0 - 6.0 mL），布比卡因的平均给药量为3.8 mL（范围3.5 - 4.0 mL）。两组达到的最大感觉阻滞平面相似（T6）。B组感觉阻滞达到最大高度的时间明显短于L组，分别为18.2±4.5分钟和23.9±3.8分钟（P<0.001）。B组达到布罗玛分级3级运动阻滞的时间也短于L组（8.7±4.1分钟）（16.0±4.5分钟）（P<0.001）。B组患者比L组需要更多的麻醉补充剂（P<0.001）。L组低血压和术后出血的发生率明显低于B组。