Bhati Kanta, Kuraning Kiran, Dhawan Sonali, Jawaid Irum, Khilji Yunus
Department of Anaesthesia, Sardar Patel Medical College, Bikaner, Rajasthan, India.
Indian J Anaesth. 2021 Sep;65(9):662-668. doi: 10.4103/ija.IJA_242_21. Epub 2021 Oct 8.
Levobupivacaine and ropivacaine are effective local anaesthetic drugs used in regional anaesthesia with low cardio-neurotoxicity profile than bupivacaine, but comparative studies are limited in children. So, we compared these two drugs intrathecally to study their efficacy and safety in school-age children.
This study was carried out in 60 American Society of Anesthesiologists class I, II and III patients aged 6-12 years, of either sex undergoing infra-umbilical surgeries. After institutional ethical committee approval and written informed consent, the patients were randomly divided into two groups. Group A received isobaric levobupivacaine (0.5%, 0.3-0.4 mg/kg), whereas group B received isobaric ropivacaine (0.5%, 0.5 mg/kg) intrathecally. Fentanyl (0.2 μg/kg) was used as an adjuvant in both the groups. Onset, peak and duration of sensory and motor blockade, duration of post-operative analgesia, time for micturition, perioperative haemodynamic parameters and complications were compared.
Onset and peak of sensory and motor block were earlier in group A. Significantly longer duration of sensory and motor block was achieved in group A (251 ± 41 min, 201 ± 40 min) compared to group B (211 ± 21 min, 102 ± 16 min) ( < 0.001). The time to first rescue analgesic was also significantly prolonged in group A (270 ± 39 min) compared to group B (233 ± 18 min) ( < 0.001). Time to micturition was much early in group B (157 ± 27 min) compared to group A (225 ± 31 min) ( < 0.001).
Intrathecal isobaric levobupivacaine and ropivacaine with fentanyl produces effective surgical anaesthesia and postoperative analgesia without any adverse effects. Early regression of sensorimotor blockade makes ropivacaine better in comparison to levobupivacaine for short infra-umbilical surgeries in children.
左旋布比卡因和罗哌卡因是用于区域麻醉的有效局部麻醉药物，与布比卡因相比，其心脏神经毒性较低，但在儿童中的比较研究有限。因此，我们通过鞘内注射比较这两种药物，以研究它们在学龄儿童中的疗效和安全性。
本研究纳入60例年龄在6至12岁、美国麻醉医师协会分级为I、II和III级、接受脐下手术的患者，性别不限。经机构伦理委员会批准并获得书面知情同意后，将患者随机分为两组。A组鞘内注射等比重左旋布比卡因（0.5%，0.3 - 0.4 mg/kg），而B组鞘内注射等比重罗哌卡因（0.5%，0.5 mg/kg）。两组均使用芬太尼（0.2 μg/kg）作为辅助药物。比较感觉和运动阻滞的起效时间、峰值时间和持续时间、术后镇痛时间、排尿时间、围手术期血流动力学参数及并发症。
A组感觉和运动阻滞的起效时间和峰值时间更早。与B组（211±21分钟，102±16分钟）相比，A组感觉和运动阻滞的持续时间显著更长（251±41分钟，201±40分钟）（<0.001）。与B组（233±18分钟）相比，A组首次补救镇痛时间也显著延长（270±39分钟）（<0.001）。与A组（225±31分钟）相比，B组排尿时间更早（157±27分钟）（<0.001）。
鞘内注射等比重左旋布比卡因和罗哌卡因加芬太尼可产生有效的手术麻醉和术后镇痛，且无任何不良反应。对于儿童短时间脐下手术，与左旋布比卡因相比，罗哌卡因感觉运动阻滞消退更早，效果更好。
