Hunan Cancer Hospital/the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China.
Hengyang Medical College, University of South China, Hengyang, Hunan, China.
Adv Ther. 2022 May;39(5):2151-2164. doi: 10.1007/s12325-022-02088-3. Epub 2022 Mar 16.
Bupivacaine is a more widely used anesthetic than mepivacaine. However, the long-acting effects of bupivacaine often lead to slow and unpredictable return. As an intermediate-acting local anesthetic, mepivacaine can enable earlier ambulation and thus has other benefits. We performed a systematic review and meta-analysis of available randomized controlled trials (RCTs) comparing the anesthetic effects of mepivacaine and bupivacaine.
On August 12, 2021, a search was performed in PubMed, Embase, and the Cochrane Library. Effect estimates with 95% CI were combined using a random effects model. We performed sensitivity analyses to explore sources of heterogeneity and stability of results.
Of the 406 papers screened, 14 population-based randomized controlled trials were included, with a total of 1007 patients. Overall, compared to bupivacaine, mepivacaine was associated with higher numbers of motor block 3 (OR, 4.05; 95% CI 1.92-8.57), shorter length of stay (SMD, - 0.77; 95% CI - 1.52 to - 0.03), faster recovery from motor block (SMD, - 1.45; 95% CI - 2.39 to - 0.51), and shorter time to return to voiding (SMD, - 1.24; 95% CI - 1.83 to - 0.64). Mepivacaine was associated with a higher incidence of transient neurologic symptoms (TNS) and transient nerve root irritation (TRI) (OR, 9.18; 95% CI 2.42-34.88). There was no statistical difference between the two anesthetics in terms of pain index on the postoperative day (SMD, 0.20; 95% CI - 0.06 to 0.46) and incidence of urinary retention (OR, 0.98; 95% CI 0.47-2.03).
Mepivacaine may have advantages over bupivacaine in terms of achieving motor block 3, shorter length of stay, earlier recovery from motor block, and earlier time to return to voiding, but it may have a higher incidence of TNS or TRI than bupivacaine. Therefore, mepivacaine may be used before bupivacaine in spinal anesthesia.
布比卡因的应用比甲哌卡因更为广泛。然而，布比卡因的长效作用往往导致苏醒时间缓慢且难以预测。甲哌卡因作为一种中效局麻药，能更早地实现患者下地活动，因此具有其他优势。我们对比较甲哌卡因和布比卡因麻醉效果的已发表随机对照试验（RCT）进行了系统回顾和荟萃分析。
我们于 2021 年 8 月 12 日在 PubMed、Embase 和 Cochrane 图书馆进行了检索。采用随机效应模型合并具有 95%置信区间的效应估计值。我们进行敏感性分析以探索异质性来源和结果稳定性。
在筛选出的 406 篇论文中，纳入了 14 项基于人群的 RCT，共有 1007 名患者。总体而言，与布比卡因相比，甲哌卡因导致 3 级运动阻滞的例数更多（OR，4.05；95%CI，1.92-8.57），住院时间更短（SMD，-0.77；95%CI，-1.52 至-0.03），运动阻滞恢复更快（SMD，-1.45；95%CI，-2.39 至-0.51），排尿恢复时间更短（SMD，-1.24；95%CI，-1.83 至-0.64）。甲哌卡因引起短暂神经症状（TNS）和短暂神经根刺激（TRI）的发生率更高（OR，9.18；95%CI，2.42-34.88）。两种麻醉剂在术后第 1 天疼痛指数（SMD，0.20；95%CI，0.06 至 0.46）和尿潴留发生率（OR，0.98；95%CI，0.47-2.03）方面无统计学差异。
与布比卡因相比，甲哌卡因在实现 3 级运动阻滞、缩短住院时间、更早恢复运动阻滞和更早恢复排尿方面可能具有优势，但 TNS 或 TRI 的发生率可能高于布比卡因。因此，在脊髓麻醉中，甲哌卡因可能优先于布比卡因使用。
