Khalil Rashaad S, Mehmud Aaliya, Banerjee Rahul, Malhotra Rajiv, Banerjee Arnab
Department of General Surgery, Blackpool Teaching Hospital Foundation Trust, England.
Faculty of Medicine, Universitatea din Oradea, Romania.
Indian J Anaesth. 2024 Feb;68(2):129-141. doi: 10.4103/ija.ija_715_23. Epub 2024 Jan 29.
Intrathecal bupivacaine is used for anaesthesia and analgesia but is associated with hypotension. Ropivacaine is an alternative drug that may have fewer cardiotoxic and neurotoxic events. This meta-analysis investigated whether intrathecal ropivacaine is associated with reduced hypotension as compared to bupivacaine.
The meta-analysis is registered in the International Prospective Register of Systematic Reviews (PROSPERO). The databases PubMed, Cinahl Plus, Google Scholar, and Scopus were searched, and papers from January 1980 to January 2023 were deemed eligible and filtered using predetermined inclusion and exclusion criteria. The primary outcome was the incidence of hypotension. Secondary outcomes were the duration of sensory block, duration of motor block, incidence of bradycardia, ephedrine usage, and duration of analgesia. Jadad scores were used to evaluate the quality of the papers. RevMan statistical software® utilised inverse variance and a random effect model to calculate the standardised mean difference with 95% confidence intervals for continuous variables and the Mantel-Haenszel test and the random effect model to calculate the odds ratio for dichotomous variables.
Thirty-three papers, including 2475 patients in total, were included. The Jadad score was between 1 and 5. The incidence of hypotension was significantly higher with intrathecal bupivacaine than with ropivacaine ( = 0.02). The duration of sensory block ( < 0.001) and motor block ( < 0.001) was prolonged with intrathecal bupivacaine. The duration of analgesia favoured intrathecal bupivacaine = 0.003).
Intrathecal ropivacaine has a reduced incidence of hypotension and a reduced duration of sensory block compared to bupivacaine.
鞘内注射布比卡因用于麻醉和镇痛，但会导致低血压。罗哌卡因是一种替代药物，可能具有较少的心脏毒性和神经毒性事件。本荟萃分析旨在研究与布比卡因相比，鞘内注射罗哌卡因是否与低血压发生率降低相关。
该荟萃分析已在国际前瞻性系统评价注册库（PROSPERO）中注册。检索了PubMed、Cinahl Plus、谷歌学术和Scopus数据库，并使用预先确定的纳入和排除标准对1980年1月至2023年1月的论文进行筛选，符合条件的论文被纳入。主要结局是低血压的发生率。次要结局包括感觉阻滞持续时间、运动阻滞持续时间、心动过缓发生率、麻黄碱使用情况和镇痛持续时间。采用Jadad评分评估论文质量。RevMan统计软件®利用逆方差和随机效应模型计算连续变量的标准化平均差及95%置信区间，利用Mantel-Haenszel检验和随机效应模型计算二分变量的比值比。
共纳入33篇论文，总计2475例患者。Jadad评分在1至5分之间。鞘内注射布比卡因的低血压发生率显著高于罗哌卡因（ = 0.02）。鞘内注射布比卡因会延长感觉阻滞（ < 0.001）和运动阻滞（ < 0.001）的持续时间。镇痛持续时间有利于布比卡因（ = 0.003）。
与布比卡因相比，鞘内注射罗哌卡因的低血压发生率较低，感觉阻滞持续时间较短。
