【摘要】 目的 观察不同剂量的舒芬太尼用于剖宫产术后硬膜外自控镇痛的效果比较。 方法 将2009年4-11月60例硬膜外麻醉下行剖宫产手术术后的患者随机分为三组，术后镇痛液A组采用0.125%罗哌卡因复合0.3 μg/mL舒芬太尼；B组为0.125%罗哌卡因复合0.4 μg/mL舒芬太尼；C组0.125%罗哌卡因复合0.5 μg/mL舒芬太尼，观察三组患者的术后镇痛效果（视觉模拟法评分，即VAS评分）及不良反应。 结果 A组VAS评分高于B组和C组，B组VAS评分高于C组（Plt;0.05）。三组患者术后恶心呕吐、运动阻滞、嗜睡及肠蠕动抑制等并发症无统计学差异（Pgt;0.05）。 结论 0.125%罗哌卡因复合0.5 μg/mL舒芬太尼以4 mL/h持续输注用于剖宫产术后患者自控硬膜外镇痛术后疼痛VAS评分最小，患者镇痛满意度最高。【Abstract】 Objective To observe the effect of postoperative patient-controlled epidural analgesia (PCEA) with three different doses of sufentanil combined with 0.125% ropivacaine after cesarean section. Methods Data was collected from April 2009 to November 2009. Sixty patients after cesarean section under continuous epidural anesthesia were randomly divided into three different groups.Group A was given sufentanil 0.3 μg/mL and 0.125% ropivacaine for PCEA, group B was given sufentanil 0.4 μg/mL and 0.125% ropivacaine, group C was given sufentanil 0.5 μg/mL and 0.125% ropivacaine. The analgesia effects were evaluated by the visual analogue scales (VAS). Side effects were also recorded. Results The VAS scores were significantly the highest in group A than that in group B and group C, the VAS scores in group B were higher than that in group C (Plt;0.05). The incidence of side effects, such as postoperative nausea and vomiting, lethargy, and pruritus, was not significant among the three groups (Pgt;0.05). Conclusion 0.5 μg/ mL sufentanil and 0.125% ropivacaine recommended for PCEA with background 4 mL/h is safe and effective for patients after cesarean section.
Objective To evaluate the effectiveness and safety of ropivacaine in spinal anesthesia. Methods We searched PubMed (1999 to 2008), OVID (1999 to 2008), EBSCO (1999 to 2008), The Cochrane Library (2000 to 2008), and CNKI (1999 to 2008) databases to identify randomized controlled trials (RCTs) that compared ropivacaine and bupivacaine for spinal anesthesia. The quality of the included RCTs was evaluated by two reviewers independently, and meta-analysis was performed by RevMan 5.0 software. Results Six RCTs were included. The methodological quality of them were all poor. Among the six RCTs, 215 patients received ropivacaine and 215 received bupivacaine. The results of meta-analyses showed that the motor-block time to complete block of ropivacaine was significantly shorter than that of bupivacaine (WMD=2.18 min, 95%CI 0.32 to 4.03, P=0.02). The motor-block time to complete recovery of ropivacaine was significantly shorter than that of bupivacaine for cesarean delivery in spinal anesthesia (SMD= – 1.82, 95%CI – 3.05 to – 0.59, P=0.004). The incidence rate of hypotension and bradycardia in spinal anestheisa with ropivacaine was lower than that with bupivacaine (OR=0.49, 95%CI 0.31 to 0.80, P=0.004; OR=0.40, 95%CI 0.03 to 4.99, P=0.47). Conclusion Equivalent doses of ropivacaine and bupivacaine provide similar analgesia in spinal anesthesia for cesarean delivery. However, haemodynamics in spinal anesthesia with ropivacaine fluctuate lightlier than with bupivacaine. Ropivacaine is suitable for spinal anesthesia in low-abdominal operations.
Objective To compare the analgesic efficiency and safety of subacromial bursa continued ropivacaine analgesia with patient-controlled intravenous analgesia for arthroscopic rotator cuff repair. Methods A total of 64 patients undergoing rotator cuff repair surgery between October 2013 and February 2015 were randomly divided into the subacromial bursa group (JFX group, 32 cases) and the patient-controlled intravenous analgesia group (JM group, 32 cases). At the end of surgery, a catheter was inserted into the subacromial bursa of the patients in JFX group under arthroscopic visualisation and fixed properly, and analgesia pump was connected after surgery; in JM group, analgesia pump was connected to the vein channel after surgery. The pain Visual Analogue Scale (VAS) (motion and rest) scores 1 hour and 12, 24, 48, 72 hours after surgery, adverse reactions, use of analgesic pump, number of additional analgesia and patients satisfaction were recorded. Results There were no differences between the two groups in the number of additional analgesia, patients satisfaction, additional use of antiemetic drugs, motion and rest VAS scores 1 hour and 12, 72 hours after surgery, and the incidence of moderate-severe pain (VAS≥4) at each time point (P>0.05). The motion and rest VAS scores 24, 48 hours after surgery in JFX group were lower than those in JM group, the analgesia times and the incidence of nausea and vomiting in JFX group were lower than those in JM group, and the differences were statistically significant (P<0.05). Conclusion Efficiency of subacromial bursa infiltration of ropivacaine sustained analgesic is slightly better than that of patient-controlled intravenous analgesia, with lower incidence of adverse reactions.
【摘要】 目的 比较单次股神经阻滞和关节腔内单次注射罗哌卡因对膝关节镜检术后镇痛效果，为临床应用提供试验依据。 方法 2009年1月-2010年7月，选择美国麻醉医师协会（ASA）Ⅰ～Ⅱ级、年龄18~65岁、拟行择期单侧下肢膝关节镜手术患者180例，随机分为股神经阻滞组和关节腔内用药组，每组90例，分别于术前1 h行股神经阻滞（0.15%罗哌卡因20 mL）和手术结束时在膝关节腔内注入0.6%罗哌卡因20 mL。于术后4、8、24 h采用视觉模拟评分法（visual analog scale，VAS）行静止和运动时疼痛评分，记录术后患者满意度、不良反应发生率，术后使用镇痛药物情况。 结果 关节腔内用药组术后镇痛药物使用率（41.11%）明显高于股神经阻滞组（20.00%）（Plt;0.005）。两组患者术后24 h静止时及术后8、24 h运动时的VAS评分关节腔内用药组均明显高于股神经阻滞组（Plt;0.001），其余各时点差异无统计学意义（Pgt;0.05）。 结论 股神经阻滞可提供更加有效的术后镇痛效果，并且用药量小，安全系数高，值得临床推广。【Abstract】 Objective To compare the effect of single-injection femoral nerve block and local anesthetic intraarticular injection for analgesia after knee arthroscopy, in order to provide the experimental base for clinical application. Methods From January 2009 to July 2010, 180 American Society of Anesthesiologists (ASA) physical status I-II patients, aged from 18 to 65 years old, and scheduled for elective single knee arthroscopy were randomly divided into two groups: femoral nerve block group and local anesthetic intraarticular injection group with 90 patients in each group. For the patients in the former group, 20 mL of 0.15% ropivacaine was injected 1 hour before operation. For the latter group, 20 mL of 0.6% ropivacaine was injected into the articular cavity after operation. Pain intension scores at rest and in motion were measured 4, 8, and 24 hours after operation by visual analog scale (VAS). The degree of patients’ satisfaction, adverse reaction incidence rate and information of taking pain-killers were also recorded. Results The rate of using pain-killers in the intraarticular injection group (41.11%) was dramatically higher than the femoral nerve block group (20.00%) (Plt;0.005). The VAS scores of patients in the intraarticular injection group at rest 24 hours after operation and in motion 8 hours and 24 hours after operation were significantly higher than the femoral nerve block group (Plt;0.001), while there was no significant difference at other points between the two groups. Conclusions Femoral nerve block is more efficient for analgesia after knee arthroscopy compared with local anesthetic intraarticular injection. It is a safe procedure requiring only a relatively small dose of medicine, and is worth being popularized.
【摘要】目的观察低浓度罗哌卡因复合舒芬太尼用于分娩镇痛的效果。方法2007年5月8月按入选标准选择100例产妇,随机分成试验组和对照组,每组50例。试验组分娩前给予低浓度罗哌卡因加舒芬太尼,对照组不行无痛分娩,通过视觉模拟评分法等指标观察镇痛效果。结果试验组镇痛后视觉模拟评分较对照组低(Plt;0.05);两组镇痛期间血压、心率差异有统计学意义（Plt;0.05），新生儿Apgar评分比较无统计学意义(Pgt;0.05)。结论联合应用罗哌卡因和舒芬太尼用于硬膜外分娩镇痛能取得较好的效果,值得在临床中推广应用。
Objective To evaluate the analgesic effect of intra-articular ropivacaine with lidocaine. Methods A double-blind randomized controlled trial was conducted. Ninety patients receiving selective knee arthroscopy were randomized into three groups of 30 patients. At the end of the operation, before the release of the tourniquet, an intra-articular injection was administered to each patient through arthroscope, in accordance with their random allocation: 0.9% normal saline (normal saline group); 100 mg ropivacaine (ropivacaine alone group) and 100 mg ropivacaine and 100 mg 2% lidocaine (ropivacaine with lidocaine group). Pain intensity was assessed after the operation using the 100-mm visual-analog scale (VAS), and the amount of supplemental analgesics used within the following 24 hours were recorded. Results The VAS scores of 2 hours postoperatively at rest, and 1, 2, 4, and 8 hours postoperatively at motion, were significantly higher in the normal saline group than in ropivacaine alone group (Plt;0.05). The VAS scores 0.5, 1 and 2 hours postoperatively at rest, and at the awaking moment, 0.5, 1, 4, 8, and 24 hours postoperatively at motion, were significantly higher in the normal saline group than in ropivacaine with lidocaine group (Plt;0.05). Conclusion Intra-articular ropivacaine can reduce a patient’s pain after operation. The combination of lidocaine with intra-articular ropivacaine can reduce the patient’s pain severity immediately after the operation and achieve an early analgesic effect.
ObjectiveTo investigate the effect and safety of subgluteal approach continous sciatic nerve block with 0.2% ropivacaine for postoperative analgesia in calcaneal fracture patients. MethodsForty calcaneal fracture patients treated from May 2012 to January 2013 were randomly assigned to two groups:20 patients in continuous sciatic nerve block group (group CSB) and 20 patients in self-controlled intravenous analgesia group (group PCIA).Patients in group CSB were given subgluteal approach continuous sciatic nerve block,and PCA pump was connected to give 0.2% ropivacaine via continuous nerve block catheter continuously for analgesia.Patients in group PCIA were given PCA pump directly for self-controlled intravenous analgesia.The movement/rest VAS scores and Ramsay scores at 2,8,24,48 hours after surgery,the dose of other analgesia drugs after surgery,the satisfaction of patients and surgeons,and side effects were recorded. ResultsThe movement and rest visual analogue scale (VSA) scores and the dose of analgesia drugs in group CSB were significantly lower than group PCIA at all time points (P<0.05).The satisfaction of patients and surgeons in group CSB was higher than group PCIA (P<0.05). ConclusionCompared with self-controlled intravenous analgesia,subgluteal approach continuous sciatic nerve block with 0.2% ropivacaine can provide better and safer postoperative analgesia for calcaneal fracture patients.
目的:观察相同剂量不同浓度的罗哌卡因用于腰丛坐骨神经联合阻滞的临床效果。方法:择期行单侧下肢手术的患者90例,年龄18~65岁,ASAⅠ或Ⅱ级,随机分为3组(n=30):A组给予0.3 ％的罗哌卡因腰丛36 mL、坐骨神经24 mL,B组给予0.36 ％的罗哌卡因腰丛30 mL、坐骨神经24 mL,C组给予0.4％罗哌卡因腰丛27 mL、坐骨神经18 mL。分别于给药后2、5、10、15、20、25、30、35 min测定下肢的感觉、运动评分以及感觉阻滞的时间和运动阻滞的时间。结果:三组患者阻滞起效时间无明显差别,高容量组完全阻滞的持续时间短于低容量组;高容量低浓度组患者完全阻滞率高于低容量组,但达到完全阻滞时间长于低容量组。结论:在剂量相同时罗哌卡因的浓度和容量会影响腰丛和坐骨神经的阻滞 效果;高容量罗哌卡因更有利于达到良好的感觉阻滞。