术后镇痛中罗哌卡因和布比卡因运动阻滞效能比较
Relative motor-blocking potencies of epidural ropivacaine and bupivacaine in the postoperative analgesia
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摘要: 目的:测定硬膜外术后镇痛中罗哌卡因和布比卡因的最小运动阻滞浓度(EC50),并对其运动阻滞效能进行比较。方法:将60例行妇科手术并要求硬膜外镇痛的患者随机分为2组,每组30例。经硬膜外导管留置于L2~3间隙,留置导管长度为3cm.分别给予罗哌卡因或布比卡因溶液10 ml。注药前和注药后30 min进行Bromage运动评分。2组患者硬膜外起始用药浓度分别为0.660%罗哌卡因,0.400%布比卡因,按照序贯法来调整每组下1例患者用药的浓度。结果:硬膜外术后镇痛中罗哌卡因EC50为0.706%;布比卡因EC50为0.443%。罗哌卡因运动阻滞的效能为布比卡因的0.63,95%的可信区间为(0.60~0.66)。结论:硬膜外罗哌卡因的运动阻滞效能小于布比卡因,仅为布比卡因运动阻滞效能的63%。Abstract: Objective:To determine the minimal motor-blocking concentration (EC50) of epidural ropivacaine and bupivacaine in the postoperative epidural analgesia,and compare the relative potency of these drugs used in epidural space.Methods:Sixty ASA I women who went gynaecologic operation and requested epidural analgesia were randomized to receive either ropivacaine or bupivacaine.Epidural catheter was placed at L2-3 and advanced for 3cm in the epidural space in a cephalad direction.Each received a 10 ml bolus of epidural ropivacaine or bupivacaine.Half an hour before and after the bolus,take a Bromage score to compare.Up-down sequential allocation was used to determine subsequent concentration:to increase the concentration one level if the previous woman did not respond and to reduce the concentration one level if the previous woman did respond.The up-down sequences were analyzed by using the Brownlee method to quantify the minimal motor-blocking local analgesic concentration.Results:The ropivacaine was 0.706% and for bupivacaine was 0.443% with a ropivacaine/bupivacaine potency ratio of 0.63 (95% CI,0.60-0.66).Conclusions:Ropivacaine was significantly less potent for motor block,at 63% that of bupivacaine.