A double-blind comparison of ropivacaine, bupivacaine, and mepivacaine during sciatic and femoral nerve blockade
A double-blind comparison of ropivacaine, bupivacaine, and mepivacaine during sciatic and femoral nerve blockade
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DOI：
10.1097/00000539-199809000-00019
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发表时间：
1998-09-01
影响因子：
5.7
通讯作者：
Torri, G
中科院分区：
文献类型：
--
作者：
Fanelli, G;Casati, A;Torri, G
目前尚无研究评价罗比卡因用于下肢周围神经阻滞的疗效。这项前瞻性、随机、双盲研究的目的是比较罗比卡因、布比卡因和甲哌卡因在坐骨神经-股神经联合阻滞中的作用。将45例ASA分级为I或II级的拇外翻患者随机分为三组，分别接受0.75%罗比卡因(ROPI，n=15)、0.5%布比卡因(BUPI，n=15)和2%甲哌卡因(MEPI，n=15)复合坐骨神经-股神经阻滞。记录手术肢体感觉和运动阻滞起效时间(手术准备时间)、运动阻滞消失时间、术后疼痛起效时间和首次止痛时间。这三组在人口统计学变量、手术持续时间和测量的视觉模拟疼痛评分方面相似。感觉和运动阻滞起效时间ROPI组和MEPI组相似，显著短于BUPI组(分别为P=0.002和P=0.001)。运动阻滞消失时间ROPI组和BUPI组晚于MEPI组(P=0.005和P=0.0001)。术后镇痛时间ROPI组(670±-227min)和BUPI组(880+/-312min)明显长于MEPI组(251min+/-47min)(P=0.0001)，术后止痛药物用量明显减少(P<0.05)。结论：对于坐骨神经-股神经阻滞，0.75%罗比卡因的起效时间与2%甲比卡因相似，术后镇痛时间介于0.5%布比卡因和2%甲比卡因之间。提示：快速起效并延长术后镇痛时间是周围神经阻滞的重要目标。我们评价了0.5%布比卡因、2%甲哌卡因和0.75%罗比卡因用于坐骨神经-股神经阻滞的临床效果，结果表明罗比卡因的起效与甲哌卡因相似，但术后镇痛介于布比卡因和甲哌卡因之间。
No study has evaluated the efficacy of ropivacaine in peripheral nerve block of the lower extremity. The purpose of this prospective, randomized, double-blind study was to compare ropivacaine, bupivacaine, and mepivacaine during combined sciatic-femoral nerve block. Forty-five ASA physical status I or II patients scheduled for elective hallux valgus repair with thigh tourniquet were randomized to receive combined sciatic-femoral block with 0.75% ropivacaine (ROPI, n = 15), 0.5% bupivacaine (BUPI, n = 15), and 2% mepivacaine (MEPI, n = 15). Time required for onset of sensory and motor block on the operated limb (readiness for surgery) and resolution of motor block, as well as onset of postsurgical pain and time of first analgesic requirement, were recorded. The three groups were similar with regard to demographic variables, duration of surgery, and measured visual analog pain scores. Onset of sensory and motor blockade was similar in Groups ROPI and MEPI and significantly shorter than in Group BUPI (P = 0.002 and P = 0.001, respectively). Resolution of motor block occurred later in Groups ROPI and BUPI than in Group MEPI (P = 0.005 and P = 0.0001, respectively). Duration of postoperative analgesia was significantly longer in Groups ROPI (670 +/- 227 min) and BUPI (880 +/-: 312 min) compared with Group MEPI (251 +/- 47 min) (P = 0.0001), with a significant decrease in postoperative pain medication requirements (P < 0.05). We conclude that for sciatic-femoral nerve block, 0.75% ropivacaine has an onset similar to that of 2% mepivacaine and a duration of postoperative analgesia between that of 0.5% bupivacaine and 2% mepivacaine. Implications: Quick onset of block with prolonged postoperative analgesia is an important goal in peripheral nerve blockade. We evaluated the clinical properties of 0.5% bupivacaine, 2% mepivacaine, and 0.75% ropivacaine for sciatic-femoral nerve block and demonstrated that ropivacaine has an onset similar to that of mepivacaine but allows for postoperative analgesia between that of bupivacaine and mepivacaine.