膝关节镜手术中使用罗哌卡因、利多卡因和布比卡因脊髓麻醉效果的比较

Comparison of spinal anesthesia efficiency of Ropivacaine, Bupivacaine, and Lidocaine using for patientsundergoing knee arthroscopy

摘要:

摘要：目的 探讨膝关节镜手术中使用罗哌卡因、利多卡因和布比卡因脊髓麻醉效果的比较。方法 前瞻性双盲随机对照试验共纳入99例患者，随机分为3组，分别接受25.0 mg罗哌卡因、15.0 mg布比卡因及40.0 mg利多卡因进行脊髓麻醉。主要研究终点是感觉阻滞完全恢复所需的时间。次要研究终点包括运动阻滞的恢复时间、失败率、低血压/心动过缓发生率、术后疼痛、首次运动、排尿和出院时间以及短暂性神经系统症状（TNS）发生率。结果 利多卡因组患者感觉阻滞恢复时间（3.1±1.7）h和布比卡因组患者感觉阻滞恢复时间（6.1±2.5）h均明显长于罗哌卡因组患者感觉阻滞恢复时间（2.6±1.2）h，差异有统计学意义（P =0.006；P =0.000）。与利多卡因和布比卡因组相比，罗哌卡因组患者运动阻滞恢复更快。罗哌卡因组患者首次下床活动、排尿和出院时间均较布比卡因组患者短，而与利多卡因组患者无差异。与利多卡因和罗哌卡因组患者相比，布比卡因组患者术后止痛药物使用更少。3组患者满意度、心律不齐/低血压发生率发生率无明显差异。结论 在使用罗哌卡因、布比卡因和利多卡因对膝关节镜手术患者进行脊髓麻醉时，应用罗哌卡因麻醉患者感觉运动阻滞恢复时间最短。

Abstract:

Abstract: Objectives To compare the spinal anesthesia efficiency of Ropivacaine, Bupivacaine, and Lidocaine using for patients undergoing knee arthroscopy. Methods 99 patients were included in this prospective, double-blinded, randomize controlled trial and randomly allocated to receive either 25.0 mg Ropivacaine, 15.0 mg Bupivacaine or 40.0 mg Lidocaine. The primary endpoint was the time until complete recovery of sensory block. Secondary endpoints included time to recovery from motor block, failure rates, incidence of hypotension/bradycardia, postoperative pain, first mobilization, voiding and discharge times, and the incidence of transient neurologic symptoms. Results Patients in the Ropivacaine group had a significantly shorter time until recovery from sensory block (2.6 ± 1.2) than patients in the Lidocaine group (3.1 ± 1.7; P = 0.006) and in the Bupivacaine group (6.1 ± 2.5; P = 0.000). Ropivacaine was associated with a significantly faster recovery from motor block than Lidocaine and Bupivacaine. Times to first mobilization, voiding, and discharge were significantly shorter for Ropivacaine when compared with Bupivacaine, but not with Lidocaine. In the Bupivacaine group, patients need less rescue medication for postoperative pain when compared with Lidocaine and Ropivacaine. Groups did not differ with respect to patient satisfaction, incidence of bradycardia/hypotension, and transient neurologic symptom rate. Conclusions For spinal anesthesia in patients undergoing ambulatory knee arthroscopy, Ropivacaine has the shortest time to complete recovery of sensory and motor block compared with Bupivacaine and Lidocaine.