三种等比重局麻药脊麻下剖宫产手术的ED_（50）比较
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摘要
目的:比较布比卡因、左旋布比卡因和罗哌卡因脊麻下满足剖宫产手术的效价。
方法:选取96名拟在腰硬联合麻醉下行剖宫产手术的单胎健康产妇,随机分成三组(n=32):分别于蛛网膜下腔注射等比重0.5%的布比卡因(布比卡因组);等比重0.5%的左旋布比卡因(左旋布比卡因组);等比重0.5%的罗哌卡因(罗哌卡因组)。采用序贯法进行试验,每组第1例病人的起始剂量为9mg,剂量间隔为1mg。设定注药后15分钟内感觉阻滞平面到T7或以上,术中无牵拉痛,注药后45分钟内硬膜外不需要追加局麻药为有效。若上一例有效,则下一例采用低一级剂量;若无效,则下一例采用高一级剂量。采用概率单位回归法计算三药满足剖宫产手术的半数有效剂量(ED_(50))及其95%可信区间(95%CI)。记录感觉阻滞平面和运动阻滞程度。
结果:三组病人的一般情况无明显差异。布比卡因的ED_(50)和ED_(95)及其95%CI分别为6.15(5.48-6.68)mg和7.62(6.91-11.82)mg。左旋布比卡因的ED_(50)和ED_(95)及其95%CI为8.06(7.46-8.62)mg和9.59(8.86-13.42)mg。罗哌卡因分别为10.55(9.73-11.49)mg和12.80(11.66-21.42)mg。左旋布比卡因与布比卡因满足剖宫产手术的效价比及其95%CI为0.76(0.68-0.87),罗哌卡因与布比卡因的效价比为0.58(0.51-0.67),罗哌卡因与左旋布比卡因的效价比为0.76(0.68-0.86)。
结论:三种不同的局麻药蛛网膜下腔阻滞均能满足剖宫产手术。三者的效价比为布比卡因:左旋布比卡因:罗哌卡因为1:0.76:0.58。
Objective: This study was aimed to compare relative potency of three local anesthetics, such as bupivacaine, levobupivacaine and ropivacaine, if injected intrathecally in patients undergoing cesarean section.
Methods: Ninety six parturients with singleton term pregnancies undergoing cesarean section with combined spinal-epidural anesthesia were enrolled in this study. The median effective dose (ED_(50)) was determined by up-down sequential allocation.The patients were randomly divided into three groups and received intrathecally injection of 0.5% bupivacaine、0.5%levobupivacaine and 0.5% ropivacaine respectively. If an upper sensory lever was achieved to T7 or above and no need for additional dosage in the next 45 min, the I.T. was considered effective. The degree of sensory and motor block was recorded.
Results: There were no differences in demographic and obstetric characteristics between the patients receiving the three local anesthetics. There were significant differences in ED_(50) values for spinal bupivacaine、levobupivacaine and ropivacaine: the ED_(50) and ED_(95) for bupivacaine were 6.15 (95%CI 5.48-6.68) mg and 7.62 (95%CI 6.91-11.82) mg; the ED_(50)and ED95 respectively of levobupivacaine were 8.06 (95%CI 7.46-8.62) mg and9.59 (95%CI 8.86-13.42) mg; for ropivacaine ED_(50) and ED_(95) were 10.55(95%CI 9.73-11.49) mg and 12.80 (95%CI 11.66-21.42) mg. The potency ratioat ED_(50) for levopivacaine and bupivacaine was 0.76 (95%CI 0.68-0.87); forropivacaine and bupivacaine was 0.58 (0.51-0.67) and for ropivacaine andlevobupivacaine was 0.76 (0.68-0.86).
Conclusions: The study confirms that three local anesthetics can be usesuccessfully for cesarean section. The relative potency ratio of bupivacaine:levobupivacaine: ropivacaine was 1:0.76:0.58.
方法:选取96名拟在腰硬联合麻醉下行剖宫产手术的单胎健康产妇,随机分成三组(n=32):分别于蛛网膜下腔注射等比重0.5%的布比卡因(布比卡因组);等比重0.5%的左旋布比卡因(左旋布比卡因组);等比重0.5%的罗哌卡因(罗哌卡因组)。采用序贯法进行试验,每组第1例病人的起始剂量为9mg,剂量间隔为1mg。设定注药后15分钟内感觉阻滞平面到T7或以上,术中无牵拉痛,注药后45分钟内硬膜外不需要追加局麻药为有效。若上一例有效,则下一例采用低一级剂量;若无效,则下一例采用高一级剂量。采用概率单位回归法计算三药满足剖宫产手术的半数有效剂量(ED_(50))及其95%可信区间(95%CI)。记录感觉阻滞平面和运动阻滞程度。
结果:三组病人的一般情况无明显差异。布比卡因的ED_(50)和ED_(95)及其95%CI分别为6.15(5.48-6.68)mg和7.62(6.91-11.82)mg。左旋布比卡因的ED_(50)和ED_(95)及其95%CI为8.06(7.46-8.62)mg和9.59(8.86-13.42)mg。罗哌卡因分别为10.55(9.73-11.49)mg和12.80(11.66-21.42)mg。左旋布比卡因与布比卡因满足剖宫产手术的效价比及其95%CI为0.76(0.68-0.87),罗哌卡因与布比卡因的效价比为0.58(0.51-0.67),罗哌卡因与左旋布比卡因的效价比为0.76(0.68-0.86)。
结论:三种不同的局麻药蛛网膜下腔阻滞均能满足剖宫产手术。三者的效价比为布比卡因:左旋布比卡因:罗哌卡因为1:0.76:0.58。
Objective: This study was aimed to compare relative potency of three local anesthetics, such as bupivacaine, levobupivacaine and ropivacaine, if injected intrathecally in patients undergoing cesarean section.
Methods: Ninety six parturients with singleton term pregnancies undergoing cesarean section with combined spinal-epidural anesthesia were enrolled in this study. The median effective dose (ED_(50)) was determined by up-down sequential allocation.The patients were randomly divided into three groups and received intrathecally injection of 0.5% bupivacaine、0.5%levobupivacaine and 0.5% ropivacaine respectively. If an upper sensory lever was achieved to T7 or above and no need for additional dosage in the next 45 min, the I.T. was considered effective. The degree of sensory and motor block was recorded.
Results: There were no differences in demographic and obstetric characteristics between the patients receiving the three local anesthetics. There were significant differences in ED_(50) values for spinal bupivacaine、levobupivacaine and ropivacaine: the ED_(50) and ED_(95) for bupivacaine were 6.15 (95%CI 5.48-6.68) mg and 7.62 (95%CI 6.91-11.82) mg; the ED_(50)and ED95 respectively of levobupivacaine were 8.06 (95%CI 7.46-8.62) mg and9.59 (95%CI 8.86-13.42) mg; for ropivacaine ED_(50) and ED_(95) were 10.55(95%CI 9.73-11.49) mg and 12.80 (95%CI 11.66-21.42) mg. The potency ratioat ED_(50) for levopivacaine and bupivacaine was 0.76 (95%CI 0.68-0.87); forropivacaine and bupivacaine was 0.58 (0.51-0.67) and for ropivacaine andlevobupivacaine was 0.76 (0.68-0.86).
Conclusions: The study confirms that three local anesthetics can be usesuccessfully for cesarean section. The relative potency ratio of bupivacaine:levobupivacaine: ropivacaine was 1:0.76:0.58.
引文
1. Albright, George A. Cardiac Arrest Following Regional Anesthesia with Etidocaine or Bupivacaine. Anesthesiology, 1979, 51: 285-287
2. McClure JH. Ropivacaine. Br J Anaesth, 1996, 76: 300-307
3. Malinovsky JM, Charles F, Kick O, et al. Intratheral anesthesia:Ropivacaine versus bupivacaine. Anesthesia and Analgesia, 2000, 91: 1457-1460
4. McClellan KJ, Spencer CM. Levobubpivacaine. Drugs, 1998, 56: 355-364
5. Foster RH, Markham A. Levobupivacaine:a review of its pharmacology and use as a local anaesthetic. Drugs, 2000, 59: 551-559
6. Lyons G, Columb M, Wilson RC, et al. Epidural pain relief in labour: potencies oflevobupivacaine and racemic bupivacaine. Br J Anaesth, 1998, 81: 899-901.
7. Polley LS, Columb MO, Naughton NN, et al. Relative analgesic potencies ofropivacaine and bupivacaine for epidural analgesia in labor: implications for therapeutic indexes. Anesthesiology, 1999, 90: 944-950.
8. Capogna G, Celleno D, Fusco P, et al. Relative potencies of bupivacaine and ropivacaine for analgesia in labour. Br J Anaesth, 1999, 82: 371-373
9. Polley LS, Columb MO, Naughton NN, et al. Relative analgesic potencies of levobupivacaine and ropivacaine for epidural analgesia in labor. Anesthesiology, 2003, 99:1354-1358.
10. Benhamou D, Ghosh C, Mercier FJ. A randomized sequential allocation study to determine the minimum effective analgesic concentration of levobupivacaine and ropivacaine in patients receiving epidural analgesia for labor. Anesthesiology, 2003, 99: 1383-1386
11. Buyse I, Stockman W, Columb M, et al. Effect of sufentanil on minimum local analgesic concentrations of epidural bupivacaine, ropivacaine and levobupivacaine in nullipara in early labour. Int J Obstet Anesth, 2007, 16: 22-28
12．孙瑞远,主编．定量药理学．第1版．北京：人民卫生出版社,1987,203—209
13. Datta S, Lambert DH, Gregus J, et al. Differential sensitivities of mammalian nerve fibers during pregnancy. Anesth Analg, 1983, 62: 1070-1072
14.Tsen LC,Tarshis J,Denson DD,et al.Measurements of Maternal Protein Binding of Bupivacaine throughout Pregnancy.Anesth Analg,1999,89:965-968
15.Van de Velde M,Dreelinck R,Dubois J.Determination of the full dose-response relation of intrathecal bupivacaine,levobupivacaine,and ropivacaine,combined with sufentanil,for labor analgesia.Anesthesiology,2007,6:149-156
16.Moller IW,Fernandes A,Edstrom HH.Subarachnoid anaesthesia with 0.5%bupivacaine:effects of density.Br J Anaesth,1984,56:11-1196
17.Kallio H,Sn(a丨¨)ll EV,Tuomas CA,et al.Comparison of hyperbaric and plain ropivacaine 15 mg in spinal anaesthesia for lower limb surgery.Br J Anaesth,2004,93:664-669
18.Critchley LA,Morley AP,Derrick J.The influence of baricity on the haemodynamic effects of intrathecal bupivacaine 0.5%.Anaesthesia.1999,54:469-474
19.Stephen PH,Malachy OC,Gary MS.The Effect of Posture and Baricity on the Spread of Intrathecal Bupivacaine for Elective Cesarean Delivery.Anesth Analg,2005,100:1159-1165
20.Chen XZ,Chen H,Lou AF.Dose-response study of spinal hyperbaric ropivacaine for cesarean section.J Zhejiang Univ Sci B,2006,7:992-997
21.Wang LZ,Zhang YF,Tang BL.Effects of intrathecal and i.v.small-dose sufentanil on the median effective dose of intrathecal bupivacaine for Caesarean section.Br J Anaesth,2007,98:792-796
22.Ginosar Y,Mirikatani E,Drover DR.ED50 and ED95 of intrathecal hyperbaric bupivacaine coadministered with opioids for cesarean delivery.Anesthesiology,2004,100:676-682
23.姚玉笙,陈彦青,甘秀峰.剖宫产患者左旋布比卡因蛛网膜下腔阻滞的量效关系.中华麻醉学杂志,2009,29:450-452
24.Gautier P,Kock MD,Huberty K,et al.Comparision of the effects of urnal intrathecalropivacaine,levobupivacaine,and bupivacaine for Caesarean section.Br J Anaesth,2003,91:684-689
25.庄心良,曾因明,陈伯銮,主编.现代麻醉学.第3版.北京:人民卫生出版社.1987,1313-1315
26.Horford,WE等主编.临床麻醉手册.第5版.沈阳:辽宁科技技术出版社.1999,406-408
27.Parpaglioni R,Frigo MG,Lemma A.Minimum local anaesthetic dose(MLAD) of intrathecal levobupivacaine and ropivacaine for Caesarean section.Anaesthesia,2006,61:110-115
28.Lacassie HJ,Habib MB,Lacassie HP,et al.Motor Blocking Minimum Local Anesthetic Concentrations of Bupivacaine,Levobupivacaine,and Ropivacaine in Labor.Reg Anesth Pain Med,2007,32:323-329
29.Camorcia M,Capogna G,Berritta C,et al.The Relative Potencies for Motor Block After Intrathecal Ropivacaine,Levobupivacaine,and Bupivacaine.Anesth Analg,2007,104:904-907
30.Coppejans HC,Vercauteren MP.Low-dose combined spinal-epidural anesthesia for cesarean delivery:a comparison of three plain local anesthetics.Acta Anaesthesiol Belg,2006,57:39-43
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14. Parpaglioni R, Frigo MG, Lemma A, et al. Minimum local anaesthetic dose (MLAD) of intrathecal levobupivacaine and ropivacaine for Caesarean section. Anaesthesia, 2006 ,61:110-115
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2. McClure JH. Ropivacaine. Br J Anaesth, 1996, 76: 300-307
3. Malinovsky JM, Charles F, Kick O, et al. Intratheral anesthesia:Ropivacaine versus bupivacaine. Anesthesia and Analgesia, 2000, 91: 1457-1460
4. McClellan KJ, Spencer CM. Levobubpivacaine. Drugs, 1998, 56: 355-364
5. Foster RH, Markham A. Levobupivacaine:a review of its pharmacology and use as a local anaesthetic. Drugs, 2000, 59: 551-559
6. Lyons G, Columb M, Wilson RC, et al. Epidural pain relief in labour: potencies oflevobupivacaine and racemic bupivacaine. Br J Anaesth, 1998, 81: 899-901.
7. Polley LS, Columb MO, Naughton NN, et al. Relative analgesic potencies ofropivacaine and bupivacaine for epidural analgesia in labor: implications for therapeutic indexes. Anesthesiology, 1999, 90: 944-950.
8. Capogna G, Celleno D, Fusco P, et al. Relative potencies of bupivacaine and ropivacaine for analgesia in labour. Br J Anaesth, 1999, 82: 371-373
9. Polley LS, Columb MO, Naughton NN, et al. Relative analgesic potencies of levobupivacaine and ropivacaine for epidural analgesia in labor. Anesthesiology, 2003, 99:1354-1358.
10. Benhamou D, Ghosh C, Mercier FJ. A randomized sequential allocation study to determine the minimum effective analgesic concentration of levobupivacaine and ropivacaine in patients receiving epidural analgesia for labor. Anesthesiology, 2003, 99: 1383-1386
11. Buyse I, Stockman W, Columb M, et al. Effect of sufentanil on minimum local analgesic concentrations of epidural bupivacaine, ropivacaine and levobupivacaine in nullipara in early labour. Int J Obstet Anesth, 2007, 16: 22-28
12．孙瑞远,主编．定量药理学．第1版．北京：人民卫生出版社,1987,203—209
13. Datta S, Lambert DH, Gregus J, et al. Differential sensitivities of mammalian nerve fibers during pregnancy. Anesth Analg, 1983, 62: 1070-1072
14.Tsen LC,Tarshis J,Denson DD,et al.Measurements of Maternal Protein Binding of Bupivacaine throughout Pregnancy.Anesth Analg,1999,89:965-968
15.Van de Velde M,Dreelinck R,Dubois J.Determination of the full dose-response relation of intrathecal bupivacaine,levobupivacaine,and ropivacaine,combined with sufentanil,for labor analgesia.Anesthesiology,2007,6:149-156
16.Moller IW,Fernandes A,Edstrom HH.Subarachnoid anaesthesia with 0.5%bupivacaine:effects of density.Br J Anaesth,1984,56:11-1196
17.Kallio H,Sn(a丨¨)ll EV,Tuomas CA,et al.Comparison of hyperbaric and plain ropivacaine 15 mg in spinal anaesthesia for lower limb surgery.Br J Anaesth,2004,93:664-669
18.Critchley LA,Morley AP,Derrick J.The influence of baricity on the haemodynamic effects of intrathecal bupivacaine 0.5%.Anaesthesia.1999,54:469-474
19.Stephen PH,Malachy OC,Gary MS.The Effect of Posture and Baricity on the Spread of Intrathecal Bupivacaine for Elective Cesarean Delivery.Anesth Analg,2005,100:1159-1165
20.Chen XZ,Chen H,Lou AF.Dose-response study of spinal hyperbaric ropivacaine for cesarean section.J Zhejiang Univ Sci B,2006,7:992-997
21.Wang LZ,Zhang YF,Tang BL.Effects of intrathecal and i.v.small-dose sufentanil on the median effective dose of intrathecal bupivacaine for Caesarean section.Br J Anaesth,2007,98:792-796
22.Ginosar Y,Mirikatani E,Drover DR.ED50 and ED95 of intrathecal hyperbaric bupivacaine coadministered with opioids for cesarean delivery.Anesthesiology,2004,100:676-682
23.姚玉笙,陈彦青,甘秀峰.剖宫产患者左旋布比卡因蛛网膜下腔阻滞的量效关系.中华麻醉学杂志,2009,29:450-452
24.Gautier P,Kock MD,Huberty K,et al.Comparision of the effects of urnal intrathecalropivacaine,levobupivacaine,and bupivacaine for Caesarean section.Br J Anaesth,2003,91:684-689
25.庄心良,曾因明,陈伯銮,主编.现代麻醉学.第3版.北京:人民卫生出版社.1987,1313-1315
26.Horford,WE等主编.临床麻醉手册.第5版.沈阳:辽宁科技技术出版社.1999,406-408
27.Parpaglioni R,Frigo MG,Lemma A.Minimum local anaesthetic dose(MLAD) of intrathecal levobupivacaine and ropivacaine for Caesarean section.Anaesthesia,2006,61:110-115
28.Lacassie HJ,Habib MB,Lacassie HP,et al.Motor Blocking Minimum Local Anesthetic Concentrations of Bupivacaine,Levobupivacaine,and Ropivacaine in Labor.Reg Anesth Pain Med,2007,32:323-329
29.Camorcia M,Capogna G,Berritta C,et al.The Relative Potencies for Motor Block After Intrathecal Ropivacaine,Levobupivacaine,and Bupivacaine.Anesth Analg,2007,104:904-907
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