The effect of the addition of ropivacaine or bupivacaine upon pruritus induced by intrathecal fentanyl in labour

Sixty patients in early labour were randomly allocated to one of three groups. The control group received intrathecal fentanyl 25 microg, the ropivacaine group received intrathecal fentanyl 25 microg and ropivacaine 2.5 mg while the bupivacaine group received intrathecal fentanyl 25 microg and bupivacaine 2.5 mg. The incidence of pruritus was 100% in controls, compared with 85% in the ropivacaine group (not significant) and 75% in the bupivacaine group (p = 0.003). The severity of pruritus was significantly less in the ropivacaine (p = 0.006) and bupivacaine (p = 0.001) groups. Most patients developed pruritus by 30 min. Pruritus above the abdomen was not reduced in patients receiving local anaesthetics. There were no significant differences in the mean pain visual analogue score, systolic blood pressure, maternal heart rate and upper level of reduced pin-prick sensation in the first 30 min. Intrathecal ropivacaine and, more so, intrathecal bupivacaine reduce the incidence and severity of pruritus from intrathecal fentanyl for labour analgesia.     

罗哌卡因与布比卡因用于腰麻硬膜外联合阻滞的效疗比较

目的：比较0．75％盐酸罗哌卡因与0．75％盐酸布比卡因在腰麻硬膜外联合阻滞中的效果。方法：50例择期妇科手术患者（ASAⅠ～Ⅱ级）随机分为两组（n=25）。分别用0．75％罗哌卡因2ml和0．75％布比卡因2ml行蛛网膜下腔阻滞。观察两组感觉、运动阻滞起效及恢复时间和用药后的不良反应。结果：两组感觉阻滞起效时间、恢复时间无明显差异。运动阻滞起效时间罗哌卡因明显慢于布比卡因（P〈0．05），运动恢复时间明显快于布比卡因（P〈0．05）。结论：0．75％罗哌卡因用于腰麻能达到完善的麻醉效果，感觉阻滞与0．75％布比卡因相似，运动阻滞起效慢，但恢复迅速。     

罗哌卡因和布比卡因对心脏毒性作用的比较

目的 :探讨 1%罗哌卡因和 0 .75 %布比卡因用于硬膜外麻醉时对心脏的毒性作用。方法 :选择择期硬膜外麻醉患者 4 0例 ,ASAⅠ级～Ⅱ级。随机分为罗哌卡因组 (R组 ,2 0例 )和布比卡因组 (B组 ,2 0例 ) ,分别于麻醉前 (T0 )和麻醉平面绝对后 (T1)抽取静脉血 3mL ,测定血清心肌肌钙蛋白I(cTnI)的浓度 ,CK MB与CK的活性 ,记录相应时点的MAP ,HR和SpO2 值。结果 :两组患者于麻醉平面绝对后相应指标均较麻醉前有所增高 (P <0 .0 1)。两组间相比麻醉平面绝对后相应指标R组低于B组 ,但无统计学意义 (P >0 .0 5 )。结论 :罗哌卡因用于硬膜外麻醉时对心脏的毒性作用小于布比卡因 ,对血流动力学的影响小 ,用于心脏病非心脏手术的患者较布比卡因安全可靠。     

不同的阻滞方法对75岁以上高龄老人阻滞效果及循环功能的影响

为比较硬膜外隙阻滞(硬外)、蛛网膜下隙阻滞(腰麻)和单侧蛛网膜下隙阻滞(腰麻)在75岁以上高龄股骨颈骨折手术中的阻滞效果及对循环的影响.选ASAⅢ～Ⅳ级90例,随机等分为3组,Ⅰ组为硬外阻滞组(A组),用1.5%Lidocaine 4ml试验剂量并确认无脊麻后,根据情况追加1.5%Lidocaine 4～6ml;Ⅱ组为腰麻组,Ⅲ组为单侧腰麻组,两组注药速度均为0.1ml·s-1,注药过程均不作往返吸注.Ⅱ组用0.75%布比卡因1ml(7.5mg),注药后仰卧;Ⅲ组患侧在下侧卧,用0.75%布比卡因0.6ml(4.5mg)、10%葡萄糖液0.4ml,注药20min后平卧.结果显示:①患侧痛觉阻滞起效由快到慢为Ⅱ组、Ⅲ组和Ⅰ组.②三组阻滞前后的心率比较,均无显著性差异;Ⅲ组阻滞前后的平均动脉压也无显著性差异,但Ⅰ和Ⅱ组的阻滞前后的平均动脉压均有显著性差异.③患侧痛觉阻滞达标率(无痛平面达L1的百分率)为Ⅰ组93.3%,Ⅱ和Ⅲ组均为100%.④阻滞不全者Ⅰ组3例,而Ⅱ和Ⅲ组则无.⑤发生低血压者Ⅰ和Ⅱ组各3例,且同时都伴有ECG的ST段下移;Ⅲ组则无.表明①单侧腰麻组起效较快、阻滞完善和患侧痛觉阻滞达标率高.②单侧腰麻所用剂量小,阻滞范围小,对循环干扰轻和阻滞平面似乎更易控制.因此,小剂量布比卡因单侧腰麻可能更适合高龄老人下肢手术.     

Diphenhydramine produces local cutaneous analgesia in response to dorsal skin noxious stimuli in the rat

Although diphenhydramine has been shown to produce longer duration of spinal block than lidocaine, few studies disclose its skin infiltrative anesthesia when compared with a long‐lasting local anesthetic, bupivacaine. The purpose of this study was to investigate whether diphenhydramine elicited cutaneous analgesia in comparison with bupivacaine. After inhibition of cutaneous trunci muscle reflex via subcutaneous injection of drugs in rats, we examined the local anesthetic effect of diphenhydramine and bupivacaine as infiltrative cutaneous analgesia in a dose‐dependent fashion. We showed that diphenhydramine, as well as bupivacaine displayed a dose‐dependent cutaneous analgesia in response to dorsal cutaneous noxious stimuli. The relative potency (50% effective dose) was bupivacaine (0.023 [0.013–0.035]%) > diphenhydramine (0.078 [0.068–0.091]%; P < 0.001). On an equipotent basis, diphenhydramine had a similar duration of action to bupivacaine. Neither local injection of saline nor intraperitoneal administration of a large dose of diphenhydramine or bupivacaine produced cutaneous analgesia (data not shown). We conclude that diphenhydramine is less potent than bupivacaine at producing cutaneous analgesia. At equipotent doses for infiltrative cutaneous analgesia, the duration of action of diphenhydramine is equal to that of bupivacaine.     

Liposome bupivacaine in peripheral nerve blocks and epidural injections to manage postoperative pain

Solifenacin is an antimuscarinic agent, administered once daily, which has been newly approved for the treatment of overactive bladder (OAB). Solifenacin administered at 5- and 10-mg once-daily doses shows efficacy for all the symptoms of OAB in both ‘wet’ and ‘dry’ patients, including improvements in patient quality of life and satisfaction. These improvements are observed as early as week 2 of treatment and are maintained over 12-week and 1-year time periods, without being compromised by the age or gender of the patient. Solifenacin demonstrates a favourable tolerability profile, with mild dry mouth as the most common adverse event associated with its use, both at the 5- and 10-mg doses; this allows for flexibility in the dosing regimen, in which physicians can administer solifenacin 5 mg, with the option to safely increase the dose to 10 mg if necessary based on the severity of patient’s symptoms. The favourable efficacy and safety profile of solifenacin, coupled with its dose flexibility, are consistent with solifenacin being a convenient treatment option for patients with OAB.     

Effect of long‐chain triglyceride lipid emulsion on bupivacaine‐induced changes in electrophysiological parameters of rabbit Purkinje cells

Lipid emulsions are used in the reversal of local anesthetic toxicity. The aim of this study was to investigate the cellular electrophysiological effects of long‐chain triglyceride lipid emulsion (LCTE) on cardiac action potential characteristics and conduction disturbances induced by bupivacaine. Purkinje fibers were dissected from the left ventricle of New Zealand white rabbit hearts and superfused with either Tyrode's solution during 30 min (control group), with bupivacaine 10^?6 m , 10^?5 m , and 5.10^?5 m alone, or in the presence of LCTE 0.5%, in addition, LCTE at 0.1%, 0.5%, and 1% was perfused alone. Electrophysiological parameters were recorded using the conventional microelectrode technique (37 °C, 1 Hz frequency). Bupivacaine 5.10^?5 m ‐induced conduction blocks (8/8 preparations): LCTE 0.5% suppressed the bupivacaine 5.10^?5 m ‐induced conduction blocks (1/8 preparations). Exposure to bupivacaine 10^?6 m , 10^?5 m , and 5.10^?5 m resulted in a significant decrease in the maximal rate of depolarization (V_max) (respectively, 25%, 55%, 75%; P < 0.002 vs. control group). In the presence of LCTE 0.5%, bupivacaine 10^?6 m did not significantly decreased V_max (13%; P = 0.10 vs. control group). The decrease in V_max resulting from bupivacaine 10^?5 m alone was significantly less in the presence of LCTE 0.5% (P < 0.01 vs. bupivacaine 10^?5 m alone). Exposure to bupivacaine 10^?6 m , 10^?5 m , and 5.10^?5 m alone or in the presence of LCTE 0.5% resulted in a significant decrease in action potential duration measured at 50% and 90% repolarization (APD₅₀ and APD₉₀; P < 0.01 vs. control group). LCTE inhibited the Purkinje fibers conduction blocks induced by bupivacaine. Moreover, LCTE 0.5% attenuates the decrease in V_max induced by bupivacaine 10^?6 m and 10^?5 m .     

罗哌卡因联合利多卡因在青光眼手术麻醉中的应用

目的探讨罗哌卡因联合利多卡因与利多卡因与布比卡因混合液在青光眼手术麻醉中的应用。方法选择72例行青光眼手术的患者,随机分成2组:罗哌卡因联合利多卡因组(罗哌利多组)37例,利多卡因联合布比卡因混合组(利多布比组)35例,由同一位手术医师对手术患者施行麻醉。在注射麻醉药后的5min、10min、15min评估患者感觉和运动阻滞情况,同时监测患者的心电图、Sp O2、血压、心率,术后1h、3h、6h评估运动阻滞程度,术后1h、3h、6h、24h评定患者的疼痛情况,同时统计两组出现一过性黑蒙的发生率。结果 72例青光眼患者中,罗哌利多组(37例)有2例患者出现心率、血压、Sp O2及心电图明显改变,而利多布比组(35例)有7例术中心率、血压有明显升高,Sp O2、心电图波动较明显。利多布比组的感觉和运动阻滞起效时间分别为(2±1)min和(7±2)min;罗哌利多组感觉阻滞起效时间为(3±1)min,只有3例患者有运动阻滞,而其余34例患者没有明显的运动阻滞。感觉阻滞两组相比差异无统计学意义(P>0.05),运动阻滞两组相比差异有统计学意义(P<0.01)。术后不同时间无疼痛患者例数罗哌利多组全部优于利多布比组,两组比较差异均有统计学意义(为P<0.01)。球周注射后出现一过性黑蒙的例数罗哌利多组0例,利多布比组2例(6%),两组间差异有统计学意义(P<0.01)。结论罗哌卡因联合利多卡因在青光眼手术麻醉中应用是安全、有效、患者更舒适的麻醉方法。     

Extracts from rabbit skin inflamed by the vaccinia virus attenuate bupivacaine-induced spinal neurotoxicity in pregnant rats

Extracts from rabbit skin inflamed by the vaccinia virus can relieve pain and promote repair of nerve injury. The present study intraperitoneally injected extracts from rabbit skin inflamed by the vaccinia virus for 3 and 4 days prior to and following intrathecal injection of bupivacaine into pregnant rats. The pain threshold test after bupivacaine injection showed that the maximum possible effect of tail-flick latency peaked 1 day after intrathecal injection of bupivacaine in the extract-pretreatment group, and gradually decreased, while the maximum possible effect in the bupivacaine group continued to increase after intrathecal injection of bupivacaine. Histological observation showed that after 4 days of intrathecal injection of bupivacaine, the number of shrunken, vacuolated, apoptotic and caspase-9-positive cells in the dorsal root ganglion in the extract-pretreatment group was significantly reduced compared with the bupivacaine group. These findings indicate that extracts from rabbit skin inflamed by the vaccinia virus can attenuate neurotoxicity induced by intrathecal injection of bupivacaine in pregnant rats, possibly by inhibiting caspase-9 protein expression and suppressing nerve cell apoptosis.