坐骨神经阻滞.doc

1.Anesth Analg. 2004 Sep;99(3):919-23. Levobupivacaine 0.2% or 0.125% for continuous sciatic nerve block: a prospective, randomized, double-blind comparison with 0.2% ropivacaine.0.2%或0.125%的左旋布比卡因用于连续坐骨神经阻滞与0.2%罗哌卡因的比较(前瞻、随机、双盲实验)Casati A, Vinciguerra F, Cappelleri G, Aldegheri G, Grispigni C, Putzu M, Rivoltini P.Department of Anesthesiology, IRCCS H San Raffaele, Via Olgettina 60, 20132 Milan, Italy. casati.andreahsr.itIn 60 patients receiving elective hallux valgus repair, we compared the efficacy of continuous popliteal sciatic nerve block produced with 0.2% ropivacaine (n = 20), 0.2% levobupivacaine (n = 20), or 0.125% levobupivacaine (n = 20) infused with a patient-controlled system starting 3 h after a 30-mL bolus of the 0.5% concentration of the study drug and for 48 h (baseline infusion rate, 6 mL/h; incremental dose, 2 mL; lockout time, 15 min; maximum incremental doses per hour, 3). No differences were reported in the intraoperative efficacy of the nerve block. The degree of pain was similar in the three groups throughout the study period, both at rest and during motion. Total consumption of local anesthetic solution during the first 24 h was 148 mL (range, 144-228 mL) with 0.2% ropivacaine, 150 mL (range, 144-200 mL) with 0.2% levobupivacaine, and 148 mL (range, 144-164 mL) with 0.125% levobupivacaine (P = 0.59). The volume of local anesthetic consumed during the second postoperative day was 150 mL (range, 144-164 mL) with 0.2% ropivacaine, 154 mL (range, 144-176 mL) with 0.2% levobupivacaine, and 151 mL (range, 144-216 mL) with 0.125% levobupivacaine (P = 0.14). A smaller proportion of patients receiving 0.2% levobupivacaine showed complete recovery of foot motor function as compared with 0.2% ropivacaine and 0.125% levobupivacaine, both at 24 h (35% vs 85% and 95%; P = 0.0005) and at 48 h (60% vs 100% and 100%; P = 0.001). We conclude that sciatic infusion with both 0.125% and 0.2% levobupivacaine provides adequate postoperative analgesia after hallux valgus repair, clinically similar to that provided by 0.2% ropivacaine; however, the 0.125% concentration is preferred if early mobilization of the operated foot is required.2. Anesth Analg. 2004 Aug;99(2):584-8, Nerve stimulator-assisted evoked motor response predicts the latency and success of a single-injection sciatic block.神经刺激器帮助下引起的运动反应可以预见单次注射坐骨神经阻滞的潜伏和成功Sukhani R, Nader A, Candido KD, Doty R Jr, Benzon HT, Yaghmour E, Kendall M, McCarthy R.Department of Anesthesiology, Northwestern University/Feinberg School of Medicine, 251 E. Huron Street, F5-704, Chicago, IL 60611, USA. Variable onset latency of single-injection sciatic nerve block (SNB) may result from drug deposition insufficiently close to all components of the nerve. We hypothesized that this variability is caused by the needle tip position relative to neural components, which is objectified by the type of evoked motor response (EMR) elicited before local anesthetic injection. One-hundred ASA I-II patients undergoing reconstructive ankle surgery received infragluteal-parabiceps SNB using 0.4 mL/kg (maximum 35 mL) of levobupivacaine 0.625%. The end-point for injection was the first elicited EMR: inversion (I), plantar flexion (PF), dorsiflexion (DF), or eversion (E) at 0.2-0.4 mA. The frequencies of the EMRs were: I 40%, PF 43%, E 14%, and DF 3%. SNB was considered complete if both tibial and common peroneal nerves were blocked and failed if either analgesia to pinprick was not observed at 30 min or anesthesia at 60 min. Patients with an EMR of I demonstrated shorter mean times (+/-95% confidence interval CI) to complete the block with 8.5 (95% CI, 6.2-10.8) min compared to 27.0 (95% CI, 20.6-33.4) min after PF (P 0.001) and 30.4 (95% CI, 24.9-35.8) min after E (P 0.001). No rescue blocks were required in group I compared with 24% (P = 0.001) and 71% (P 0.001) of patients in groups PF and E, respectively. We conclude that EMR type during nerve stimulator-assisted single-injection SNB predicts latency and success of complete SNB because the observed EMR is related to the positioning of the needle tip relative to the tibial and common peroneal nerves.3. Reg Anesth Pain Med. 2003 Jul-Aug;28(4):294-303. Levobupivacaine versus ropivacaine for sciatic nerve block in the rat.鼠坐骨神经阻滞实验中左旋布比卡因与罗哌卡因的比较Sinnott CJ, Strichartz GR.Pain Research Center, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Womens Hospital, 75 Francis Street, Boston, MA 02115, USA.BACKGROUND AND OBJECTIVES: Ropivacaine and levobupivacaine, both single S- enantiomers, are being promoted as safer alternatives to racemic bupivacaine. To determine whether levobupivacaine produces a more potent and longer lasting peripheral nerve block than ropivacaine, we compared functional blockade of sciatic nerve in the rat at several doses with these 2 agents. METHODS: Percutaneous sciatic nerve blocks were performed in 6 groups of rats (n = 8) with 0.1 mL of 0.0625%, 0.125%, and 0.25% of levobupivacaine or ropivacaine, with and without 1:200,000 epinephrine. In the 2 different hindlegs of the same 8 rats, we measured the degree and duration of deficit of 3 functions of peripheral nerve (proprioception, motor function, nociception) effected by the 2 respective drugs at the same concentration, using a blinded cross-over design. RESULTS: In general, both degree and duration of functional deficits produced by levobupivacaine were slightly greater than those from ropivacaine at the same dose. At the lowest concentration (0.0625%), no functions were completely blocked and the only significant difference was a longer motor impairment by levobupivacaine. At the highest concentration (0.25%), all formulations completely blocked the 3 functions, all of which lasted longer with levobupivacaine than ropivacaine. There were no significant differences in degree and duration of deficits between the 2 drugs at midconcentration (0.125%). The actions of both drugs were generally potentiated by epinephrine, but the rank order of potency was not altered. CONCLUSIONS: At the lowest concentration (0.0625%), levobupivacaine produces a greater degree of motor impairment and a longer duration of proprioceptive impairment relative to ropivacaine. At the middle concentration (0.125%), there no differences between the 2 drugs. At the higher concentration (0.25%), which is within the range used clinically for peripheral nerve block (0.25%-0.5%), levobupivacaine produces approximately a 30% longer duration of complete block in each modality compared with that by ropivacaine.4. J Clin Anesth. 2002 Mar;14(2):111-4. Clinical properties of levobupivacaine or racemic bupivacaine for sciatic nerve block.坐骨神经阻滞中左旋布比卡因与消旋布比卡因临床性质的比较Casati A, Chelly JE, Cerchierini E, Santorsola R, Nobili F, Grispigni C, Di Benedetto P, Torri G.Vita-Salute University, Department of Anesthesiology, IRCCS H. San Raffaele, Milan, Italy. casati.andreahsr.itSTUDY OBJECTIVE: To compare the intraoperative and postoperative clinical properties of the sciatic nerve block performed with either 0.5% bupivacaine or 0.5% levobupivacaine for orthopedic foot procedures. DESIGN: Randomized, double-blind study. SETTING: Inpatient unit of a university-affiliated hospital. PATIENTS: 30 ASA physical status I and II patients undergoing elective hallux valgus repair under regional anesthesia. INTERVENTIONS: After administering intravenous (IV) midazolam premedication (0.05 mg/kg), a femoral nerve block was performed with 15 mL of mepivacaine 2%. Patients were then randomly allocated to receive, in a double-blind fashion, a sciatic nerve block with 20 mL of either 0.5% bupivacaine (n = 15) or 0.5% levobupivacaine (n = 15). MEASUREMENTS AND MAIN RESULTS: An observer who was blinded to the study drug recorded the onset time, quality, and duration of the sciatic nerve block. Postoperative analgesia consisted of 100 mg IV ketoprofen every 8 hours, with the first administration given at the patients request. Mean (+/-SEM) onset time of the sciatic nerve block was 35 +/- 5 minutes for bupivacaine and 31 +/- 6 minutes for levobupivacaine (p = not significant NS). The duration of motor and sensory blocks with bupivacaine was 761 +/- 112 minutes and 790 +/- 110 minutes, respectively, and 716 +/- 80 minutes and 814 +/- 73 minutes, respectively, with levobupivacaine (p = NS). The first pain medication was requested after 844 +/- 96 minutes with bupivacaine and 872 +/- 75 minutes after levobupivacaine (p = NS). No differences in the quality of nerve block and patient satisfaction were reported between the two groups. CONCLUSIONS: A dose of 20 mL of 0.5% levobupivacaine induces sciatic nerve block of similar onset, duration, and intensity as the block produced by the same volume and concentration of the racemic solution of bupivacaine.5.Anesth Analg. 2002 Apr;94(4):987-90, A double-blinded, randomized comparison of either 0.5% levobupivacaine or 0.5% ropivacaine for sciatic nerve block.0.5%左旋布比卡因与0.5%罗哌卡因用于坐骨神经阻滞的比较（双盲、随机）Casati A, Borghi B, Fanelli G, Cerchierini E, Santorsola R, Sassoli V, Grispigni C, Torri G.Department of Anesthesiology, Vita-Salute University, IRCCS H. San Raffaele, Milan, Italy. casati.andreahsr.itTo compare intraoperative and postoperative clinical properties of levobupivacaine and ropivacaine for sciatic nerve block, 50 ASA physical status I and II patients undergoing hallux valgus repair received a femoral nerve block with 15 mL of 2% mepivacaine. They were then randomly allocated in a double-blinded fashion to receive a sciatic nerve block with either 0.5% levobupivacaine (n = 25) or 0.5% ropivacaine (n = 25). An independent blinded observer evaluated the onset time of surgical anesthesia as well as the quality of the surgical block and postoperative analgesia. The median (range) onset time of surgical block at the sciatic nerve distribution was 30 min (5-60 min) with levobupivacaine and 15 min (5-60 min) with ropivacaine (P = 0.63). Four patients (two patients in each group) received a supplementary ankle block by the surgeon just before the beginning of surgery. All four patients also rec