下肢矫形手术麻醉：罗比卡因和布比卡因感觉–运动阻滞和血流动力学稳定性的随机对照试验

贵州医科大学    麻醉与心脏电生理课题组

翻译：王波          编辑：王波          审校：曹莹


背景
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腰麻因其有效、起效快、安全性好等优点，成为下肢矫形手术首选的麻醉技术。虽然布比卡因长期以来一直被认为是黄金标准，但其心血管副作用引发了人们对罗比卡因的兴趣，罗比卡因是一种更新的药物，安全性更好。本研究比较了高压罗比卡因(0.75%)和布比卡因(0.5%)在腰麻中的感觉–运动阻滞特性和血流动力学稳定性。

方法


一项前瞻性、随机、双盲试验在100名接受择期下肢矫形手术的患者中进行。参与者被平均分配为鞘内注射3毫升0.75%高压罗比卡因或3毫升0.5%高压布比卡因。主要结果包括感觉和运动阻滞的起效时间、持续时间和强度。次要指标包括血流动力学参数(血压、心率)、首次止痛抢救时间和不良反应发生率。数据分析采用t检验、卡方检验和效应大小估计。

结果

【罂粟摘要】下肢矫形手术麻醉：罗比卡因和布比卡因感觉-运动阻滞和血流动力学稳定性的随机对照试验

与罗比卡因相比，布比卡因表现出更快的感觉(2.96min比3.60min，p<；0.001)和运动阻滞起效(4.68min比5.29min，p<；0.001)和更长的运动阻滞持续时间(152.5比126.3分钟，p<；0.001)。然而，罗比卡因提供了更好的血流动力学稳定性，显著减少了低血压和心动过缓的发作(p<；0.05)。罗比卡因感觉阻滞持续时间略短(188.2比190.0分钟；p=0.019)，但感觉阻滞强度高(80.1%比74.0%；p=0.012)。布比卡因组首次要求止痛的时间显著延长(205.1比152.7分钟；p<；0.001)。


结论


      这项研究强调，虽然布比卡因适合长时间的手术，但罗比卡因更适合于较短的手术或有心血管风险的患者，提供更好的血流动力学稳定性和安全性。需要进一步的研究来探索剂量–反应关系和这些麻醉药的长期结果。

原始文献来源：Sorout D, Mahajan N, Singh RK, Saiyad SS, Sharma M. Lower Limb Orthopedic Anesthesia: A Randomized Trial Comparing Ropivacaine and Bupivacaine for Sensory-Motor Block and Hemodynamic Stability. Cureus. 2025 May 18;17(5):e84377. doi: 10.7759/cureus.84377. PMID: 40535370; PMCID: PMC12176252.

Lower Limb Orthopedic Anesthesia: A Randomized Trial Comparing Ropivacaine and Bupivacaine for Sensory-Motor Block and你Hemodynamic Stability

Background：Spinal anesthesia is the preferred anesthetic technique for lower limb orthopedic surgeries due to its efficacy, rapid onset, and favorable safety profile. While bupivacaine has long been considered the gold standard, its cardiovascular side effects have prompted interest in ropivacaine, a newer agent with a better safety margin. This study compares the sensory-motor block characteristics and hemodynamic stability of hyperbaric ropivacaine (0.75%) and bupivacaine (0.5%) in spinal anesthesia. 

Methods：A prospective, randomized, double-blind trial was conducted on 100 patients undergoing elective lower limb orthopedic surgeries. Participants were equally assigned to receive either 3 mL of 0.75% hyperbaric ropivacaine or 3 mL of 0.5% hyperbaric bupivacaine intrathecally. Primary outcomes included onset time, duration, and intensity of sensory and motor block. Secondary measures included hemodynamic parameters (blood pressure, heart rate), time to first rescue analgesia, and incidence of adverse effects. Data were analyzed using t-tests, chi-square tests, and effect size estimation. 

Results： Bupivacaine exhibited faster sensory (2.96 vs. 3.60 min, p<0.001) and motor block onset (4.68 vs. 5.29 min, p<0.001), and longer motor block duration (152.5 vs. 126.3 min, p<0.001) compared to ropivacaine. However, ropivacaine offered better hemodynamic stability, with significantly fewer hypotensive and bradycardic episodes (p<0.05). The duration of sensory block was slightly shorter with ropivacaine (188.2 vs. 190.0 min; p=0.019), though block intensity was higher (80.1% vs. 74.0%; p=0.012). Time to first analgesic request was significantly longer with bupivacaine (205.1 vs. 152.7 min; p<0.001). 

Conclusion： This study highlights that while bupivacaine is suited for long-duration surgeries, ropivacaine is preferable for shorter procedures or patients with cardiovascular risks, offering enhanced hemodynamic stability and safety. Further researc.

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