硬脊膜外給予Ropivacaine應用於台灣地區病人作術後止痛之使用經驗

Epidural Ropivacaine for Postoperative Analgesia in Taiwanese Patients

背景：Ropivacaine為最新的，也是第一個由純單旋鏡像物發展出之長效醯胺類局部麻醉劑。Ropivacaine對中樞神經系統毒性較低及對心血管系統較安全，所以它在麻醉及術後止痛使用上有利。但依據國外論文所提供的使用劑量(0.2％)，在台灣地區病人應用上會出現其下肢極為明顯的麻木現象。或許，這是因台灣人與西方人在遺傳及體質上有所差異所致。因此建議藥量(0.2％)應調低到適當份量，以便降低其副作用及不適的感覺。方法：本實驗分作三組，每組有病人35名。三組所使用之Ropivacaine的濃度分別是A組為0.15％、B組為0.125％、C組為0.10％。病人於術後開始使用，並於0 min、30 min、1 h、3 h、6 h、 12 h、24 h記錄其VAS分數、Bromage分數及副作用等。結果：三組的基本資料無顯著差異。在疼痛指數(VAS score)方面，A組(0.15％)與B組(0.125％)沒有明顯之不同。可是，C組(0.10％)與A、B組比較後，有統計學上之差異。C組止痛效果較差。副作用方面，如麻木、噁心、蓄尿等症狀，在A組出現較其他兩組為多。結論：Ropivacaine濃度越高，其副作用相對增加。所以在此實驗中，單獨使用Ropivacaine以濃度0.125％之效果最佳，副作用也相對最少。所以，此劑量是較適合台灣地區病人使用之。

Background: Ropivacaine is the latest long-acting amide local anesthetic. As it is less cardiovasculotoxic and neurotoxic than bupivacaine it is an attractive anesthetic agent used in clinical anesthesia and postoperative analgesia. This study was undertaken to seek for a suitable dosage of ropivacaine in postoperative analgesia for Taiwanese patients whose average physicality is not entirely compatible with the pharmacopeially recommended dosage for western people. Methods: For assessment of epidural ropivacaine for postoperative analgesia 105 adult patients were enrolled and randomly allotted to three groups. Patients in Group A were given epidurally 0.15% ropivacaine, while those in Group B and Group C were given 0.125% and 0.10% ropivacaine respectively. Pain was evaluated with visual analogue scale (VAS) and modified Bromage scale, and adverse effects were recorded at the designated points of time during the postoperative 24-hour period. Results: The demographic profiles were comparable among three groups. In VAS score, Group A (3.20 ± 0.47) and B (3.11 ± 0.41) did not differ much, while Group C (3.97 ± 0.71) the score was signally higher than Group A and Group B (P< 0.05). Adverse effects, such as paraesthesia, nausea and urinary retention were observed more in Group A. Conclusions: From the results of this study, we are of the opinion that 0.125% ropivacaine could provide a postoperative analgesia in Taiwanese patients to their satisfaction with less adverse effects.