以兩種劑量之0.75％不含糖Ropivacaine作脊椎麻醉：於中國人剖腹生產手術麻醉效果及安全性之比較

Spinal Anesthesia with Two Different Dosages of 0.75% Glucose-free Ropivacaine: A Comparison of Efficacy and Safety in Chinese Parturients Undergoing Cesarean Section

背景：本研究的目的在比較兩種劑量2.5毫升（18.75毫克）及3毫升（22.5毫克）之0.75％不含糖Ropivacaine作脊椎麻醉，於中國人剖腹生產之臨床麻醉效果及安全性之比較。方法：此研究以隨機、公開標記之方式，把40位病患分成二組：A組以ropivacaine 2.5毫升（18.75毫克）及B組以ropivacaine 3毫升（22.5毫克），用於剖腹生產之脊椎麻醉上。術中及術後作感覺及運動神經阻斷的評估，包括：感覺神經阻斷之起始時間、最大的頭側分佈、達最大感覺神經阻斷時間、感覺神經阻斷全部時間；運動神經完全阻斷起始時間及復原時間等。其他如生理徵象及副作用均記錄之。結果：在兩組間並沒有顯著差異者包括有：感覺神經阻斷達L3之起始時間（1.8 ± 6.7分鐘及23 ± 9.8分鐘）、最大頭側分佈[T3-4 (C3-T7)及T3(C2-T8)]、最大的阻斷皮節數(20.7 ± 3.5及20.2 ± 3.4)、達最大感覺神經阻斷之時間（15.4 ± 5.5分鐘及20.3 ± 15.1分鐘）、阻斷恢復至L3之時間（200.8 ± 59.5分鐘及215 ± 37.6分鐘）及運動神經阻斷完全恢復之時間（208.5 ± 55.5分鐘及226.5 ± 46.1分鐘）等。只有在運動神經完全阻斷之起始時間（15.4 ± 5.6分鐘及10.4 ± 4.7分鐘）中，B組較A組為快(P < 0.05)；在血流動力學方面，除了在開始麻醉時A組較常出現短暫性低血壓外，其他血壓及副作用方面兩組均無明顯差異。結論：從本研究得知，以18.75 mg （2.5毫升）或22.5 mg（3毫升）之0.75％不含糖ropivacaine在中國人剖腹產中作脊椎麻醉時，可得相同之麻醉較果及安全性。

Background: We compared the clinical efficacy and safety between 2 doses of 2.5 ml (18.75 mg) and 3 ml (22.5 mg) of 0.75% glucose free spinal ropivacaine in Chinese parturients undergoing Cesarean section. Methods: In this randomized, open-label study, 40 parturients enrolled were divided into two groups: Group A received a 2.5 ml 0.75% ropivacaine as opposed to 3 ml in Group B. Sensory and motor blocks were assessed during and after surgery until complete recovery. Eight standard measurements were taken: time at onset of sensory block; maximum cephalic sensory spread; maximum number of blocked segments; time to maximum sensory block; duration of sensory block at L3; time at onset of complete motor block and duration until complete recovery. Vital signs and any adverse effects related to spinal anesthesia were also recorded. Results : Five of the 6 variables showed no significant difference between groups A and B: onset time of sensory block at L3 was 1.8 ± 6.7 min vs. 2.3 ± 9.8 min; maximum cephalic spread was T3-4 (C3-T7) vs. T3 (C2-T8); maximum number of blocked segments was 20.7 ± 3.5 vs. 20.2 ± 3.4; time to maximum sensory block 15.4 ± 5.5 min 20.3 ± 15.1 min; time for regression to L3 was 200.8 ± 59.5 min vs. 215.0 ± 37.6 min and time for complete recovery of motor block 208.5 ± 55.5 min vs. 226.5 ± 46.1 min. Group B had a significantly faster onset time for complete motor block (P < 0.05) 15.4 ± 5.6 min vs. 10.4 ± 4.7 min. Moreover, there were no significant differences in global hemodynamic changes during and after the operation. Transient hypotension attacks were more frequent in group A at the be-ginning of anesthesia, perhaps due to inadequate prehydration. Otherwise, there were no differences in adverse effects during or after surgery. Conclusions: We conclude that for Cesarean section in Chinese parturients either 18.75 mg (2.5 ml) or 22.5 mg (3 ml) 0.75% glucose-free ropivacaine can provide a spinal anesthesia of the same efficacy and safety.