2013

A comparison of the eff ects of intrathecal ropivacaine and bupivacaine during cesarean section

Amaç: Sezaryenlerde intratekal izobarik ropivakain ve bupivakain ile opioidlerin motor ve duyusal blok özelliklerine etkilerinin karşılaştırılması amaçlandı. Yöntem ve gereç: Elli iki gebe spinal anestezi için 25 μg fentanil + 100 μg morfi n ile % 0,5 izobarik bupivakain 10 mg (Grup B) veya % 0,75 izobarik ropivakain 15 mg (Grup R) vermek üzere rastgele iki gruba ayrıldı. Duyusal ve motor blok özellikleri kaydedildi. Bulgular: T6’da duyusal blok elde etme zamanı Grup B’de Grup R’den anlamlı olarak hızlıydı (2,7 ± 1,8 ile 4,2 ± 2,5 dk). Maksimum duyusal blok seviyesine ulaşma süresi Grup B’de Grup R’den hızlı bulundu (8,1 ± 4,1 ile 11,6 ± 5,6 dk). Grup B’de T10 ve L1 dermatomlarına gerileme süreleri (118,2 ± 24,2 ile 145,5 ± 28,1 dk, sırasıyla) Grup R’den daha kısaydı (135 ± 32,1 ile 162,5 ± 32,5 dk, sırasıyla). Motor blok süresi Grup B’de Grup R’den daha uzundu (165,8 ± 32,5 ile 135,2 ± 45,7 dk). Sonuç: İntratekal izobarik ropivakain ile opioidler daha uzun duyusal blok ve daha kısa motor blok süresiyle sezaryenler için bupivakainden üstün olabilir.

Sezaryenlerde intratekal ropivakain ve bupivakainin etkilerinin karşılaştırılması

Aim: To compare the eff ects of intrathecal plain bupivacaine or ropivacaine with those of opioids on sensory and motor block characteristics during cesarean section (C/S). Materials and methods: Fift y-two ASA I or II women were randomly allocated into 2 groups to administer either 10 mg of 0.5% plain bupivacaine (Group B), or 15 mg of 0.75% plain ropivacaine (Group R) with 25 μg fentanyl and 100 μg morphine for spinal anesthesia. Characteristics of the sensory and motor block were recorded. Results: Th e time to achieve sensory block at T6 was signifi cantly faster in Group B than in Group R (2.7 ± 1.8 min vs. 4.2 ± 2.5 min). Th e time to reach maximum sensory block was signifi cantly faster in Group B than in Group R (8.1 ± 4.1 min vs. 11.6 ± 5.6 min). Th e times of sensory block regression to T10 and L1 dermatomes were signifi cantly shorter in Group B (118.2 ± 24.2 min and 145.5 ± 28.1 min, respectively) than in Group R (135 ± 32.1 min and 162.5 ± 32.5 min, respectively). Motor block duration was significantly longer in Group B than in Group R (165.8 ± 32.5 min vs. 135.2 ± 45.7 min). Conclusion: Intrathecal plain ropivacaine with opioids might be superior to bupivacaine in terms of a longer sensory block, and a shorter motor block duration for C/S.

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1. Tsen L. Anesthesia for Cesarean Delivery. In: Chestnut DH, Polley LS, Tsen LC, Wong CA, editors. Chestnut’s Obstetric Anesthesia Principals and Practice. 4th ed. Philadelphia: Mosby Elsevier; 2009. p. 521-74.
2. Ogun CO, Kirgiz EN, Duman A, Okesli S, Akyurek C. Comparison of intrathecal isobaric bupivacaine-morphine and ropivacaine-morphine for Caesarean delivery. Br J Anaesth 2003; 90: 659-64.
3. Khaw KS, Ngan Kee WD, Wong M, Ng F, Lee A. Spinal ropivacaine for cesarean section: a dose-fi nding study. Anesthesiology 2001; 95: 1346-50.
4. Gautier P, Kock MD, Huberty L, Demir T, Izydorczic M, Vanderick B. Comparison of the eff ects of intrathecal ropivacaine, levobupivacaine, and bupivacaine for caesarean section. Br J Anaesth 2003; 91: 684-9.
5. Carvalho B, Durbin M, Drover DR, Cohen SE, Ginosar Y, Riley ET. Th e ED50 and ED95 of intrathecal isobaric bupivacaine with opioids for cesarean delivery. Anesthesiology 2005; 103: 606-12.
6. Danelli G, Fanelli G, Berti M, Cornini A,Lacava L, Nuzzi M, Fanelli A. Spinal ropivacaine or bupivacaine for cesarean delivery: a prospective, randomized, double-blind comparison. Reg Anesth Pain Med 2004; 29: 221-6.
7. Kallio H, Snall ET, Kero MP, Rosenberg PH. A comparison of intrathecal plain solutions containing ropivacaine 20 or 15 mg versus bupivacaine 10 mg. Anesth Analg 2004; 99: 713-7.
8. Malinovsky JM, Charles F, Kick O, Lepage JY, Malinge M, Cozian A, Bouchet O, Pinaud M. Intrathecal anesthesia: Ropivacaine versus bupivacaine. Anesth Analg 2000; 91; 1457- 60.
9. Polley LS, Columb MO, Naughton NN, Wagner DS, Van de Ven CJ. Relative analgesic potencies of ropivacaine and bupivacaine for epidural analgesia in labor: implications for theurapeutic indexes. Anesthesiology 1999; 99: 944-50.
10. Camorcia M, Capogna G, Lyons G C, Columb MO. Th e relative motor block potencies of intrathecal ropivacaine: Eff ects of concentration. Anesth Analg 2004; 98: 1779- 82.
11. Camorcia M, Capogna G, Berritta C, Columb MO. Th e relative potencies for motor block aft er intrathecal ropivacaine, levobupivacaine, and bupivacaine. Anesth Analg 2007; 104: 904-7.