Minimum local analgesic doses of ropivacaine, levobupivacaine, and bupivacaine for intrathecal labor analgesia

被引:106
作者
Camorcia, M
Capogna, G
Columb, MO
机构
[1] Cita Roma Hosp, Dept Anesthesia, I-00152 Rome, Italy
[2] Cita Roma Hosp, Dept Obstet Anesthesia, I-00152 Rome, Italy
[3] Univ S Manchester Hosp, Dept Anesthesia, Manchester M20 8LR, Lancs, England
[4] Univ S Manchester Hosp, Dept Intens Med, Manchester M20 8LR, Lancs, England
关键词
D O I
10.1097/00000542-200503000-00025
中图分类号
R614 [麻醉学];
学科分类号
100217 [麻醉学];
摘要
Background: Doses for intrathecal opioid-local anesthetic mixtures have been arbitrarily chosen. The aim of this study was to compare the analgesic efficacies of intrathecal ropivacaine, levobupivacaine, and bupivacaine for labor analgesia and to determine the analgesic potency ratios for these three drugs. For this purpose, the authors used the up-down sequential allocation model, which estimates the minimum local analgesic dose for intrathecal local anesthetic. Methods: Ninety-seven nulliparous; term parturients in spontaneous labor, requesting combined spinal-epidural analgesia, were randomly allocated to one of three groups to receive 0.25% spinal ropivacaine, levobupivacaine, or bupivacaine. The initial dose of the local anesthetic drug was chosen to be 2.5 mg, and the testing interval was set at 0.25 mg. The subsequent doses were determined by the response of the previous parturient. Efficacy was accepted if the visual analog pain score decreased to 10 turn or less on a 100-mm scale within 30 min. The minimum local analgesic dose was calculated using the method of Dixon and Massey. Results: The intrathecal minimum local analgesic dose was 3.64 mg (95% confidence interval, 3.33-3.96 mg) for ropivacaine, 2.94 (2.73-3.16) mg for levobupivacaine, and 2.37 (2.17-2.58) mg for bupivacaine. The relative analgesic potency ratios were 0.65 (0.56-0.76) for ropivacaine:bupivacaine, 0.80 (0.70-0.92) for ropivacaine:levobupivacaine, and 0.81 (0.69-0.94) for levobupivacaine:levobupivacaine. There were significant trends (P less than or equal to 0.021) for greater motor block with bupivacaine and levobupivacaine. Conclusions: This study suggests a potency hierarchy of spinal bupivacaine > levobupivacaine > ropivacaine.
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页码:646 / 650
页数:5
相关论文
共 22 条
[1]
A Randomized sequential allocation study to determine the minimum effective analgesic concentration of levobupivacaine and ropivacaine in patients receiving epidural analgesia for labor [J].
Benhamou, D ;
Ghosh, C ;
Mercier, FJ .
ANESTHESIOLOGY, 2003, 99 (06) :1383-1386
[2]
BROMAGE PR, 1965, ACTA ANAESTH SCAND, VS, P55
[3]
Epidural test dose with levobupivacaine and ropivacaine:: determination of ED50 motor block after spinal administration [J].
Camorcia, M ;
Capogna, G ;
Lyons, G ;
Columb, M .
BRITISH JOURNAL OF ANAESTHESIA, 2004, 92 (06) :850-853
[4]
THE ADDITION OF BUPIVACAINE TO INTRATHECAL SUFENTANIL FOR LABOR ANALGESIA [J].
CAMPBELL, DC ;
CAMANN, WR ;
DATTA, S .
ANESTHESIA AND ANALGESIA, 1995, 81 (02) :305-309
[5]
Relative potencies of bupivacaine and ropivacaine for analgesia in labour [J].
Capogna, G ;
Celleno, D ;
Fusco, P ;
Lyons, G ;
Columb, M .
BRITISH JOURNAL OF ANAESTHESIA, 1999, 82 (03) :371-373
[6]
Collis R, 2002, TXB OBSTET ANAESTHES, P108
[7]
Effect of maternal ambulation on labour with low-dose combined spinal-epidural analgesia [J].
Collis, RE ;
Harding, SA ;
Morgan, BM .
ANAESTHESIA, 1999, 54 (06) :535-539
[8]
Dixon WJ, 1983, INTRO STAT ANAL, P428
[9]
The relative motor blocking potencies of epidural bupivacaine and ropivacaine in labor [J].
Lacassie, HJ ;
Columb, MO ;
Lacassie, HP ;
Lantadilla, RA .
ANESTHESIA AND ANALGESIA, 2002, 95 (01) :204-208
[10]
Combined spinal-epidural analgesia in labour: comparison of two doses of intrathecal bupivacaine with fentanyl [J].
Lee, BB ;
Kee, WDH ;
Hung, VYS ;
Wong, ELY .
BRITISH JOURNAL OF ANAESTHESIA, 1999, 83 (06) :868-871