WITH ISOBARIC BUPIVACAINE (5 MG/ML)

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, 49, 2013, 3 63 (5 MG/ML) (5 MG/ML).,.,.,..,..,, SPINAL ANESTHESIA: COMPARISON OF ISOBARIC ROPIVACAINE (5 MG/ML) WITH ISOBARIC BUPIVACAINE (5 MG/ML) D. Tzoneva, Vl. Miladinov, Al. Todorov, M. P. Atanasova, Y. Borisov and St. Hinev Department of Anesthesiology and Intensive Care, University Hospital "Aleksandrovska", Medical University Sofia : : : Summary:. - ( ) -, -., S-. - - -. (5 mg/ml) - (5 mg/ml),. 34, -, : R ( ; N = 17) B ( - ; N = 17). ; ( ); - ; ;.. -, 1,2 - B. R - ; 1,2 -, 1,3 -,... (5 mg/ml) - -., -.,,,, - -,,,,... 1, 1431, e-mail: dochka_tobova@abv.bg Recently, the proportion of loco-regional methods of intraoperative analgesia and pain management has increased. Spinal anesthesia (SA) is a popular, widely used in clinical practice technique for analgesia with a high success rate and good safety profile. Ropivacaine is a new amide local anesthetic, synthesized as a pure S-enantiomer. Its unquestionable advantages are prolonged action and the ability to achieve differential sensorimotor blockade with lower sys-

64....... temic toxicity. The aim of the study was to compare the effects of equipotent doses of isobaric ropivacaine (5 mg/ml) to isobaric bupivacaine (5 mg/ml), administered intrathecally for intraoperative analgesia in adult patients. Thirty-four adult patients scheduled for inguinal hernia repair and anorectal surgery under intrathecal anesthesia were randomized in two groups according to the administrated local anesthetic: group R (ropivacaine; N = 17) and group B (bupivacaine; N = 17). The onset, duration and segmental level of sensory and motor blockade were examined, as well as hemodynamic variables, side effects, and time to first void. The results showed that ropivacaine produced spinal anesthesia with similar clinical profile to bupivacaine. In group R the onset of the sensory blockade was slower with a 1.2 times shorter duration and complete motor block developed rarer than in the group with bupivacaine. The recovery from spinal block was 1.2 times faster, and the time to void was 1.3 times shorter in patients who had received ropivacaine, compared with patients in group B. The hemodynamic changes were similar in both groups. In the early postoperative period no patients reported any complaints. In conclusion, isobaric ropivacaine (5 mg/ml) produces equivalent intrathecal anesthesia for inguinal hernia repair and anorectal surgery with faster recovery compared to bupivacaine. Ropivacaine is a local anesthetic with good tolerability; provides effective intraoperative analgesia with minimal motor function suppression and reduced potential for cardioand CNS-toxicity. Key words: Address for correspondence: spinal anesthesia; ropivacaine, bupivacaine, inguinal hernia repair, anorectal surgery, adult patients Dochka Tzoneva, M. D., Department of Anesthesiology and Intensive Care, University Hospital "Aleksandrovska", Medical University, 1, Sv. G. Sofyiski St., Bg 1431 Sofia, e-mail: dochka_tobova@abv.bg ( ) ( 35-40%).,, - 44%, 55%, 39%, 59%, - 50% [25]. - ( ) [10]. - - ( )., -, -,, - [16]., S-., -, - [22]., - -, ( - - ), -, ( - - ). - [23] - [2, 14],, -. - - - - ( ) - [15, 26]. - 90- -. - -, 2004. -. - (5 mg/ml) (5 mg/ml), - -.

, 49, 2013, 3 65, (N = 34), ASA -, -,,, 4. : > 18, -,. -. : R ( ; N = 17) B ( ; N = 17). - (1:1,5) [23]. 10 ml/kg - - (LP) L 2-3 L 3-4 - - 25-G. - -. -, -. ( - ) 15. - (5 mg/ml): - ; - ( ); - ;. - 5, Bromage- (1 = ; 2 = ; 3 = - ; 4 = ) - ( 22- G). - - Th 10 Th 12 ( ). 30, - -. - ( - [ ] 30% ) -,, i.v. - 10 mg. ( < 45./ ) - 0,5 mg i.v. - : ( ),,,, SpO 2. -,,, 5. -, i.v. -,. -,. - - ; -., -, ASA. IBM SPSS Statistics 19.0 for Windows (2010). -,, ANOVA, -. ± SD, - (%). < 0,05. 34 -,. -. 1.. 2. 1. R (Ropivacaine) B (Bupivacaine),. 44,1 ± 5,3 50,1 ± 5,2, /, n 13/4 14/3, kg 80,3 ± 2,8 82,6 ± 2,9, cm 174,3 ± 1,2 175,2 ± 1,1 ASA /II/III, n 2/10/5 1/13/3, n 10 14-7 3 * ± SD

66....... 2. LP, n R (Ropivacaine) L 2-3 3 7 L 3-4 14 10, ml ( ), n B (Bupivacaine) 3,34 ± 0,5 3,39 ± 0,4 Th 10 12 14 Th 12 5 3, min (S 2 ), min, n 21,8 ± 1,5 (15-30) 18,6 ± 1,4 (15-20) 205,0 ± 15,5 248,0 ± 44,0 Bromage 4 13 17 Bromage 3 3 Bromage 2 1, min -, min -, n, < 45./min, < 30% + - -, n Atropine 69,4 ± 10,3 81,2 ± 4,1 232,0 ± 46,9 302,0 ± 45,7 1 3 3 5 3 Ephedrine 3 1 Midazolam 5 6 Propofol 2, n * ± SD -,,, ASA, (. 1), (. 2). -. ( R: 21,8 ± 1,5 min; B: 18,6 ± 1,4 min; > 0,5). - R, 205,0 ± 15,5 min 248,0 ± 44,0 min ( < 0,5). - - (> 90%). - 13 R ( < 0,5). - 41,2% (N = 7) R 35,3% (N = 6) B ( > 0,5). - R (17,6%), -. (5,9%) B -,. 180-12 R (70,6%), 7 (41,2%) ( < 0,5). R - ( : 232,0 ± 46,9 min 302,0 ± 45,7 min; < 0,5). - - -. - 0,5 mg/ml ( 10 ml)., - -., ( B), 1,2 -, 1,2 -, - 1,3 -. - 50% -, - R - (1,2 ) - (1,3 ), -, - ( ). -,, -, -,, -, - [20, 24, 27, 28]., - -, -, - ( 12 mg, -, - 8 mg, ) [4, 14, 16, 20, 23]. -,

, 49, 2013, 3 67 - [3, 4, 13]. - - -, - - - [3, 4]. - - - - - -, -, - -. Buckenmaier. [5] (4 mg) 20 mcg - - 2 3. -, - -., -. -,,,, - [21];, - - [30]. -. [9, 29]. -, -. Albright (1979), - -, [1]. - -, R- -, S- - [12]., -,, -, [6].. Chazalon. - - (,, - ) 66-, - [11]. (300 mg; 6,7 mg/kg) - -. Huet 66- (1,88 mg/kg) - - [17]. -. - -,, - - [18, 22]. in vitro, in vivo, - - [6, 19, 29].,. - ( = ), ( -, - ),, -. [7, 8]., - - - [21].,.,, - -.

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