胸段硬膜外麻醉中罗哌卡因与布比卡因分别对下尿路功能的影响：随机临床实验
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Thoracic Epidural Ropivacaine versus Bupivacaine on Lower Urinary Tract Function ：A Randomized Clinical Trial
背景与目的
胸段硬膜外麻醉使用布比卡因与临床上因逼尿肌活动力弱而致的排尿残余有关。这项研究的目的是分别使用罗哌卡因和布比卡因后以残余尿量和最大尿流率比较排尿功能障碍的风险。我们的假设是，罗哌卡因会导致更少的排尿残余，因为罗哌卡因已经证明对运动阻滞的影响更小。
方 法
在这个单中心，平行小组，随机，双盲的优效试验中，42名接受开放性肾脏手术的病人被平分接受0.125%布比卡因或0.2%罗哌卡因的硬膜外麻醉，最后纳入36例。入选标准是具有正常的膀胱功能。患者在手术前和胸段硬膜外麻醉期间进行了尿动力检查。主要指标是排尿残留术前和在胸段硬膜外麻醉术后的差异。次要指标是在组内和组之间的最大尿流率变化。
结 果
从基线到术后的排尿残余（ml）的中位数为布比卡因组300（范围，30到510;P<0。001）和罗哌卡因组125（范围，30到350;P=0.011），组之间平均差地差异显著（175;95%CI，295到40;P = 0.012)。最大尿流率（mls/s）的中位数在布比卡因组（12;范围,28到 3;P<0.001）罗哌卡因组（4;范围,16 到7;P=0.025）组之间平均差差异显著（7;95%CI，0-12;P = 0.028)。疼痛评分分数相似。没有不良事件发生。
结 论
使用罗哌卡因与布比卡因相比，在胸段硬膜外镇痛法中使用罗哌卡因可以显著降低排尿后残余，对逼尿肌功能损害更小。
原始文献摘要
Stefan A. Girsberger, ,Marc P. Schneider, etc;Effect of Thoracic Epidural Ropivacaine versus Bupivacaine on Lower Urinary Tract Function:A Randomized Clinical Trial;Anesthesiology 2018; 128:511-9
Background: Thoracic epidural analgesia with bupivacaine resulted in clinically relevant postvoid residuals due to detrusor underactivity. This study aimed to compare the risk of bladder dysfunction with ropivacaine versus bupivacaine using postvoid residuals and maximum flow rates. Our hypothesis was that ropivacaine would result in lower postvoid residuals, because ropivacaine has been shown to have less effect on motor blockade.
Methods: In this single-center, parallel-group, randomized, double-blind superiority trial, 42 patients undergoing open renal surgery were equally allocated to receive epidural bupivacaine 0.125% or ropivacaine 0.2%, and 36 were finally included. Inclusion criterion was normal bladder function. Patients underwent urodynamic investigations preoperatively and during thoracic epidural analgesia. Primary outcome was the difference in postvoid residual preoperatively and during thoracic epidural analgesia postoperatively. Secondary outcomes were changes in maximum flow rate between and within the groups.
Results: Median difference in postvoid residual (ml) from baseline to postoperatively was 300 (range, 30 to 510; P < 0.001) for bupivacaine and 125 (range, 30 to 350; P = 0.011) for ropivacaine, with a significant mean difference between groups ( 175; 95% CI, 295 to 40; P = 0.012). Median difference in maximum flow rate (ml/s) was more pronounced with bupivacaine ( 12; range, 28 to 3; P < 0.001) than with ropivacaine ( 4; range, 16 to 7; P = 0.025) with a significant mean difference between groups (7; 95% CI, 0 to 12; P = 0.028). Pain scores were similar. No adverse events occurred.
Conclusions: Postvoid residuals were significantly lower using ropivacaine compared to bupivacaine for thoracic epidural analgesia reflecting less impairment of detrusor function with ropivacaine.
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