■在剖宫产(CS)硬膜外麻醉中使用罗哌卡因或布比卡因仍未达成共识,因为它们的麻醉效力和相关并发症仍然存在争议。本系统综述和荟萃分析旨在比较硬膜外罗哌卡因和布比卡因用于选择性CSs的疗效,并探讨产妇和新生儿的相关并发症。
■我们搜索了PubMed,MEDLINE,Embase,科克伦图书馆,科学直接,和谷歌学者到2023年6月30日进行随机对照试验(RCT),比较了罗哌卡因和布比卡因的硬膜外选择性CSs。硬膜外麻醉(EA)的成功率是主要结果。次要结局包括感觉阻滞的发作时间,母体副作用,新生儿Apgar评分和脐动脉pH值。
■我们分析了532例产妇的8个随机对照试验。0.75%罗哌卡因的感觉阻滞起效时间比0.5%布比卡因短(SMD=-0.43,95%CI:-0.70至-0.17;p=.001)。与0.5%布比卡因相比,0.5%罗哌卡因导致恶心减少(RR=0.49,95%CI:0.28至0.83;p=.008)。此外,罗哌卡因组和布比卡因组硬膜外麻醉成功率无显著差异,母体副作用(低血压,心动过缓,颤抖),新生儿Apgar评分和脐动脉pH值。
■研究结果表明,硬膜外罗哌卡因和布比卡因在选择性CSs的成功率方面没有显着差异(85.9%vs.83.5),母体副作用(低血压,心动过缓,颤抖),新生儿Apgar评分和脐动脉pH值。但与0.5%布比卡因相比,0.75%罗哌卡因硬膜外麻醉对减少感觉阻滞的起效时间有轻微效果,0.5%罗哌卡因可降低产妇恶心的发生率.
UNASSIGNED: It is still no consensus on the use of ropivacaine or bupivacaine in
epidural anesthesia for cesarean section (CS), because their anesthetic potency and relative complications remains controversial. This system
review and meta-analysis aimed to compare the efficacy of
epidural ropivacaine and bupivacaine for elective CSs and investigate relative complications for parturients and neonates.
UNASSIGNED: We searched PubMed, MEDLINE, Embase, Cochrane Library, Science-Direct, and Google Scholar to June 30, 2023 for randomized controlled trials (RCTs), which compared epidural ropivacaine with bupivacaine for elective CSs. The success rate of
epidural anesthesia (EA) was primary outcome. The secondary outcomes included onset times of sensory block, maternal side effects, neonatal Apgar scores and umbilical artery pH.
UNASSIGNED: We analyzed 8 RCTs with 532 parturients. 0.75% ropivacaine is associated with a shorter onset time of sensory block than 0.5% bupivacaine (SMD = -0.43, 95% CI: -0.70 to -0.17; p = .001). 0.5% ropivacaine resulted in a reduced nausea than 0.5% bupivacaine (RR = 0.49, 95% CI: 0.28 to 0.83; p = .008). In addition, there were no significant difference between ropivacaine and bupivacaine groups in terms of success rate of epidural anesthesia, maternal side effects (hypotension, bradycardia, shivering), and neonatal Apgar scores and umbilical artery pH.
UNASSIGNED: The findings suggest that there were no significant difference between
epidural ropivacaine and bupivacaine for elective CSs in terms of the success rate (85.9% vs. 83.5), maternal side effects (hypotension, bradycardia, shivering), and neonatal Apgar scores and umbilical artery pH. But compared with 0.5% bupivacaine,
epidural 0.75% ropivacaine was mildly effective for reducing onset time of sensory block and 0.5% ropivacaine reduced the incidence of maternal nausea.