Objective To investigate whether the peri pheral administration of amitri ptyl ine and bupivacaine produces anti-hyperalgesic effect and to screen the neurotoxicological effect on sciatic nerve blockade in a rat model of neuropathic pain. Methods Twenty-four adult male SD rats [weighing (200 ± 20) g] were made the models of chronic constriction injury (CCI) and randomly divided into 3 groups (n=8) 5 days after operation: group A (amitriptyl ine), group B (bupivacaine) and group C (normal sal ine). 0.5 mL 0.5% amitriptyl ine, 0.5% bupivacaine or normal sal ine were given in group A, group B, and group C, respectively through implanted cannulas after 5, 7 and 9 days of CCI once a day for successive 3 days. The motor function was measured before administration and 1, 2, 4, 8, 12 and 24 hours after every administration. Mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL) were measured before administration and 1, 3, 5 and 7 days after the third administration. The operated sciatic nerve samples were obtained for neuropathological examination under l ight microscope. Results Twenty-four CCI rats were all survival without infection, palsy and catheter fall ing off. Compared with group C, the rats of group A and group B both produced significant ambulation deficits after every administration (P lt; 0.05). The ambulation deficits lasted 2 hours (group B) and 8 hours (group A) respectively. But the ambulation deficits of CCI rats were all reversible. The MWT and TWL of group A 1 and 3 days after the third administration increased when compared with those before administration and 5 and 7 days after the third administration, and when compared with group B and group C (P lt; 0.05). There was no significant difference (P gt; 0.05) in l ight microscopic neuropathological examination among three groups. Epineurial tissue and endoneurium tissue integrity, tidy arrangement of fibers, less inflammatory cell and no marked degeneration of myel inated fibers were observed. Conclusion Repeated sciatic nerve blockade with 0.5% amitriptyl ine has peripheral anti-hyperalgesic effects on neuropathic pain of rats. No morphological evidence of neurotoxicity in the sciatic nerve of rats is observed in 0.5% amitriptyl ine.
Objective To evaluate the effectiveness and safety of ropivacaine in spinal anesthesia. Methods We searched PubMed (1999 to 2008), OVID (1999 to 2008), EBSCO (1999 to 2008), The Cochrane Library (2000 to 2008), and CNKI (1999 to 2008) databases to identify randomized controlled trials (RCTs) that compared ropivacaine and bupivacaine for spinal anesthesia. The quality of the included RCTs was evaluated by two reviewers independently, and meta-analysis was performed by RevMan 5.0 software. Results Six RCTs were included. The methodological quality of them were all poor. Among the six RCTs, 215 patients received ropivacaine and 215 received bupivacaine. The results of meta-analyses showed that the motor-block time to complete block of ropivacaine was significantly shorter than that of bupivacaine (WMD=2.18 min, 95%CI 0.32 to 4.03, P=0.02). The motor-block time to complete recovery of ropivacaine was significantly shorter than that of bupivacaine for cesarean delivery in spinal anesthesia (SMD= – 1.82, 95%CI – 3.05 to – 0.59, P=0.004). The incidence rate of hypotension and bradycardia in spinal anestheisa with ropivacaine was lower than that with bupivacaine (OR=0.49, 95%CI 0.31 to 0.80, P=0.004; OR=0.40, 95%CI 0.03 to 4.99, P=0.47). Conclusion Equivalent doses of ropivacaine and bupivacaine provide similar analgesia in spinal anesthesia for cesarean delivery. However, haemodynamics in spinal anesthesia with ropivacaine fluctuate lightlier than with bupivacaine. Ropivacaine is suitable for spinal anesthesia in low-abdominal operations.
Objective To assess the analgesic effect of caudal bupivacaine with neostigmine for hypospadias surgery in children. Methods We searched The Cochrane Library (Issue 2, 2008), MEDLINE (1966-2008), EMbase (1980-2008), CBMdisc (1978-2008), CNKI (1989-2008) and Wanfang Database using the keywords “bupivacaine”, “neostigmine” and “hypospadias” to identify randomized control trials (RCTs) of caudal bupivacaine with neostigmine versus bupivacaine alone for hypospadias surgery in children. The methodological quality of included RCTs was evaluated by two reviewers independently, and Meta-analysis was conducted using RevMan 5.0.13 software. Results We identified 3 RCTs including 160 patients which had an uncertain risk of bias. The results of meta-analysis showed no significant difference found between bupivacine alone and bupivacine plus 1 µg/kg neostigmine (WMD= 0.05, 95%CI – 6.76 to 6.86, P= 0.99), but a difference was found between bupivacine alone and bupivacine plus 1 µg/ kg, 2 µg/kg, or 3 µg/ kg neostigmine (WMD= 12.79, 95%CI 10.96 to 14.62, Plt; 0.000 01; WMD= 12.10, 95%CI – 6.76 to 6.86, Plt; 0.000 01; WMD= 11.90, 95%CI 9.17 to 14.63, Plt;0.000 01). The duration of postoperative analgesia of the bupivacaine with neostigmine group was longer than that of bupivacine alone. Conclusions Because of the small sample size and the unclear risk of bias in the included RCTs, the effectiveness of caudal bupivacaine with neostigmine for postoperative pain management after hypospadias surgery in children is not completely confirmed. So more large sample size, double-blind RCTs are needed.
Objective To compare the analgesic effect, duration and incidence of adverse reactions of liposome bupivacaine and bupivacaine hydrochloride after intercostal nerve block in single-pore thoracoscopic lung surgery. Methods A total of 228 patients in our hospital who needed to undergo thoracoscopic lung surgery were selected and divided into two groups by random number table method: a group B with bupivacaine hydrochloride (n=128) and a group LB with liposome bupivacaine (n=110). Intraoperative intercostal nerve block was performed under endoscopy, and the time of first use of analgesic drugs after surgery, cumulative use of opioids 72 h after surgery, incidence of postoperative nausea and vomiting, length of stay and other indicators were evaluated and recorded. Results Visual analogue scale (VAS) scores at 4 h, 8 h, 12 h, 24 h, 48 h and 72 h in the LB group were significantly lower than those in the group B (P<0.05). The total number of activities within 48 h after surgery in the group B was significantly lower than that in the LB group (P<0.05), and the postoperative hospitalization days in the LB group was shorter than that in the group B, but the difference was not statistically significant.There was no statistical difference between the two groups in postoperative adverse reactions Conclusion Intercostal nerve block with liposome bupivacaine during single-pore thoracoscopic lung surgery can significantly reduce postoperative pain, improve quality of life, and promote recovery. It is worthy of clinical promotion.