脂质体包裹罗哌卡因在人口腔粘膜表面麻醉中的应用  

作　　者：Michelle Franz-Montan André L. R. Silva Karina Cogo Cristiane de C. Bergamaschi Maria C.Volpato José Ranali Eneida de Paula Francisco C. Groppo 胥亮(译) 岳云(校) 

机构地区：[1]Department of Physiological Sciences, Dentistry School of Piracicaba, Piracicaba, SP, Brazil [2]Department of Biochemistry, Institute of Biology, State University of Campinas-UNICAMP, Campinas, SP, Brazil [3]不详

出　　处：《麻醉与镇痛》2008年第4期80-84,共5页Anesthesia & Analgesia

摘　　要：背景如果能够消除局部麻醉时针刺所导致的疼痛，将是牙科学的一个重大进步。方法在本交叉双盲研究中，我们评估了脂质体包裹罗哌卡因用于表面麻醉的效果。30例健康志愿者接受了各60mg的表面麻醉药：1％脂质体包裹罗哌卡因，1％普通罗哌卡因，2．5％利多卡因和2．5％丙胺卡因混合物（EMLA），以及20％苯佐卡因凝胶。麻醉位置在右上犬齿处的颊皱褶，各种药物于不同时间应用，每种使用2分钟。当30G针头刺入后，以视觉模拟评分法（VAS）评估疼痛。用针刺试验测定表面麻醉的维持时间，用电子牙髓刺激器评估牙髓反应。结果在脂质体包裹罗哌卡因组、罗哌卡因组、EMLA组及苯佐卡因组中，VAS中位数和四分位数间距（以cm计）分别为0．8（0．4～1．5），1．6（0．8～2．6），1．1（0．3～2．7），2．2（0．9～2．9）。脂质体包裹罗哌卡因组较苯佐卡因组的VAS评分均数更低（P=0．0205）。在脂质体包裹罗哌卡因组、罗哌卡因组、EMLA组及苯佐卡因组中，软组织麻醉持续时间的中位数和四分位数间距分别为11（7～14），6．5（4～11），14（11～16），7（6～9）分钟。EMLA和脂质体包裹罗哌卡因的镇痛效能相当，与其他麻醉药相比，软组织麻醉持续时间更长（P=0．0001）。结论1％脂质体包裹罗哌卡因凝胶在减轻针刺疼痛和软组织麻醉维持时间上与EMLA相当。以上所有表面麻醉药均不能产生牙髓麻醉作用。BACKGROUND： The elimination of pain caused by needle insertion for local anesthesia would be a significant advance in dentistry. METHODS： In this blinded cross-over study we evaluated the efficacy of liposome-encapsulated ropivacaine for topical anesthesia. Thirty healthy volunteers received 60 mg topical anesthetics： Liposome-encapsulated 1% ropivacaine, 1% plain ropivacaine, 2.5% lidocaine and 2.5% prilocaine mixture （EMLA）, and 20% benzocaine gel, in the buccal fold of the upper-right canine for 2 min in different sessions. After insertion of 30-G needles, pain was rated on a visual analog scale （VAS）. A pinprick test was used to measure the duration of topical anesthesia. The pulpar response was assessed by an electric pulp tester. RESULTS： VAS median and interquartile range （in cm） were 0. 8 （0. 4 - 1.5）, 1.6 （0.8 - 2.6）, 1. 1 （0. 3 - 2.7）, 2.2 （0.9 - 2.9） for liposome-encapsulated ropivacaine, ropivacaine, EMLA, and benzocaine groups, respectively. The liposome-encapsulated ropivacaine group showed lower VAS mean values when compared with the benzocaine group （P = 0. 0205）. The median values and interquartile range for the duration of soft tissue anesthesia were 11 （7 - 14）, 6. 5 （4 - 11 ）, 14 （11 - 16）, and 7 （6 - 9） rain for liposome-encapsulated ropivacaine, ropivacaine, EMLA, and benzocaine groups, respectively. EMLA and liposome-encapsulated ropivacaine were just as efficient for reducing pain, and showed longer soft tissue anesthesia when compared to the other local anesthetics （P = 0. 0001 ）. CONCLUSIONS： Liposomal-encapsulated 1% ropivacaine geI was equivalent to EMLA for reducing pain during needle insertion and for the duration of soft tissue anesthesia. None of the topical anesthetics was effective for inducing pulpal anesthesia.

关 键 词：粘膜表面麻醉 脂质体包裹 罗哌卡因 视觉模拟评分法 VAS评分 苯佐卡因 EMLA 口腔 

分 类 号：R614.2[医药卫生—麻醉学] R512.6[医药卫生—外科学]