【罂粟摘要】阿替卡因和布比卡因在下颌第三磨牙手术中的疗效比较:一项随机对照试验

阿替卡因和布比卡因在下颌第三磨牙手术中的疗效比较:一项随机对照试验

贵州医科大学  麻醉与心脏电生理课题组

翻译：安丽  编辑：张中伟   审校：曹莹

      0        1       背景        

这项随机、三盲试验的目的是确定阿替卡因和布比卡因在下颌第三磨牙拔除中的麻醉、镇痛效果比较和对血流动力学的影响。

      0        2       方法        

选择26例接受双侧下颌第三磨牙切除手术的患者，随机分为阿替卡因组和布比卡因组。评估麻醉作用的起效时间、术中舒适度、使用溶液总量、术后麻醉和镇痛持续时间、抢救性镇痛药使用、术后疼痛、术中出血和血流动力学参数情况。

      0        3       结果        

阿替卡因组相对于布比卡因组麻醉起效更快，术中舒适度更好，有效麻醉所需的局麻溶液更少。布比卡因组术后麻醉和镇痛时间明显延长，术后6小时和48小时视觉模拟镇痛评分值较低。两种方案在抢救性镇痛药物使用、术中出血或血流动力学方面无显著差异。

        0         4         结论        

阿替卡因术中麻醉的疗效优于布比卡因，麻醉起效快，患者舒适度高，术中强化作用少。但布比卡因在术后镇痛方面有优势，由于其残留麻醉和镇痛作用，减少了术后疼痛。在下颌第三磨牙手术中，两种低剂量的麻醉溶其血流动力学变化相似。

      0         5         原始文献来源        

Berkay Tokuç, Fatih Mehmet Coşkunses.Comparison of the effects of articaine and bupivacaine in impacted mandibular third molar tooth surgery: a randomized, controlled trial.J Dent Anesth Pain Med 2021;21(6):575-582.

    英文原文        

Comparison of the effects of articaine and bupivacaine in impacted mandibular third molar tooth surgery: a randomized, controlled trial

Abstract

Background: The aim of this randomized, triple-blind trial was to determine the anesthetic, analgesic, and hemodynamic effects of articaine and bupivacaine in the extraction of impacted mandibular third molar teeth.

Methods: Twenty-six patients who underwent removal of bilaterally symmetric mandibular third molars were randomly assigned to articaine and bupivacaine groups in a split-mouth design. The onset of anesthetic action, intraoperative comfort, total amount of solution used, duration of postoperative anesthesia and analgesia, rescue analgesic use, postoperative pain, intraoperative bleeding, and hemodynamic parameters were evaluated.

Results: In the articaine group, the onset of anesthetic activity was faster, intraoperative comfort was greater, and effective anesthesia required less local anesthetic solution. The bupivacaine group showed a significantly longer duration of postoperative anesthesia and analgesia, in addition to lower visual analog scale values at 6 and 48 hours postoperatively. There were no significant differences between the two solutions regarding rescue analgesic medication use, intraoperative bleeding, or hemodynamics.

Conclusion: Articaine showed greater clinical efficacy than bupivacaine in intraoperative anesthesia, achieving faster onset of anesthetic action and greater patient comfort while also requiring less reinforcement during surgery. However, bupivacaine was superior in terms of postoperative anesthesia, reducing postoperative pain due to its residual anesthetic and analgesic effects. Both anesthetic solutions led to similar hemodynamics at low doses in mandibular third molar surgery

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