目 的
本研究的目的是评价腹腔注射布比卡因(IP)对猫卵巢子宫切除术(OVH)的镇痛效果。
方 法
在获得主人的书面同意后，45只猫被纳入了一项随机、前瞻性、盲法研究。麻醉方案包括麻醉方案包括乙酰丙嗪-丁丙诺啡-丙泊酚-异氟烷每组15只猫，腹腔注射0.9%生理盐水(阴性对照组和阳性对照组，NG组和PG组)或布比卡因组(2 mg/kg，布比卡因组，BG)，每组15只，分别给予生理盐水(NG)和阳性对照组(PG)或布比卡因(2 mg/kg)腹腔注射(布比卡因2 mg/kg，布比卡因组，BG)。实验组给予美洛昔康(0.2 mg/kg SC)。术后8h行OVH，采用动态交互视觉模拟评分(DIVAS)、Unesp-Botucatu多维综合疼痛评分(MCPS)和机械伤害性阈值(MNT)评定疼痛程度。术后镇静采用DIVAS评分。丁丙诺啡和/或美洛昔康用于抢救性镇痛。采用重复测量、线性模型和Cochran-Mantel-Haenszel检验进行统计学分析(P<0.05)。
结 果
治疗对给予抢救性镇痛的次数有显著影响（P=0.002）（PG，n=2，13%；NG，n=12，80%；BG，n=4，27%），NG组的次数高于PG（P=0.0004）和BG（P=0.02）组。不同时间点的DIVAS、MCPS和MNT与基线值相比有显著性差异；然而，各组之间的数据没有显著差异。
结 论
在疼痛评分、抢救镇痛次数和MNT方面，PG组和BG组的镇痛效果相似。在抢救性镇痛的基础上，腹腔注射布比卡因可为猫OVH后提供镇痛作用。
个人经验与感想
1.布比卡因的pKa为8.1，蛋白结合率很高（95%），使得其作用持续时间很长（6～8h）。其安全剂量的范围要低于利多卡因、甲哌卡因、罗哌卡因等。由于布比卡因的安全性较差，可以选择使用利多卡因＋肾上腺素/罗哌卡因来替代布比卡因。
2.有些医生在临床中常常使用利多卡因和布比卡因的结合，期待结合后有着利多卡因快的起效时间和布比卡因长的持续时间，然而适得其反，在2009和2013年的两个实验中表示混合使用局麻药并不缩短起效时间，又缩短了持效时间。所以在此不建议联合使用局麻药。
3.除了利多卡因外，不建议其他局部麻醉药静脉用药，会产生较严重的中毒反应。静脉给予利多卡因的毒性相对要比其他的酰胺类局麻药更低，而且可以静脉给予来治疗全身性疼痛，以及治疗室性心律不齐
4.腹腔内浸润阻滞的技术，在最新的指南中有提及和推广。可在开腹后立即进行阻滞，或在完成腹部手术关腹前阻滞。
Analgesic efficacy of intraperitoneal administration of bupivacaine in catsObjectives The aim of this study was to evaluate the analgesic efficacy of intraperitoneal (IP) bupivacaine in cats undergoing ovariohysterectomy (OVH).Methods Forty-five cats were included in a randomized, prospective, blinded study after owners’ written consent was obtained. The anesthetic protocol included acepromazine–buprenorphine–propofol–isoflurane. A ventral midline incision was made and cats (n = 15/group) were administered either IP saline 0.9% (negative and positive control groups; NG and PG, respectively) or IP bupivacaine (2 mg/kg; bupivacaine group; BG). Cats in the PG received meloxicam (0.2 mg/kg SC). An OVH was performed and postoperative pain was evaluated using a dynamic interactive visual analog scale (DIVAS), the UNESP-Botucatu multidimensional composite pain scale (MCPS) and mechanical nociceptive thresholds (MNT) for up to 8 h after the end of surgery. Postoperative sedation was evaluated using DIVAS. Rescue analgesia was provided with buprenorphine and/or meloxicam. Repeated measures linear models and a Cochran–Mantel–Haenszel test were used for statistical analysis (P <0.05).Results There was a significant effect of treatment on the number of times rescue analgesia was administered (P = 0.002) (PG, n = 2, 13%; NG, n = 12, 80%; BG, n = 4, 27%) with the number of rescues being higher in the NG group than in the PG (P = 0.0004) and BG (P = 0.02) groups. The DIVAS, MCPS and MNT were significantly different when compared with baseline values at different time points; however, data were not significantly different among groups.Conclusions and relevance Treatments PG and BG produced similar analgesia in terms of pain scores, number of times rescue analgesia was administered and MNT. Based on rescue analgesia, IP administration of bupivacaine provides analgesia in cats after OVH.
