150mg左布比卡因含或不含肾上腺素用于坐骨-股神经阻滞的药动学和药效学

Pharmacokinetics and pharmacodynamics of 150 mg levobupivacaine with or without epinephrine for the treatment of sciatic-femoral nerve block

目的观察下肢手术患者坐骨-股神经阻滞时肾上腺素对150 mg左布比卡因药代动力学和药效学的影响。方法择期行踝关节手术患者40例,ASAⅠ~Ⅱ级,随机分为两组:单用左布比卡因组(L组)、左布比卡因复合1:200 000肾上腺素组(LE组),每组20例。超声引导下,L组采用0.5%左布比卡因各15 m L(共30 m L,150 mg)分别行坐骨神经阻滞和股神经阻滞;LE组采用0.5%左布比卡复合1:200 000肾上腺素因各15 m L(共30 m L,150 mg)分别依次行坐骨神经阻滞和股神经阻滞。在股神经阻滞给药结束即刻、给药结束后5、15、30、45、60、120、180、360、720 min各采集静脉血5 m L。气相色谱-质谱联用分析检测各点血浆左布比卡因浓度,用药物与统计软件Kinetica 4.4.1计算药代动力学参数,评估神经阻滞起效和维持时间。结果在15、30 min,LE组血浆左布比卡因浓度低于L组(P<0.05)。LE组左布比卡因血药浓度峰值(C_(max))低于L组(P<0.01);两组其他药动学参数比较,差异无统计学意义(P>0.05)。两组神经阻滞起效时间和维持时间比较,差异无统计学意义(P>0.05)。结论150 mg左布比卡因坐骨-股神经阻滞时,肾上腺素可以降低血浆左布比卡因C_(max),但对神经阻滞的起效和维持时间没有影响。

Objective To investigate the effects of epinephrine on the pharmacokinetics and pharmacodynamics of 150 mg levobupivacaine in patients with lower extremity surgery under ischial-femoral nerve block. Methods Forty patients with ASA Ⅰ-Ⅱ undergoing elective ankle arthroplasty were random Ly divided into two groups including levobupivacaine group（L group）, levobupivacaine combined with 1：200000 epinephrine group（LE group）, with 20 cases in each group. Under the guidance of ultrasound, the L group was treated with the sciatic nerve block and femoral nerve block by 15 m L 0.5% levobupivacaine（total 30 m L, 150 mg）. The LE group was treated with the sciatic nerve block and femoral nerve block by 0.5% levobupivacaine combined with 1： 200000 epinephrine of 15 m L（total 30 m L, 150 mg）.5 m L venous blood was collected immediately after the end of administration in the femoral nerve block and at 5, 15,30, 45, 60, 120, 180, 360, 720 min after the end of administration. The concentration of levobupivacaine in plasma at each time point was detected by gas chromatography-mass spectrometry（GC-MS）. Pharmacokinetic parameters were calculated using Kinetica 4.4.1 drug and statistical software. The onset and duration of nerve block was evaluated. Results At 15 and 30 minutes, the levobupivacaine concentration in LE group was lower than that in L group（ P〈0.05）. The peak plasma concentration of levobupivacaine in LE group was lower than that in L group（P〈0.01）. There was no significant difference in the other pharmacokinetic parameters between the two groups（P〈0.05）. There was no significant difference in the onset time and the maintenance time of nerve block between the two groups（P〈0.05）. Conclusion Epinephrine can reduce Cmax of plasma levobupivacaine in 150 mg levobupivacaine-induced ischial-femoral nerve block, but has no effect on the onset and maintenance of nerve block.