0.5%罗哌卡因用于区域麻醉下腹股沟疝修补术的临床效用、安全性及血浆浓度

Clinical usefulness, safety, and plasma concentration of ropivacaine 0.5% for inguinal hernia repair in regional anesthesia.

作者信息

Wulf H, Behnke H, Vogel I, Schröder J

机构信息

Department of Anesthesiology and Critical Care Medicine, Hospital of the Philipps-University, Marburg, Germany.

出版信息

Reg Anesth Pain Med. 2001 Jul-Aug;26(4):348-51. doi: 10.1053/rapm.2001.23208.

DOI:10.1053/rapm.2001.23208

PMID:11464355

Abstract

BACKGROUND AND OBJECTIVE

The aim of this study was to evaluate the pharmacokinetics, feasibility, and clinical effects of ropivacaine in regional anesthesia (ilioinguinal-iliohypogastric blocks [IIB], genitofemoral block plus local infiltration) for inguinal hernia repair.

METHODS

Following ethics committee approval and informed consent, 21 male adults received 60 mL ropivacaine 0.5% (without vasoconstrictor). In 11 patients, further injections of 5 to 10 mL were given while preparing the hernial sack. Plasma concentration of ropivacaine was determined in venous blood after 10, 20, 30, 45, 60, 90, 120, and 300 minutes using reversed-phase high pressure liquid chromatography (HPLC).

RESULTS

Peak plasma concentrations of ropivacaine were 1.5 +/- 0.6 (0.7 to 2.6) microg/mL (mean +/- SD [range]). These maximum concentrations occurred after 45 (30 to 60) minutes (median [range]). No signs of central nervous or cardiovascular toxicity were observed. Twelve of 21 patients did not need any additional analgesics within 24 hours postoperatively. One patient had a femoral motor block lasting 6 hours, 5 patients reported sensory femoral block lasting 5 to 12 hours. Patients, as well as the surgeon, were very satisfied with the procedure, and all patients stated that they would like to have it performed again that way in case of an inguinal hernia on the opposite side.

CONCLUSION

A ropivacaine dose of 60 to 70 mL of 0.5% appears adequate for regional anesthesia for inguinal hernia repair regarding conditions for surgery, safety, ambulation, and postoperative pain relief.

摘要

背景与目的

本研究旨在评估罗哌卡因用于腹股沟疝修补区域麻醉（髂腹股沟 - 髂腹下神经阻滞[IIB]、生殖股神经阻滞加局部浸润）时的药代动力学、可行性及临床效果。

方法

经伦理委员会批准并获得知情同意后，21名成年男性接受了60 mL 0.5%罗哌卡因（不含血管收缩剂）。11名患者在准备疝囊时额外注射了5至10 mL。使用反相高压液相色谱法（HPLC）在10、20、30、45、60、90、120和300分钟后测定静脉血中罗哌卡因的血浆浓度。

结果

罗哌卡因的血浆峰值浓度为1.5±0.6（0.7至2.6）μg/mL（平均值±标准差[范围]）。这些最高浓度出现在45（30至60）分钟后（中位数[范围]）。未观察到中枢神经或心血管毒性迹象。21名患者中有12名在术后24小时内不需要任何额外的镇痛药。1名患者出现股神经运动阻滞持续6小时，5名患者报告股神经感觉阻滞持续5至12小时。患者和外科医生对该操作都非常满意，所有患者均表示若对侧发生腹股沟疝，希望再次采用这种方式进行手术。