Wiedemann D, Mühlnickel B, Staroske E, Neumann W, Röse W
Department of Anaesthesiology and Critical Care Medicine, Otto von Guericke University, Magdeburg, Germany.
Br J Anaesth. 2000 Dec;85(6):830-5. doi: 10.1093/bja/85.6.830.
The pharmacokinetics of ropivacaine were evaluated during long-term continuous epidural analgesia (CEDA) for about 120 h. The total and free plasma concentrations of ropivacaine and the alpha1-acid glycoprotein (AAG) concentration were measured in 12 patients after total knee arthroplasty. The infusion rate was adjusted according to patients' analgesic needs or side effects. The mean (SD) rate of infusion of ropivacaine (Naropin 2 mg ml(-1)) was 14.6 (3.2) mg h(-1) on the day of surgery and was increased after surgery to 15.4 (4.4) mg h(-1) on days 1-5. This was equivalent to an absolute dose of 1786 (553) mg of ropivacaine over the entire infusion period. After an initial increase, the mean free ropivacaine plasma concentration nearly plateaued and than decreased slightly after approximately 70 h. The individual peak free plasma concentration was 0.096 (0.034) microg ml(-1). The highest individual free plasma concentration was 0.16 microg ml(-1). The individual peak total plasma concentration, 4.1 (1.2) microg ml(-1), was achieved after 67.7 (16.5) h, although the AAG concentration increased throughout the observation period. Our data support the safety and efficacy of long-term ropivacaine CEDA.
在为期约120小时的长期连续硬膜外镇痛（CEDA）期间，对罗哌卡因的药代动力学进行了评估。在12例全膝关节置换术后的患者中，测量了罗哌卡因的总血浆浓度和游离血浆浓度以及α1-酸性糖蛋白（AAG）浓度。根据患者的镇痛需求或副作用调整输注速率。手术当天，罗哌卡因（耐乐品2 mg ml⁻¹）的平均（标准差）输注速率为14.6（3.2）mg h⁻¹，术后1 - 5天增加至15.4（4.4）mg h⁻¹。这相当于在整个输注期间罗哌卡因的绝对剂量为1786（553）mg。在最初升高后，游离罗哌卡因的平均血浆浓度几乎达到平稳状态，然后在约70小时后略有下降。个体游离血浆浓度峰值为0.096（0.034）μg ml⁻¹。个体游离血浆浓度最高值为0.16 μg ml⁻¹。尽管在整个观察期内AAG浓度升高，但个体总血浆浓度峰值在67.7（16.5）小时后达到4.1（1.2）μg ml⁻¹。我们的数据支持长期罗哌卡因CEDA的安全性和有效性。
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