Snoeck M M J, Vree T B, Gielen M J M, Lagerwert A J
Department of Anesthesiology, Canisius Wilhelmina Hospital, Nijmegen, NL.
Int J Clin Pharmacol Ther. 2003 Mar;41(3):107-13. doi: 10.5414/cpp41107.
Fracture of the upper femur is a common injury in the elderly. Several anesthetic techniques exist for surgery of traumatic hip fracture. The aim of this investigation was to study plasma concentrations and safety of 2 mg/kg bupivacaine in a femoral "3-in-1" nerve block in patients older than 80 years of age.
A 3-in-1 femoral nerve block, combined with a general anesthetic was used in 10 elderly patients aged over 80 years. They were undergoing emergency surgery for stabilization of their fractured femur. Bupivacaine plasma concentrations of radial artery blood samples were assessed over a 6-hour period after a femoral 3-in-1 injection of 2 mg/kg bupivacaine 0.375% with epinephrine (1:400,000).
No toxic reactions to bupivacaine were seen. In 8 of the 10 patients per- and postoperative analgesia were adequate as a result of the nerve block. Patients experienced loss of sensation and analgesia for 26.6 +/- 4.6 hours (mean +/- SD). This was inversely related to the apparent steady state concentration of bupivacaine. The mean of the individual peak plasma concentrations of bupivacaine (C(max) was 0.74+/- 0.64 microg/ml. The highest plasma concentration was 1.83 microg/ml. Large variations in plasma concentrations were detected in these patients. Bupivacaine metabolites were not detected.
A femoral 3-in-1 nerve block, using 2 mg/kg bupivacaine with epinephrine, provides prolonged pain reliefwithout local anesthetic toxicity in elderly patients. It is a satisfactory supplementary analgesic technique for hip and knee surgery in the elderly.
股骨上段骨折是老年人的常见损伤。创伤性髋部骨折手术有多种麻醉技术。本研究的目的是研究80岁以上患者在股神经“三合一”阻滞中使用2mg/kg布比卡因时的血浆浓度及安全性。
10例80岁以上老年患者采用股神经“三合一”阻滞联合全身麻醉。他们正在接受急诊手术以固定股骨骨折。在股神经“三合一”注射2mg/kg 0.375%布比卡因加肾上腺素（1:400,000）后6小时内评估桡动脉血样中的布比卡因血浆浓度。
未观察到对布比卡因的毒性反应。10例患者中有8例因神经阻滞术，术中和术后镇痛效果良好。患者感觉丧失和镇痛时间为26.6±4.6小时（平均值±标准差）。这与布比卡因的表观稳态浓度呈负相关。布比卡因的个体血浆峰值浓度平均值（C(max)）为0.74±0.64μg/ml。最高血浆浓度为1.83μg/ml。在这些患者中检测到血浆浓度有很大差异。未检测到布比卡因代谢产物。
使用2mg/kg布比卡因加肾上腺素的股神经“三合一”阻滞可为老年患者提供持久的疼痛缓解且无局部麻醉药毒性。它是老年患者髋部和膝部手术令人满意的辅助镇痛技术。
