局部麻醉药浓度对人体皮肤毛细血管血流的影响。

Effect of local anesthetic concentration on capillary blood flow in human skin.

作者信息

Guinard J P, Carpenter R L, Morell R C

机构信息

Service d'Anesthesiologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

出版信息

Reg Anesth. 1992 Nov-Dec;17(6):317-21.

PMID:1286052

Abstract

OBJECTIVES

The objective of this study was to evaluate and compare the effect of lidocaine, mepivacaine, and bupivacaine on capillary blood flow in humans over therapeutic and subtherapeutic concentrations.

METHODS

The effect of each treatment in eight unmedicated male volunteers was measured in a randomized, controlled, double-blind comparison. Each participant received subcutaneous injections (total, 14), at separate sites on the abdomen, consisting of 0.2 ml lidocaine (0.05%, 0.5%, 1%, and 2%), mepivacaine (0.05%, 0.5%, 1%, and 2%), bupivacaine (0.025%, 0.25%, 0.5%, and 0.75%), saline, or saline with epinephrine (5 micrograms/ml), and at an additional site a needle stick was performed and no injection made. Cutaneous blood flow was measured with a laser Doppler capillary perfusion monitor before and for 60 minutes after these interventions.

RESULTS

The maximum increase in cutaneous blood flow was 277 +/- 141% to 511 +/- 136% (mean +/- SE) after lidocaine, 124 +/- 110% to 316 +/- 155% after mepivacaine, and 242 +/- 193% to 725 +/- 198% after bupivacaine. The increase in blood flow depended on local anesthetic concentration: low concentrations induced minimal changes, whereas higher concentrations caused great increases in cutaneous blood flow. Injection of saline or needle stick alone increased cutaneous blood flow 285 +/- 237% and 260 +/- 121%, respectively.

CONCLUSIONS

Our findings indicate that the trauma of needle stick or saline injection produces a significant increase in cutaneous capillary blood flow. Injection of clinically useful concentrations of bupivacaine and lidocaine produced even greater increases in capillary blood flow, indicating a vasodilatory effect. Injection of the lowest concentrations of lidocaine and bupivacaine caused flow to increase to a magnitude similar to that after injection of saline. In contrast, clinically useful concentrations of mepivacaine do not increase capillary blood flow to a greater extent than saline, and lower concentrations tend to blunt the increase in blood flow, indicating a mild vasoconstrictor effect.

摘要

目的

本研究的目的是评估和比较利多卡因、甲哌卡因和布比卡因在治疗浓度和亚治疗浓度下对人体毛细血管血流的影响。

方法

在8名未用药的男性志愿者中，通过随机、对照、双盲比较来测量每种治疗方法的效果。每位参与者在腹部不同部位接受皮下注射（共14次），注射药物包括0.2毫升利多卡因（0.05%、0.5%、1%和2%）、甲哌卡因（0.05%、0.5%、1%和2%）、布比卡因（0.025%、0.25%、0.5%和0.75%）、生理盐水或含肾上腺素（5微克/毫升）的生理盐水，在另一个部位进行针刺但不注射。在这些干预前后，使用激光多普勒毛细血管灌注监测仪测量皮肤血流。

结果

利多卡因注射后皮肤血流最大增加幅度为277±141%至511±136%（平均值±标准误），甲哌卡因注射后为124±110%至316±155%，布比卡因注射后为242±193%至725±198%。血流增加取决于局部麻醉剂浓度：低浓度引起的变化最小，而高浓度导致皮肤血流大幅增加。单独注射生理盐水或针刺分别使皮肤血流增加285±237%和260±121%。

结论

我们的研究结果表明，针刺或注射生理盐水的创伤会使皮肤毛细血管血流显著增加。注射临床常用浓度的布比卡因和利多卡因会使毛细血管血流增加得更多，表明有血管舒张作用。注射最低浓度的利多卡因和布比卡因会使血流增加到与注射生理盐水后相似的程度。相比之下，临床常用浓度的甲哌卡因不会比生理盐水更大程度地增加毛细血管血流，较低浓度往往会抑制血流增加，表明有轻微的血管收缩作用。