Costello T G, Cormack J R, Mather L E, LaFerlita B, Murphy M A, Harris K
Department of Anaesthesia, St Vincent's Hospital, Melbourne, Victoria, Australia.
Br J Anaesth. 2005 Jun;94(6):848-51. doi: 10.1093/bja/aei135. Epub 2005 Apr 7.
Levobupivacaine is an effective local anaesthetic agent for nerve blockade with less systemic toxicity than racemic bupivacaine. The safety and efficacy of levobupivacaine for scalp blockade during awake craniotomy have not been addressed previously.
Serial arterial plasma levobupivacaine concentrations following scalp blockade were measured to 2 h in 10 patients booked for awake craniotomy for epilepsy or tumour surgery. Bilateral scalp blockade providing surgical anaesthesia was achieved with a mean dose of 177 mg (2.5 mg kg(-1), range 1.6-3.2 mg kg(-1)) of levobupivacaine (0.5%, 5 mg ml(-1)) with epinephrine (5 microg ml(-1)) added immediately before the block insertion.
The maximum measured plasma levobupivacaine concentration was 1.58 (0.44) microg ml(-1) [mean (SD)] with a mean time to peak plasma concentration of 12 (4) min. There were no episodes in any of the 10 patients of symptoms or signs suggestive of either CNS or CVS toxicity.
This study demonstrated a relatively rapid rise of plasma levobupivacaine concentration without evidence of cardiovascular or central nervous system sequelae in a sample population of patients who may be particularly prone to perioperative seizures.
左旋布比卡因是一种有效的局部麻醉药，用于神经阻滞时全身毒性低于消旋布比卡因。左旋布比卡因用于清醒开颅手术时头皮阻滞的安全性和有效性此前尚未得到探讨。
对10例预定进行癫痫或肿瘤手术清醒开颅的患者，在头皮阻滞后2小时内连续测量动脉血浆左旋布比卡因浓度。在阻滞前立即加入肾上腺素（5μg/ml），使用平均剂量177mg（2.5mg/kg(-1)，范围1.6 - 3.2mg/kg(-1)）的左旋布比卡因（0.5%，5mg/ml）实现双侧头皮阻滞以提供手术麻醉。
测得的血浆左旋布比卡因最大浓度为1.58（0.44）μg/ml[均值（标准差）]，血浆浓度达峰平均时间为12（4）分钟。10例患者中无一例出现提示中枢神经系统或心血管系统毒性的症状或体征。
本研究表明，在可能特别容易发生围手术期癫痫的患者样本中，血浆左旋布比卡因浓度相对迅速升高，但无心血管或中枢神经系统后遗症的证据。
