Baranowski A P, Dean Y, Pither C E
Department of Physiology, St. Thomas' Hospital, London.
Anaesthesia. 1991 Dec;46(12):1023-9. doi: 10.1111/j.1365-2044.1991.tb09914.x.
Twenty-four patients receiving epidural anaesthesia were studied to test the hypothesis that 1:200,000 adrenaline administered into the epidural space 5 minutes before 20 ml bupivacaine 0.5% would improve nerve block and delay systemic absorption of the local anaesthetic. Group A/B received 20 ml adrenaline 1:200,000 5 minutes before 20 ml bupivacaine 0.5%, group S/BA 20 ml saline followed by 20 ml bupivacaine 0.5% with 100 micrograms adrenaline, and group S/B saline 20 ml followed by 20 ml plain bupivacaine 0.5%. Mean maximum plasma concentrations of bupivacaine tended to be lower in the adrenaline groups. A delay in the time to peak plasma concentration of bupivacaine was noted in the A/B group; this indicated that priming with adrenaline may be effective at delaying early systemic uptake of the local anaesthetic. In both adrenaline groups a more prolonged epidural block and increased efficacy were noted, although this was only significant for the duration of block at T6 (p = 0.023) and duration of motor block at Bromage level 1 (p = 0.016) in group A/B. There seems little clinical advantage in administering adrenaline 5 minutes before bupivacaine.
对24例接受硬膜外麻醉的患者进行了研究，以验证以下假设：在注射20毫升0.5%布比卡因前5分钟，向硬膜外腔注入1:200,000的肾上腺素，会改善神经阻滞并延迟局部麻醉药的全身吸收。A/B组在注射20毫升0.5%布比卡因前5分钟接受20毫升1:200,000的肾上腺素；S/BA组先注射20毫升生理盐水，然后注射含100微克肾上腺素的20毫升0.5%布比卡因；S/B组先注射20毫升生理盐水，然后注射20毫升单纯的0.5%布比卡因。布比卡因的平均最大血浆浓度在肾上腺素组中往往较低。在A/B组中，布比卡因达到血浆峰浓度的时间有所延迟；这表明预先使用肾上腺素可能有效延迟局部麻醉药的早期全身吸收。在两个肾上腺素组中，均观察到硬膜外阻滞时间延长且效果增强，尽管这仅在A/B组中T6节段的阻滞持续时间（p = 0.023）和布罗玛分级1级的运动阻滞持续时间（p = 0.016）方面具有统计学意义。在布比卡因前5分钟给予肾上腺素似乎没有什么临床优势。
