相同剂量不同浓度罗哌卡因对腰丛-坐骨神经阻滞的临床疗效及药代动力学研究

[Clinical efficacy and pharmacokinetics of different concentrations of ropivacaine with the same dosage on blocking lumbar plexus with sciatic nerves].

作者信息

Xu Hong-wei, Zhang Lan, Cao Wei, Zhang Xiang, Zhang Wen-sheng

机构信息

Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China.

出版信息

Sichuan Da Xue Xue Bao Yi Xue Ban. 2009 May;40(3):495-8.

PMID:19627013

Abstract

OBJECTIVE

To test the clinical efficacy and pharmacokinetics of different concentrations of ropivacaine with the same dosage on blocking lumbar plexus with sciatic nerves.

METHODS

Written informed consents from 60 ASA I or II patients scheduled for unilateral lower-extremity surgery were obtained. The patients were randomly divided into two groups (n=30 each). Group A received 60 mL (lumbar-plexus 36 mL, sciatic nerve 24 mL) of 0.3% ropivacaine. Group B received 45 mL (lumbar-plexus 27 mL, sciatic nerve 18 mL) of 0.4% ropivacaine. Sensory and motor functions were evaluated at 2, 5, 10, 15, 20, 25, 30, and 35 minutes after drug injection. The duration of nerve blockade were recorded. Blood samples were randomly taken from 24 patients (12 for each group) for testing plasma ropivacine levels at 5, 15, 25, 35, 45, 60, 90, and 120 minutes after drug injection. The total plasma ropivacaine were determined by HPLC. The pharmacokinetic parameters were calculated using computer program DAS ver 2.0.

RESULTS

The onset time of nerve blockade in the two groups showed no difference. The length of blockade by ropivacaine in group A was shorter than in group B. The patients in group A had higher scores of sensory than the patients in group B. But group A had lower percentage of patients with > or = 2 Bromage scales than group B. The main pharmacokinetic parameters in group A and B were: Cmax (3.17 +/- 1.24) mg/L and (2.40 +/- 0.72) mg/L; tmax (25 +/- 12.3) min and (29 +/- 11.4) min, AUC(0-infinity) (248 +/- 45) mg/(L x min) and (215 +/- 56) mg/(L x min); t1/2alpha (25.5 +/- 9.5) min and (37.0 +/- 12.9) min; t1/2beta (208 +/- 89.0) min and (215 +/- 95.8) min, respectively.

CONCLUSION

With the same dosage, ropivacaine, in a lower concentration achieves better insensate. The plasma concentration-time curve for ropivacaine fits into a two-compartment pharmacokinetic model. The larger volume of ropivacain produces greater Cmax, and AUC(0-infinity) than the lower volume of ropivacain with the same dosage.

摘要

目的

测试相同剂量不同浓度的罗哌卡因在腰丛联合坐骨神经阻滞中的临床疗效及药代动力学。

方法

选取60例拟行单侧下肢手术的ASA I或II级患者，获取其书面知情同意书。将患者随机分为两组（每组n = 30）。A组接受60 mL（腰丛36 mL，坐骨神经24 mL）0.3%的罗哌卡因。B组接受45 mL（腰丛27 mL，坐骨神经18 mL）0.4%的罗哌卡因。在注药后2、5、10、15、20、25、30和35分钟评估感觉和运动功能。记录神经阻滞持续时间。随机抽取24例患者（每组12例）的血样，于注药后5、15、25、35、45、60、90和120分钟检测血浆罗哌卡因水平。采用高效液相色谱法测定血浆总罗哌卡因浓度。使用计算机程序DAS ver 2.0计算药代动力学参数。

结果

两组神经阻滞起效时间无差异。A组罗哌卡因的阻滞时间短于B组。A组患者的感觉评分高于B组。但A组 Bromage评分≥2级的患者百分比低于B组。A组和B组的主要药代动力学参数分别为：Cmax（3.17±1.24）mg/L和（2.40±0.72）mg/L；tmax（25±12.3）分钟和（29±11.4）分钟，AUC(0 - ∞)（248±45）mg/(L·min)和（215±56）mg/(L·min)；t1/2α（25.5±9.5）分钟和（37.0±12.9）分钟；t1/2β（208±89.0）分钟和（215±95.8）分钟。