Johnson M D, Mickler T, Arthur G R, Rosenburg S, Wilson R
Department of Anesthesia, Massachusetts General Hospital, Boston.
J Cardiothorac Anesth. 1990 Apr;4(2):200-3. doi: 10.1016/0888-6296(90)90238-b.
In a double-blinded study, 15 American Society of Anesthesiologists class I or II patients, following lateral thoracotomy with general anesthesia, were randomized into two groups for intercostal nerve block with either bupivacaine, 0.5%, and epinephrine, 1:200,000, or plain bupivacaine, 0.5%. Blood concentrations of bupivacaine, epinephrine, and norepinephrine were serially measured. Blood pressure, heart rate, respiratory rate, temperature, and electrocardiogram were monitored. Peak blood bupivacaine concentrations were significantly lower in patients receiving bupivacaine with epinephrine. Peak epinephrine concentrations were significantly greater in patients receiving bupivacaine with epinephrine, but still within a safe range. No significant differences were seen in heart rate, blood pressure, respiratory rate, or temperature between the two groups, and/no dysrhythmias occurred. Peak norepinephrine concentrations were not significantly different between the two groups. The potential risk of toxic bupivacaine blood concentrations associated with intercostal nerve blocks can be reduced by the addition of epinephrine at a concentration of 1:200,000.
在一项双盲研究中，15例美国麻醉医师协会I级或II级患者，在全身麻醉下行侧胸壁切开术后，被随机分为两组，分别用0.5%布比卡因加1:200,000肾上腺素或单纯0.5%布比卡因进行肋间神经阻滞。连续测量布比卡因、肾上腺素和去甲肾上腺素的血药浓度。监测血压、心率、呼吸频率、体温和心电图。接受布比卡因加肾上腺素的患者血布比卡因峰值浓度显著较低。接受布比卡因加肾上腺素的患者肾上腺素峰值浓度显著较高，但仍在安全范围内。两组间心率、血压、呼吸频率或体温无显著差异，也未发生心律失常。两组间去甲肾上腺素峰值浓度无显著差异。肋间神经阻滞相关的布比卡因血药浓度中毒潜在风险可通过添加浓度为1:200,000的肾上腺素来降低。
