Université Paris-Sud, Laboratoire d'Anesthesie, INSERM U788, Departement d'anesthesie, 78 av du general leclerc, F-94276 Le Kremlin Bicêtre, France.
Anesth Analg. 2011 Sep;113(3):617-25. doi: 10.1213/ANE.0b013e31821f108a. Epub 2011 May 19.
To further explain the mechanisms of action involved in the analgesic effect of a local anesthetic wound infusion, we evaluated parietal and visceral sensitivity as well as indices of inflammation after laparotomy and administration of a local anesthetic. Ropivacaine was administered at different dosages by a continuous infusion using a multiholed catheter in the preperitoneal position or systemically in rats.
Nine groups of rats received 2 injections after laparotomy or sham surgery: (1) a bolus injection (ropivacaine or saline) via a preperitoneal catheter and (2) an IM injection (IM) (ropivacaine or saline). These injections were followed by a continuous infusion (ropivacaine or saline) in the preperitoneal catheter for 24 hours and 1 IM injection every 8 hours. Mechanical and visceral thresholds after stimulation were evaluated 3 times during the 48 hours after surgery. Stimulated production of tumor necrosis factor α, and interleukin 1β in whole-blood cultures were measured by enzyme-linked immunosorbent assay. The ropivacaine plasma concentration was measured by gas chromatography.
Preperitoneal infusion of high doses of ropivacaine and systemic ropivacaine similarly prevented mechanical and visceral sensitivity alterations and led to a better functional recovery. The analgesic effect of systemic administration was associated with an anti-inflammatory effect.
In the current study, high-dose ropivacaine administered via a preperitoneal infusion or systemic boluses had the same effect on mechanical and visceral sensitivity after laparotomy. Moreover, systemic administration was associated with an anti-inflammatory effect. The merits of the comparable benefit of systemic and high-dose preperitoneal infusion of ropivacaine need to be confirmed with further studies.
为了进一步解释局部麻醉剂伤口输注的镇痛作用的作用机制，我们评估了剖腹手术后壁和内脏敏感性以及炎症指标，并给予局部麻醉剂。在剖腹手术或假手术后，通过多孔预腹膜导管或全身给予不同剂量的罗哌卡因进行连续输注。
9 组大鼠接受 2 次注射：（1）通过预腹膜导管进行单次注射（罗哌卡因或生理盐水）和（2）IM 注射（罗哌卡因或生理盐水）。这些注射后，通过预腹膜导管进行 24 小时持续输注和每 8 小时进行 1 次 IM 注射。术后 48 小时内，3 次评估机械和内脏刺激后的阈值。通过酶联免疫吸附试验测量全血培养物中肿瘤坏死因子-α和白细胞介素 1β的刺激产生。通过气相色谱法测量罗哌卡因的血浆浓度。
高剂量罗哌卡因的预腹膜输注和全身罗哌卡因输注均相似地预防了机械和内脏敏感性改变，并导致更好的功能恢复。全身给药的镇痛作用与抗炎作用有关。
在本研究中，通过预腹膜输注或全身推注给予高剂量罗哌卡因对剖腹手术后的机械和内脏敏感性具有相同的作用。此外，全身给药与抗炎作用有关。全身和高剂量预腹膜输注罗哌卡因的等效益处的优点需要进一步研究来证实。
