Prien T, Goeters C
Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin der Westfälischen Wilhelms-Universität Münster.
Anasth Intensivther Notfallmed. 1990 Feb;25(1):59-63.
Quality of anaesthesia and risk of intoxication are competing principles in IVRA. To evaluate the optimal prilocaine concentration with injection of 40 ml, 300 patients were randomly allocated to receive either a 0.5 (PRI 0.5), 0.75 (PRI 0.5) or a 1.0 (PRI 1.0) per cent solution. Using PRI 0.5, fifteen patients required supplementary fentanyl, with PRI 0.75 one, and with PRI 1.0 two (p less than or equal to 0.05). General anaesthesia proved necessary in three patients of the PRI 0.5 and 0.75 groups, respectively, and in one patient of the PRI 1.0 group (NS). With PRI 1.0 seven patients had subjective signs of intoxication upon tourniquet release, with PRI 0.75 none, and with PRI 0.5 one (p less than or equal to 0.05). Objective symptoms of local anaesthetic toxicity were not observed. The incidence of tourniquet-related pain was 25-30% in all three groups and not related to the prilocaine concentration. In conclusion, with 40 ml injection volume the 0.75% solution of prilocaine offers the optimal relation between incidence of anaesthesia and risk of intoxication.
局部静脉麻醉中，麻醉质量和中毒风险是相互矛盾的原则。为评估注入40毫升时丙胺卡因的最佳浓度，将300例患者随机分为三组，分别接受0.5%（PRI 0.5）、0.75%（PRI 0.75）或1.0%（PRI 1.0）的丙胺卡因溶液。使用PRI 0.5时，15例患者需要追加芬太尼；使用PRI 0.75时，1例患者需要追加；使用PRI 1.0时，2例患者需要追加（p≤0.05）。PRI 0.5组和PRI 0.75组分别有3例患者、PRI 1.0组有1例患者需要全身麻醉（无显著性差异）。使用PRI 1.0时，7例患者在松开止血带时有中毒的主观症状；使用PRI 0.75时，无患者出现；使用PRI 0.5时，1例患者出现（p≤0.05）。未观察到局部麻醉药毒性的客观症状。三组中止血带相关疼痛的发生率均为25% - 30%，且与丙胺卡因浓度无关。总之，当注射量为40毫升时，0.75%的丙胺卡因溶液在麻醉发生率和中毒风险之间提供了最佳平衡。
