Schnorr C, Menges T, Hempelmann G
Abteilung Anästhesiologie und Operative Intensivmedizin am Klinikum der Justus-Liebig-Universität Giessen.
Anasth Intensivther Notfallmed. 1990 Jun;25(3):193-7.
The use of local anaesthetic mixtures in regional anaesthesia has been discussed controversially. This assumption led us to conduct an inquiry on anaesthesiologist opinion on local anaesthetic mixtures. The study was performed on 131 anaesthesiologists answering a questionnaire. It was asked how often and how many procedures of regional anaesthesia were performed, whether local anaesthetic mixtures were used or not, and what were the most common mixtures. Other questions were in what kind of regional anaesthesia mixtures were applied, and which causes led to the use of local anaesthetic mixtures. Local anaesthetic mixtures were used by 70.2% of the anaesthesiologists who responded. Generally, however, parent components were preferred (88.3%). The types of regional anaesthesia in which mixtures were applied, were blockades of plexus brachialis (50.4%), spinal anaesthesia (29.0%), and epidural anaesthesia (28.4%). Locally applied anaesthetic mixtures - in 40.5% a mixture of bupivacaine and prilocaine and in 38.2% a mixture of bupivacaine and mepivacaine - were used in 58.0% because of their short latency and their long duration. In 27.5% the reply was that the anaesthesiologists used such combinations since in these the maximal doses of the parent components were not exceeded. In 22.9% it was argued that mixtures were less toxic than the parent components. On the other hand, the application of local anaesthetic mixtures was rejected because of their unpredictable effect (33.6%), and also to avoid local anaesthetic interactions (13.7%). The results of the inquiry demonstrate that the use of local anaesthetic mixtures in regional anaesthesia is common practice. However, mixing local anaesthetics may produce unpredictable interactions. We conclude that mixtures of local anaesthetics should be used only in exceptional cases.
局部麻醉混合剂在区域麻醉中的应用一直存在争议。这一假设促使我们对麻醉医生关于局部麻醉混合剂的看法进行调查。该研究对131名回答问卷的麻醉医生进行。问卷询问了他们进行区域麻醉的频率和手术数量、是否使用局部麻醉混合剂以及最常用的混合剂是什么。其他问题包括在何种区域麻醉中应用混合剂以及使用局部麻醉混合剂的原因。70.2%的回复麻醉医生使用局部麻醉混合剂。然而，总体而言，更倾向于使用单一成分（88.3%）。应用混合剂的区域麻醉类型有臂丛神经阻滞（50.4%）、脊髓麻醉（29.0%）和硬膜外麻醉（28.4%）。58.0%的情况是局部应用的麻醉混合剂——40.5%为布比卡因和丙胺卡因的混合剂，38.2%为布比卡因和甲哌卡因的混合剂——因其起效时间短和持续时间长而被使用。27.5%的回复称麻醉医生使用此类混合剂是因为其中单一成分的最大剂量未被超过。22.9%的人认为混合剂的毒性低于单一成分。另一方面，23.6%的人拒绝使用局部麻醉混合剂是因为其效果不可预测，还有13.7%是为了避免局部麻醉药相互作用。调查结果表明，局部麻醉混合剂在区域麻醉中的应用很普遍。然而，混合局部麻醉药可能会产生不可预测的相互作用。我们得出结论，局部麻醉药混合剂仅应在特殊情况下使用。
