Buettner J, Klose R, Hoppe U, Wresch P
Department of Anesthesiology and Intensive Care, Berufsgenossenschaftliche Unfallklinik, Federal Republic of Germany.
Reg Anesth. 1989 May-Jun;14(3):124-7.
In order to find out whether repeated doses of plain mepivacaine are appropriate for long-lasting microvascular surgery, a catheter-induced axillary plexus block was performed in 17 patients by using 400 mg of mepivacaine-HC1 every two hours. All patients underwent replantation surgery of one or more amputated fingers. Duration of operation varied from 8 to 24 hours. In all cases, there was adequate analgesia and muscle relaxation for the surgical procedure. Serum levels of mepivacaine were determined before, and 15 and 60 minute after the initial injection. With each following injection of mepivacaine, blood samples were taken at the same time schedule. Within the first eight hours, after four 400 mg doses of mepivacaine were given, all serum levels remained below the level of 5 to 6 micrograms/ml, which is said to be the lower level for mild cerebral toxic reactions in venous blood (blood/plasma distribution 0.92 +/- 0.04). After this time, when more than 1600 mg of mepivacaine had been administered, two patients exceeded the level of 6 micrograms/ml. The highest serum concentration observed in any of the patients was 7.0 micrograms/ml. This was 15 minutes after the 12th injection of 400 mg of mepivacaine and an overall dosage of 4800 mg. None of the patients showed evident signs of central nervous system or cardiovascular toxicity.
为了确定重复剂量的普通甲哌卡因是否适用于长时间的微血管手术，对17例患者进行了导管诱导的腋路臂丛神经阻滞，每两小时使用400mg盐酸甲哌卡因。所有患者均接受了一个或多个断指的再植手术。手术时间从8小时到24小时不等。在所有病例中，手术过程中均有足够的镇痛和肌肉松弛效果。在首次注射前、注射后15分钟和60分钟测定甲哌卡因的血清水平。每次后续注射甲哌卡因时，均按相同时间采集血样。在最初的八小时内，给予四次400mg剂量的甲哌卡因后，所有血清水平均保持在5至6微克/毫升以下，据说这是静脉血中轻度脑毒性反应的较低水平（血/浆分布为0.92±0.04）。在此之后，当给予超过1600mg甲哌卡因时，两名患者超过了6微克/毫升的水平。在任何患者中观察到的最高血清浓度为7.0微克/毫升。这是在第12次注射400mg甲哌卡因且总剂量为4800mg后15分钟。所有患者均未表现出明显的中枢神经系统或心血管毒性迹象。
