Schubert Ann-Kristin, Müller Stefan, Wulf Hinnerk, Steinfeldt Thorsten, Wiesmann Thomas
Department of Anesthesiology and Intensive Care Medicine, University Hospital Marburg, Philipps University of Marburg, Marburg, Germany.
Department of Anesthesiology and Intensive Care Medicine, Diakoniekrankenhaus Schwäbisch Hall, Schwäbisch Hall, Germany.
Local Reg Anesth. 2019 Aug 29;12:71-80. doi: 10.2147/LRA.S203569. eCollection 2019.
Skeletal muscle microvascular blood flow plays a critical role in many myopathologies. The influence of bupivacaine and adjuvants on skeletal muscle microvascular perfusion and tissue oximetry is poorly understood but might be a relevant risk factor for myopathies after local anesthetic administration. The aim of this experimental study was to determine the effects of bupivacaine alone or in combination with epinephrine or clonidine on skeletal muscle perfusion and tissue oximetry.
Combined tissue spectrophotometry and Laser-Doppler flowmetry and tissue oximetry were used to assess local muscle blood flow in anesthetized pigs after topical administration of test solutions (bupivacaine, bupivacaine with epinephrine or clonidine, saline). Measurements were performed for up to 60 mins.
The application of bupivacaine alone did not alter relative muscle blood flow significantly, whereas the addition of epinephrine or clonidine to bupivacaine resulted in a significant reduction of relative muscle blood flow at T30 and T60. However, bupivacaine resulted in a significant decrease of tissue oximetry values when compared to saline control group at T30 and T60. The application of bupivacaine combined with clonidine or epinephrine resulted in no significant reduction of tissue oximetry when compared to bupivacaine alone.
Bupivacaine alone results in a significant decrease of tissue oximetry in skeletal muscle which is not increased by the addition of epinephrine or clonidine despite further reductions of microcirculatory perfusion. Overall, bupivacaine alone or with adjuvants does produce local muscle ischemia for which pathological consequences need to be addressed in further studies.
骨骼肌微血管血流在许多肌病中起关键作用。布比卡因和佐剂对骨骼肌微血管灌注和组织血氧饱和度的影响尚不清楚，但可能是局部麻醉药给药后发生肌病的一个相关危险因素。本实验研究的目的是确定单独使用布比卡因或与肾上腺素或可乐定联合使用对骨骼肌灌注和组织血氧饱和度的影响。
在给麻醉猪局部应用测试溶液（布比卡因、含肾上腺素或可乐定的布比卡因、生理盐水）后，采用联合组织分光光度法、激光多普勒血流仪和组织血氧饱和度测定法评估局部肌肉血流。测量持续60分钟。
单独应用布比卡因对相对肌肉血流无显著影响，而在布比卡因中加入肾上腺素或可乐定导致在T30和T60时相对肌肉血流显著降低。然而，与生理盐水对照组相比，布比卡因在T30和T60时导致组织血氧饱和度值显著降低。与单独使用布比卡因相比，布比卡因与可乐定或肾上腺素联合应用导致组织血氧饱和度无显著降低。
单独使用布比卡因可导致骨骼肌组织血氧饱和度显著降低，尽管微循环灌注进一步降低，但加入肾上腺素或可乐定并不会使其升高。总体而言，单独使用布比卡因或与佐剂联合使用确实会产生局部肌肉缺血，其病理后果需要在进一步研究中加以探讨。
