UOC Anesthesia and Intensiva Care Unit, Padua University Hospital, Padova, Italy
Department of Medicine, DIMED, Università degli Studi di Padova, Padova, Italy.
Reg Anesth Pain Med. 2021 Jan;46(1):86-89. doi: 10.1136/rapm-2020-101718. Epub 2020 Aug 31.
Erector spinae plane (ESP) block is an emerging interfascial block with a wide range of indications for perioperative analgesia and chronic pain treatment. Recent studies have focused their attention on mechanisms of action of ESP block. However, the pharmacokinetics of drugs injected in ESP is, as of now, uninvestigated. The aim of this brief report is to investigate the pharmacokinetics of lidocaine in a series of 10 patients.
We are reporting a case series of 10 patients undergoing bilateral ESP block for multilevel lumbar spine surgery.ESP was performed with 3.5 mg/kg of lidocaine based on ideal body weight. Lidocaine concentration was dosed at 5, 15, 30 min and at 1, 2 and 3 hours.
T was 5 min for all the patients. C ranged from 1.2 to 3.8 mg/L (mean: 2.59 mg/L). AUC was high (76%, on average) suggesting an almost complete bioavailability. Age had a negative correlation with T½ of lidocaine.
Lidocaine pharmacokinetic after ESP block is well-described by a two-compartment model with a rapid and extensive rate of absorption. Nevertheless, its peak concentrations never exceeded the accepted toxicity limit. Elimination half-life was slightly prolonged, probably due to the advanced age of some patients.
竖脊肌平面（ESP）阻滞是一种新兴的筋膜间阻滞技术，具有广泛的围术期镇痛和慢性疼痛治疗适应证。最近的研究集中在 ESP 阻滞的作用机制上。然而，到目前为止，ESP 中注射药物的药代动力学尚未得到研究。本简要报告的目的是研究 10 例患者中利多卡因的药代动力学。
我们报告了 10 例接受双侧 ESP 阻滞行多节段腰椎手术的患者的病例系列。根据理想体重，ESP 中注射 3.5mg/kg 的利多卡因。利多卡因浓度在 5、15、30 分钟和 1、2 和 3 小时时进行剂量测定。
所有患者的 T 均为 5 分钟。C 范围为 1.2 至 3.8mg/L（平均值：2.59mg/L）。AUC 较高（平均为 76%），提示几乎完全的生物利用度。年龄与利多卡因的 T½呈负相关。
ESP 阻滞后利多卡因的药代动力学通过双室模型得到很好的描述，具有快速和广泛的吸收速率。然而，其峰值浓度从未超过可接受的毒性限度。消除半衰期略有延长，可能是由于部分患者年龄较大。
