Almasi Robert, Rezman Barbara, Kriszta Zsofia, Patczai Balazs, Wiegand Norbert, Bogar Lajos
Department of Anesthesiology and Intensive Care, University of Pecs Medical School, 7624, Pécs Ifjuság u.13, Hungary.
Department of Traumatology and Hand Surgery, University of Pecs Medical School, 7624, Pécs Ifjuság u.13, Hungary.
Heliyon. 2020 Sep 2;6(9):e04718. doi: 10.1016/j.heliyon.2020.e04718. eCollection 2020 Sep.
Visualization of the nerve structures of brachial plexus allows anesthesiologists to use a lower dose of local anesthetics. The content of this low dose is not unequivocal, consequently, the pharmacokinetics of local anesthetics used by various authors are difficult to compare. In this study, the onset times and duration of the analgesic effect of local anesthetic mixture solutions used for brachial plexus blocks are investigated and the quality of anesthesia is compared. 85 unpremedicated American Society of Anesthesiologist physical status I-III, 19-83-year-old patients scheduled for upper limb trauma surgery are assigned to four groups for the axillary-supraclavicular block with lidocaine 1% and bupivacaine 0,5% 1:1 mixture (Group LB) or bupivacaine 0.33% (Group BS) or lidocaine 0,66% (Group LS) or bupivacaine 0.5% and lidocaine 1% 2:1 mixture (Group BL). 0.4 ml/kg was administered to the four groups. The onset time was significantly shorter in the lidocaine group (LS 13.0 ± 1.02) than in the other study groups (LB 16.64 ± 0.89; BS 17.21 ± 0.74; BL 16.92 ± 0.51 min ±SEM, p = 0.002). No differences were observed in the onset times between LB, BS, and BL groups (p > 0.05). Statistical differences were found in the duration of local anesthetics between LB (392.9 ± 20.4), BS (546.4 ± 14.9), LS (172.85 ± 7.8), and BL (458.7 ± 11.9 min ±SEM, p = 0.001). Lidocaine does not shorten the onset times, but significantly decreases the duration of action of bupivacaine when used in mixture solutions. Lidocaine exhibits a good quality of block in the applied dose, while other solutions have excellent quality. Bupivacaine without lidocaine has the longest duration of action to achieve the longest postoperative analgesia.
可视化臂丛神经结构可使麻醉医生使用更低剂量的局部麻醉药。然而，这一低剂量的具体含量并不明确，因此，不同作者所使用的局部麻醉药的药代动力学难以进行比较。在本研究中，对用于臂丛神经阻滞的局部麻醉混合溶液的起效时间和镇痛效果持续时间进行了研究，并比较了麻醉质量。将85例未使用术前药、美国麻醉医师协会身体状况分级为I - III级、年龄在19 - 83岁、计划进行上肢创伤手术的患者分为四组，分别接受1%利多卡因和0.5%布比卡因1:1混合液（LB组）、0.33%布比卡因（BS组）、0.66%利多卡因（LS组）或0.5%布比卡因和1%利多卡因2:1混合液（BL组）进行腋 - 锁骨上阻滞。四组均给予0.4 ml/kg的药物。利多卡因组（LS组，13.0 ± 1.02）的起效时间明显短于其他研究组（LB组，16.64 ± 0.89；BS组，17.21 ± 0.74；BL组，16.92 ± 0.51分钟±标准误，p = 0.002）。LB组、BS组和BL组之间的起效时间未观察到差异（p > 0.05）。在局部麻醉药的持续时间方面，LB组（392.9 ± 20.4）、BS组（546.4 ± 14.9）LS组（172.85 ± 7.8）和BL组（458.7 ± 11.9分钟±标准误，p = 0.001）之间存在统计学差异。利多卡因在混合溶液中使用时，虽不会缩短起效时间，但会显著缩短布比卡因的作用持续时间。在所应用的剂量下，利多卡因表现出良好的阻滞质量，而其他溶液具有优异的质量。不含利多卡因的布比卡因作用持续时间最长，可实现最长的术后镇痛。
