Tuominen M, Pitkänen M, Rosenberg P H
Acta Anaesthesiol Scand. 1987 May;31(4):276-8. doi: 10.1111/j.1399-6576.1987.tb02565.x.
Interscalene brachial plexus block was performed on 40 patients for prophylactic pain relief after shoulder surgery. A dose of 1.25 mg/kg of 0.5% bupivacaine was injected for the block (Group 1) and continued with an infusion of 0.25% bupivacaine 0.25 mg/kg/h (Group 2). If the postoperative analgesia was insufficient, the patients received i.m. oxycodone 0.15 mg/kg. In Group 1, one patient managed without oxycodone supplementation during the 24-h observation period compared with eight patients in Group 2 (P less than 0.01). The rest of the patients received 3.8 +/- 1.6 doses (Group 1) and 2.5 +/- 1.2 doses (Group 2) of oxycodone (P less than 0.05). At 30 min, the mean bupivacaine plasma concentration was 1.0 microgram/ml in Group 1 and 0.9 microgram/ml in Group 2. The mean plasma level of bupivacaine increased from 0.7 microgram/ml after 180 min to 1.1 micrograms/ml (P less than 0.01) after 24 h of infusion, providing some evidence of accumulation during infusion. The dizziness and confusion experienced by three patients could be associated with the local anaesthetic, as they obtained relief after the infusion was stopped.
对40例患者实施了肌间沟臂丛神经阻滞，以预防肩部手术后的疼痛。第1组给予0.5%布比卡因1.25 mg/kg进行阻滞，并持续输注0.25%布比卡因0.25 mg/kg/h（第2组）。若术后镇痛效果不佳，患者肌内注射0.15 mg/kg羟考酮。在24小时观察期内，第1组有1例患者未补充羟考酮，而第2组有8例患者未补充（P<0.01）。其余患者分别接受了3.8±1.6剂（第1组）和2.5±1.2剂（第2组）的羟考酮（P<0.05）。30分钟时，第1组布比卡因平均血浆浓度为1.0μg/ml，第2组为0.9μg/ml。输注24小时后，布比卡因平均血浆水平从180分钟时的0.7μg/ml升至1.1μg/ml（P<0.01），这为输注期间药物蓄积提供了一些证据。3例患者出现的头晕和意识模糊可能与局部麻醉药有关，因为在停止输注后症状缓解。
