Debruyne D, Moulin M, Thomassin C, Locker B, Tartiere J, Bigot M C, Besnard M, Berthelin C, Beguin J
Clin Pharmacol Ther. 1985 Nov;38(5):549-53. doi: 10.1038/clpt.1985.222.
Prilocaine pharmacokinetics were determined in 60 patients receiving the drug by two different routes of administration (intra-articular and subcutaneous) during arthroscopy under local anesthesia with controlled pressure irrigation. Resorption of prilocaine by subcutaneous tissues was slow and did not lead to high serum levels. On the contrary, prilocaine resorption by the synovium was fast and induced a sharp serum peak (265.8 +/- 163.5 ng/ml) in the hour after the end of the examination. The drug was completely eliminated from the blood after 24 hours, as the prilocaine t1/2 is about 5 hours. The first procedure was perfected to reduce the risk of methemoglobinemia, which occurred in four of 105 patients. Applied pressure was lowered to 100 mm Hg to prevent the escape of anesthetic solution into the soft tissue of the leg, the prilocaine concentration was reduced to 1 gm/L, and the arthroscope was only set up after a delay to allow the intra-articular anesthetic effect of prilocaine to become established. So far, 200 arthroscopies have been performed with this improved protocol without any problem.
在局部麻醉下通过控制压力冲洗进行关节镜检查期间，对60例接受两种不同给药途径（关节内和皮下）药物的患者进行了丙胺卡因的药代动力学研究。皮下组织对丙胺卡因的吸收缓慢，不会导致血清水平升高。相反，滑膜对丙胺卡因的吸收很快，并在检查结束后1小时内引起血清峰急剧升高（265.8±163.5 ng/ml）。由于丙胺卡因的半衰期约为5小时，该药物在24小时后从血液中完全消除。第一个程序得到完善以降低高铁血红蛋白血症的风险，105例患者中有4例发生了高铁血红蛋白血症。施加的压力降至100 mmHg以防止麻醉溶液渗入腿部软组织，丙胺卡因浓度降至1 g/L，并且延迟设置关节镜以使丙胺卡因的关节内麻醉效果得以确立。到目前为止，按照这种改进方案已经进行了200例关节镜检查，没有出现任何问题。
