Kalso E A, Lalla M L, Rosenberg P H, Tuominen M K, Santavirta S, Gripenberg J
Anesth Analg. 1983 Sep;62(9):796-801.
The possible myotoxic effect of bupivacaine in combination with tourniquet ischemia was evaluated in 11 patients who underwent surgery of an arm under intravenous regional anesthesia. Eleven patients with the same kind of surgery and tourniquet who had general anesthesia served as controls. Venous blood bupivacaine concentrations in the anesthetized arm were high at the end of tourniquet time (27.2-202 micrograms/m1) and varied from 2.3 to 12.3 micrograms/ml 10 min after tourniquet release. Changes in blood-gas tensions and plasma potassium and lactate concentrations before and just after tourniquet release correlated with the ischemia time. Changes in creatine phosphokinase, lactate dehydrogenase and aspartate aminotransferase activities, possible indices of loss of integrity of muscle cell membranes, varied considerably and did not correlate with the ischemia time. There were no significant differences between the two groups in any of the parameters. Electron microscopy revealed no evidence of muscle degeneration 24 hr after the use of tourniquet with either bupivacaine intravenous regional (n = 4) or general anesthesia (n = 3).
在11例接受臂部静脉区域麻醉手术的患者中，评估了布比卡因与止血带缺血联合使用时可能产生的肌毒性作用。11例接受相同手术和使用止血带且采用全身麻醉的患者作为对照。在止血带使用结束时，麻醉臂部的静脉血布比卡因浓度较高（27.2 - 202微克/毫升），止血带松开10分钟后，浓度在2.3至12.3微克/毫升之间变化。止血带松开前后的血气张力、血浆钾和乳酸浓度变化与缺血时间相关。肌酸磷酸激酶、乳酸脱氢酶和天冬氨酸氨基转移酶活性的变化，这些可能是肌肉细胞膜完整性丧失的指标，变化很大且与缺血时间无关。两组在任何参数上均无显著差异。电子显微镜检查显示，在使用止血带并采用布比卡因静脉区域麻醉（n = 4）或全身麻醉（n = 3）24小时后，均未发现肌肉变性的证据。
