Fuhrer Y, Charpentier C, Boulanger G, Menu N, Grosdidier G, Laxenaire M C
Département d'anesthésie-réanimation chirurgicale, hôpital central, Nancy, France.
Ann Fr Anesth Reanim. 1996;15(2):128-34. doi: 10.1016/0750-7658(96)85033-7.
The aims of this study were to assess the analgesic effect of the intraperitoneal topical administration of 0.375% bupivacaine in patients undergoing laparoscopic cholecystectomy and to carry out a pharmacokinetic study of bupivacaine administered topically by intraperitoneal route.
Randomized, double-blind controlled trial.
Twenty-four patients of ASA physical status 1 or 2, undergoing elective laparoscopic cholecystectomy, were included. Anaesthesia technique was the same for all patients. At the end of surgery, they were randomly assigned to one of two groups. Patients in group bupivacaine were administered 0.375% bupivacaine, 0.6 mL.kg-1 intraperitoneally in both subdiaphragmatic areas and the cholecystectomy wound, those of the control group were given the same volume of NaCl 0.9%. Analgesia was provided by morphine PCA. Postoperative pain, assessed on a 100 mm visual analogue pain scale (VAS), and administered morphine were recorded 30 min after extubation, and 0.5, 1, 2, 3, 6, 12, 24, 36 and 48 hours later. Blood samples were collected 2, 5, 15, 30, 60, 90, 120, 180, 300 and 480 min after the intraperitoneal administration of bupivacaine to measure bupivacaine plasma concentration. Statistics included Student t test and Chi square test. P < 0.05 was considered significant.
There was no significant difference between the two groups with regard to VAS scores during the first 48 postoperative hours. Morphine requirements (total and at each point) were also similar. Plasma bupivacaine concentrations reached a plateau at 10-20 min, and then decreased slowly. The median plasma peak concentration was 0.94 +/- 0.47 microgram.mL-1. In one patient toxic concentrations (> 1.6 micrograms.mL-1) during the first 60 min after intraperitoneal administration were obtained, while in another patient a concentration of 1.58 micrograms.mL-1 was reached twice.
Intraperitoneal administration of 0.6 mL.kg-1 of 0.375% bupivacaine is ineffective in reducing postoperative pain after laparoscopic cholecystectomy. Furthermore these high doses of bupivacaine may result in toxic plasma concentrations. This technique is not safe and cannot be recommended.
本研究旨在评估0.375%布比卡因腹腔内局部给药对接受腹腔镜胆囊切除术患者的镇痛效果，并对经腹腔途径局部给药的布比卡因进行药代动力学研究。
随机、双盲对照试验。
纳入24例美国麻醉医师协会（ASA）身体状况为1或2级、接受择期腹腔镜胆囊切除术的患者。所有患者的麻醉技术相同。手术结束时，他们被随机分为两组。布比卡因组患者在双侧膈下区域和胆囊切除伤口处腹腔内注射0.375%布比卡因，剂量为0.6 mL·kg-1，对照组患者注射相同体积的0.9%氯化钠溶液。通过吗啡自控镇痛（PCA）提供镇痛。在拔管后30分钟以及之后的0.5、1、2、3、6、12、24、36和48小时，记录以100 mm视觉模拟疼痛量表（VAS）评估的术后疼痛情况以及给予的吗啡量。在腹腔内注射布比卡因后2、5、15、30、60、90、120、180、300和480分钟采集血样，以测量布比卡因血浆浓度。统计学方法包括Student t检验和卡方检验。P < 0.05被认为具有统计学意义。
术后48小时内，两组患者的VAS评分无显著差异。吗啡需求量（总量及各时间点）也相似。布比卡因血浆浓度在10 - 20分钟达到平台期，然后缓慢下降。血浆峰浓度中位数为0.94±0.47微克·mL-1。1例患者在腹腔内给药后的前60分钟内出现中毒浓度（> 1.6微克·mL-1），另1例患者的浓度两次达到1.58微克·mL-1。
腹腔内注射0.6 mL·kg-1的0.375%布比卡因对减轻腹腔镜胆囊切除术后的疼痛无效。此外，这些高剂量的布比卡因可能导致血浆中毒浓度。该技术不安全，不推荐使用。
