Atanassoff P G, Weiss B M, Brull S J
Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06510-8051, USA.
J Clin Anesth. 1996 Nov;8(7):535-9. doi: 10.1016/s0952-8180(96)00117-1.
To assess plasma levels and the potential toxicity of lidocaine following two different approaches to the obtruator nerve.
Prospective, randomized, clinical trial.
Operating rooms of a university hospital.
45 ASA physical status I, II and III patients over 40 years of age, and undergoing transurethral resection of urinary bladder tumors.
A prospective study compared lidocaine plasma levels following direct and indirect (3-in-1) obturator nerve block using lidocaine 1.5% plus 1:200,000 epinephrine. Patients with unilateral urinary bladder tumors were randomized to receive direct obturator nerve block with 15 ml of lidocaine (Group A, n = 20), while those with bilateral tumors received a bilateral direct obturator nerve block with 30 ml (2 x 15 ml) of lidocaine (Group B, n = 12). A third group of patients with unilateral bladder tumors received 3-in-1 indirect) obturator nerve block with 40 ml of lidocaine (Group C, n = 17). Plasma lidocaine concentration was determined every 5 minutes for 30 minutes, and at 45, 60, and 90 minutes after the block.
In Group A, mean (+/- SD) peak plasma lidocaine level of 1.35 +/- 0.5 micrograms/ml (range 0.61 to 2.41 micrograms/ml) occurred 45 minutes after injection. In Group B, a peak of 3.63 +/- 2.07 micrograms/ml (0.75 to 7.21 micrograms/ml) occurred 15 minutes after injection. Mean peak level in Group C of 2.08 +/- 0.77 micrograms/ml (0.84 to 3.21 micrograms/ml) occurred 60 minutes after injection Lidocaine concentrations were significantly higher in Groups B and C than in Group A, and they were higher in Group B than in Group C. No patient had any signs of symptoms of local anesthetic toxicity.
Despite a lower total dose of lidocaine administered (450 mg), higher mean and peak plasma levels were reached sooner with bilateral direct obturator nerve block compared with the indirect obturator nerve block (600 mg), indicating a faster blood absorption of lidocaine following direct block. Both types of obturator nerve block prevented adductor muscle contraction in a large percentage of cases.
评估两种不同闭孔神经阻滞方法后利多卡因的血浆水平及其潜在毒性。
前瞻性、随机临床试验。
大学医院手术室。
45例年龄超过40岁、美国麻醉医师协会（ASA）身体状况分级为I、II和III级、正在接受膀胱肿瘤经尿道切除术的患者。
一项前瞻性研究比较了使用1.5%利多卡因加1:200,000肾上腺素进行直接和间接（三合一）闭孔神经阻滞后的利多卡因血浆水平。单侧膀胱肿瘤患者被随机分配接受15毫升利多卡因的直接闭孔神经阻滞（A组，n = 20），而双侧肿瘤患者接受30毫升（2×15毫升）利多卡因的双侧直接闭孔神经阻滞（B组，n = 12）。第三组单侧膀胱肿瘤患者接受40毫升利多卡因的三合一间接闭孔神经阻滞（C组，n = 17）。在阻滞开始后的30分钟内，每隔5分钟测定一次血浆利多卡因浓度，并在45、60和90分钟时测定。
A组注射后45分钟时，血浆利多卡因平均（±标准差）峰值水平为1.35±0.5微克/毫升（范围0.61至2.41微克/毫升）。B组注射后15分钟时出现峰值，为3.63±2.07微克/毫升（0.75至7.21微克/毫升）。C组注射后60分钟时平均峰值水平为2.08±0.77微克/毫升（0.84至3.21微克/毫升）。B组和C组的利多卡因浓度显著高于A组，且B组高于C组。没有患者出现任何局部麻醉药毒性的症状体征。
尽管双侧直接闭孔神经阻滞使用的利多卡因总剂量较低（450毫克），但与间接闭孔神经阻滞（600毫克）相比，其平均和峰值血浆水平更快达到更高值，表明直接阻滞后利多卡因的血液吸收更快。两种类型的闭孔神经阻滞在大部分病例中都能防止内收肌收缩。
