Simon M A, Gielen M J, Alberink N, Vree T B, van Egmond J
Department of Anesthesiology, Medisch Spectrum Twente Enschede, The Netherlands.
Reg Anesth. 1997 Jan-Feb;22(1):29-34. doi: 10.1016/s1098-7339(06)80053-2.
The purpose of this study was to compare the effectiveness of three local anesthetic agents for intravenous regional anesthesia in the upper limb. Side effects and plasma concentrations of the drugs in the doses administered for IVRA were also studied.
Thirty patients in ASA groups I and II received intravenous regional anesthesia for surgery of the upper limb. In a double-blind prospective study, they were randomly allocated to receive one of three local anesthetics: articaine, lidocaine, or prilocaine. Patients received 40 mL of a 0.5% solution of the local anesthetic. The onset time of sensory block was assessed by pinprick and the extent of motor block was was scored as 0-3. Plasma concentrations of local anesthetics were determined in all patients from serial arterial blood samples drawn at predetermined times before and after tourniquet release.
The onset time of sensory block was significantly shorter (2.5 minutes) in the articaine group than in the lidocaine group (11.1 minutes) or the prilocaine group (10.9 minutes) (Scheffe, P < .05). Development of motor block was equal in all three groups (score 2). Estimation of plasma concentrations by high performance liquid chromatography showed that the peak level in all 30 patients was reached immediately after release of the tourniquet; plasma concentrations thereafter gradually declined. Maximum concentrations of articaine, lidocaine, and prilocaine were, 1.85, 8.5, and 4.4 micrograms/mL, respectively. No signs of local anesthetic toxicity of the cardiovascular or central nervous systems were seen.
Articaine had the fastest onset of sensory block and the lowest peak plasma concentration of the three local anesthetics when used for intravenous regional anesthesia.
本研究旨在比较三种局部麻醉剂用于上肢静脉区域麻醉的效果。同时还研究了静脉区域麻醉给药剂量下药物的副作用和血浆浓度。
30例ASA I级和II级患者接受上肢手术的静脉区域麻醉。在一项双盲前瞻性研究中，他们被随机分配接受三种局部麻醉剂之一：阿替卡因、利多卡因或丙胺卡因。患者接受40 mL 0.5%的局部麻醉剂溶液。通过针刺评估感觉阻滞的起效时间，并将运动阻滞程度评分为0 - 3分。在止血带松开前后的预定时间采集系列动脉血样，测定所有患者局部麻醉剂的血浆浓度。
阿替卡因组感觉阻滞的起效时间（2.5分钟）明显短于利多卡因组（11.1分钟）或丙胺卡因组（10.9分钟）（Scheffe检验，P <.05）。三组的运动阻滞发展程度相同（评分为2分）。通过高效液相色谱法估计血浆浓度显示，所有30例患者在止血带松开后立即达到峰值水平；此后血浆浓度逐渐下降。阿替卡因、利多卡因和丙胺卡因的最大浓度分别为1.85、8.5和4.4微克/毫升。未观察到心血管或中枢神经系统局部麻醉药毒性的迹象。
用于静脉区域麻醉时，阿替卡因的感觉阻滞起效最快，且三种局部麻醉剂中其血浆峰值浓度最低。
