Downing J W, Johnson H V, Gonzalez H F, Arney T L, Herman N L, Johnson R F
Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
Anesth Analg. 1997 Mar;84(3):527-32. doi: 10.1097/00000539-199703000-00011.
We studied the maternal pharmacokinetics of epidural lidocaine and bupivacaine in 20 healthy parturients with institutional review board approval and written, informed consent. Epidural anesthesia was induced using either 2% lidocaine with epinephrine 1:200,000, n = 10, or 0.5% plain bupivacaine, n = 10. Maternal arterial (Ma) blood was sampled at regular intervals and umbilical venous (Uv) blood at delivery. Results for lidocaine and bupivacaine, respectively, were (mean +/- SEM): age 30.4 +/- 1.5 and 24.7 +/- 1.6 yr; weight 74.0 +/- 4.2 and 74.9 +/- 4.5 kg; duration of surgery 55.5 +/- 4.3 and 53.1 +/- 3.5 min; epidural dosage 6.1 +/- 0.6 and 1.5 +/- 0.2 mg/kg; elimination half-life 113.9 +/- 5.6 and 110.4 +/- 20.4 min; plasma clearance 6.1 +/- 0.4 and 13.6 +/- 1.3 mL.kg-1.min-1; volume of distribution 0.98 +/- 0.1 and 1.67 +/- 0.3 L/kg; time to peak concentration 31 +/- 2.3 and 40.5 +/- 1.7 min; peak Ma concentration 6.4 +/- 0.65 and 0.8 +/- 0.1 microgram/mL; and Uv/Ma gradient 0.43 +/- 0.05 and 0.26 +/- 0.1. Peak Ma lidocaine concentrations in 2 of 10 patients reached potentially toxic levels without producing clinical toxicity, whereas peak bupivacaine Ma concentrations never approached levels considered unsafe. The results suggest that epidural bupivacaine reliably produces acceptable Ma concentrations below the toxic range.
在获得机构审查委员会批准并取得书面知情同意后，我们研究了20名健康产妇硬膜外利多卡因和布比卡因的母体药代动力学。硬膜外麻醉诱导采用含1:200,000肾上腺素的2%利多卡因（n = 10）或0.5%普通布比卡因（n = 10）。定期采集母体动脉（Ma）血样，并在分娩时采集脐静脉（Uv）血样。利多卡因和布比卡因的结果分别为（均值±标准误）：年龄30.4±1.5岁和24.7±1.6岁；体重74.0±4.2千克和74.9±4.5千克；手术时间55.5±4.3分钟和53.1±3.5分钟；硬膜外剂量6.1±0.6毫克/千克和1.5±0.2毫克/千克；消除半衰期113.9±5.6分钟和110.4±20.4分钟；血浆清除率6.1±0.4毫升·千克⁻¹·分钟⁻¹和13.6±1.3毫升·千克⁻¹·分钟⁻¹；分布容积0.98±0.1升/千克和1.67±0.3升/千克；达峰时间31±2.3分钟和40.5±1.7分钟；Ma峰浓度6.4±0.65微克/毫升和0.8±0.1微克/毫升；以及Uv/Ma梯度0.43±0.05和0.26±0.1。10名患者中有2名的Ma利多卡因峰浓度达到潜在中毒水平，但未产生临床毒性，而布比卡因的Ma峰浓度从未接近被认为不安全的水平。结果表明，硬膜外布比卡因能可靠地产生低于中毒范围的可接受Ma浓度。
