Ropivacaine, Interleukin-6 and Tumor Necrosis Factor Alpha Plasma Levels during Intermittent Epidural and Continuous Wound Infusion of Ropivacaine for Analgesia after Hysterectomy or Myomectomy: An Observational Study
Ropivacaine, Interleukin-6 and Tumor Necrosis Factor Alpha Plasma Levels during Intermittent Epidural and Continuous Wound Infusion of Ropivacaine for Analgesia after Hysterectomy or Myomectomy: An Observational Study
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子宫切除术或子宫肌瘤切除术后间歇性硬膜外和连续伤口输注罗哌卡因用于镇痛期间罗哌卡因、白细胞介素 6 和肿瘤坏死因子 α 的血浆水平：一项观察性研究
DOI：
10.1159/000448758
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发表时间：
2016
期刊：
影响因子：
3.1
通讯作者：
A. Fassoulaki
中科院分区：
文献类型：
--
作者：
S. Markantonis;A. Melemeni;Marina Markidou;Stefania Irene Haikali;V. Karalis;A. Fassoulaki
背景/目标：长效局麻药罗哌卡因在硬膜外（EP）给药或连续皮下（SC）输注后的浓度-时间曲线尚未得到充分评价。本研究的目的是测定EP和SC期间罗哌卡因的总血浆浓度以及细胞因子白细胞介素-6（IL-6）和肿瘤坏死因子α（TNF-α）水平的变化。在这项前瞻性随机对照试验中，随机选择18例接受腹式子宫切除术或子宫肌瘤切除术的患者，通过EP导管每6小时或通过伤口持续输注沿着推注给药后，皮肤切口持续48 h。采用高效液相色谱-紫外分光光度法测定推注前和推注后2、4、8、24、48和50 h的罗哌卡因血药浓度，ELISA法测定推注后0、8和24 h的IL-6和TNF-α水平，并进行统计学分析。结果如下：在EP期间，平均± SD罗哌卡因浓度在术后50 h内相对稳定，即239 ± 89 ng/ml，而在SC期间，2 - 8 h之间的初始浓度（101.5 ± 42.9 ng/ml）相对低于24-50 h浓度（437.1 ± 206 ng/ml）。在EP和SC期间0 - 24 h之间观察到IL-6水平升高，但仅在EP期间0 - 24 h之间TNF-α水平略有升高。结论：在整个给药时间间隔内，EP和SC的罗哌卡因血药浓度均是安全的。IL-6水平在相同的时间间隔内增加，而TNF水平仅略有变化。
Background/Aims: The concentration-time profile of the long-acting local anesthetic ropivacaine after epidural (EP) administration at fixed time intervals or continuous subcutaneous (SC) infusion has not been fully evaluated. The objective of this work was to determine total plasma concentrations of ropivacaine and changes in cytokine interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) levels during EP and SC. Methods: In this prospective randomized controlled trial, 18 patients undergoing abdominal hysterectomy or myomectomy were randomly selected to receive ropivacaine either every 6 h via an EP catheter or by continuous wound infusion along the skin incision, after a bolus dose, for 48 h. Total plasma ropivacaine concentrations were measured before the bolus and 2, 4, 8, 24, 48, and 50 h after the bolus using high-performance liquid chromatography-UV and IL-6 and TNF-α levels were measured at 0, 8 and 24 h with ELISA and analyzed statistically. Results: During EP, mean ± SD ropivacaine concentrations were relatively stable up to 50 h postoperatively, that is, 239 ± 89 ng/ml, while during SC, initial concentrations between 2 and 8 h were comparatively lower (101.5 ± 42.9 ng/ml) than 24-50 h concentrations (437.1 ± 206 ng/ml). An increase in IL-6 levels was noted between 0 and 24 h during EP and SC, but TNF-α levels increased slightly, between 0 and 24 h, only during EP. Conclusion: Ropivacaine plasma concentrations with both EP and SC were found to be safe throughout the administration time interval. IL-6 levels increased during the same time interval, while TNF levels varied only slightly.