Vasoactive characteristics of bupivacaine and levobupivacaine with and without adjuvant epinephrine in peripheral human skin
Vasoactive characteristics of bupivacaine and levobupivacaine with and without adjuvant epinephrine in peripheral human skin
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DOI：
10.1093/bja/aei095
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发表时间：
2005-05-01
影响因子：
9.8
通讯作者：
Belch, JJF
中科院分区：
文献类型：
--
作者：
Newton, DJ;McLeod, GA;Belch, JJF
背景将肾上腺素添加到局部麻醉制剂中以延长其作用并减少其全身吸收。布比卡因和左布比卡因在临床剂量下引起血管舒张，但较低剂量似乎引起血管收缩。本研究的目的是充分表征这些麻醉剂的血管活性作用，使用客观的血流测量，并评估增加肾上腺素的影响。应用激光多普勒成像技术，对10名健康男性志愿者皮内注射8种剂量布比卡因和左旋布比卡因后前臂皮肤血流反应进行了测量。试验剂量范围为0.008%至0.75%，5个最高剂量均在2.5 μ g/ml肾上腺素辅助和不辅助的情况下给药。对两种麻醉剂的较低亚临床浓度（0.008-0.0625%）的累积反应小于或类似于单独使用生理盐水产生的反应，表明净血管收缩效应。较高剂量引起净血管舒张，左布比卡因反应一般低于相应的布比卡因反应（P=0.022）。肾上腺素2.5 μ g/ml（-1）显著降低了对两种药物临床剂量的反应（P < 0.001），产生了净血管收缩。布比卡因和左布比卡因在皮内注射时具有双相血管效应，亚临床剂量引起净血管收缩。加入肾上腺素2.5 μ g ml（-1）可明显降低这些反应。
Background. Epinephrine is added to local anaesthetic preparations to prolong their action and reduce their systemic absorption. Bupivacaine and levobupivacaine cause vasodilatation at clinical doses, but lower doses appear to cause vasoconstriction. The aim of this study was to characterize fully the vasoactive effects of these anaesthetics, using an objective measure of blood flow, and to assess the influence of adding epinephrine.Methods. Laser Doppler imaging was used to measure the forearm skin blood flow responses to intradermal injection of eight doses of bupivacaine and levobupivacaine in 10 healthy male volunteers. The doses tested ranged from 0.008% to 0.75%, and the five highest doses were administered both with and without adjuvant epinephrine 2.5 mu g ml(-1).Results. The cumulative responses to the lower subclinical concentrations (0.008-0.0625%) of both anaesthetics were smaller than or similar to that produced by saline alone, indicating a net vasoconstrictive effect. Higher doses caused net vasodilatation, and the levobupivacaine responses were generally lower than the corresponding bupivacaine responses (P=0.022). Epinephrine 2.5 mu g ml(-1) significantly reduced the responses to clinical doses of both drugs (P < 0.001), producing net vasoconstriction.Conclusions. Bupivacaine and levobupivacaine have a biphasic vascular effect when injected intradermally, with subclinical doses causing net vasoconstriction. The addition of epinephrine 2.5 mu g ml(-1) decreases these responses markedly.