不同浓度罗哌卡因在电视胸腔镜手术患者锯肌前平面阻滞中的镇痛作用和药代动力学：一项前瞻性随机试验。

IF 3.2 4区医学 Q2 PHARMACOLOGY & PHARMACY

Clinical therapeutics Pub Date : 2025-01-01 DOI:10.1016/j.clinthera.2024.11.003

Lingkai Tang MSc , Caomei Xu MSc , Jianfen Xie B.S. , Jiahao Xu MSc , Chen Chen PhD , Jiang Shen B.S. , Nan Hu PhD , Lan Qiu PhD

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引用次数: 0

摘要

目的：研究不同浓度罗哌卡因在锯肌前平面阻滞（SAPB）中的镇痛效果及药动学，评价其疗效和安全性。方法：选取36例接受电视胸腔镜（VATS）肺切除术的患者。超声引导下，用3 mg/kg不同浓度（0.25%、0.5%、0.75%，分别称为L组、M组、H组）的罗哌卡因诱导SAPB。采用LC-MS/MS法测定SAPB后1、15、30、45、60 min、2、4、8、12、24 h血浆中罗哌卡因浓度。其他评估指标包括休息和运动时的数值评定量表（NRS）评分、皮节阻塞的频率、发病时间和有效平面、要求质量(QoR)-15量表、慢性术后疼痛以及IL-6和IL-8水平。结果：L组NRS评分显著高于其他各组（P < 0.05），说明L组的镇痛效果在三组中最差。H组麻醉有效面较低，术后慢性疼痛发生率明显增高。在SAPB后1 min、1 H和24 H， H组IL-8水平显著低于其他各组。H组罗哌卡因血药浓度最高，M组次之，l组次之。H组罗哌卡因血药浓度高可能增加局麻药引起全身毒性的风险。与L组、H组比较，M组镇痛效果更好，安全性更好。三组间Cmax、t1/2、AUC0-∞差异显著。意义：对于接受VATS的患者，建议使用0.5%罗哌卡因治疗SAPB。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Analgesic Effects and Pharmacokinetics of Ropivacaine at Different Concentrations in Serratus Anterior Plane Block in Patients Undergoing Video-Assisted Thoracoscopic Surgery: A Prospective Randomized Trial

Purpose

Investigate the analgesia effects and pharmacokinetics of ropivacaine at different concentrations in Serratus Anterior Plane Block (SAPB) and assess the efficacy and safety.

Methods

Thirty-six patients undergoing video-assisted thoracoscopic surgery (VATS) pulmonary resections were enrolled. Ultrasound-guided SAPB was induced with 3 mg/kg ropivacaine at different concentrations (0.25%, 0.5%, and 0.75%, referred to as Group L, Group M, and Group H, respectively). The concentration of ropivacaine in the plasma at 1, 15, 30, 45, 60 min, 2, 4, 8, 12, and 24 h after SAPB was determined by LC-MS/MS. Other evaluated measures included the Numerical Rating Scale (NRS) scores at rest and on movement, the frequency of dermatomes blocked, onset time and effective plane, Quality of Requirements(QoR)-15 scale, chronic postsurgical pain, and the level of IL-6 and IL-8.

Findings

The NRS scores were significantly higher in Group L than those in other groups (P < 0.05), indicating that the analgesic effect of Group L was the worst among the three groups. Group H had a lower effective plane of anesthesia and significantly higher incidence of chronic postsurgical pain. The IL-8 level was significantly lower in Group H than in other groups at 1 min, 1 h, and 24 h after SAPB. The ropivacaine concentrations were the highest in Group H, followed by Group M and Group L. The high blood concentration of ropivacaine in Group H may increase the risk of systemic toxicity from local anesthetics. Compared to Group L and Group H, Group M had superior analgesic effects and better safety. Among the three groups, C_max, t_1/2, and AUC_0-∞ differed significantly.

Implications

For patients undergoing VATS, using 0.5% ropivacaine for SAPB is recommended.

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来源期刊

Clinical therapeutics 医学-药学

CiteScore

6.00

自引率

3.10%

发文量

154

审稿时长

9 weeks

期刊介绍： Clinical Therapeutics provides peer-reviewed, rapid publication of recent developments in drug and other therapies as well as in diagnostics, pharmacoeconomics, health policy, treatment outcomes, and innovations in drug and biologics research. In addition Clinical Therapeutics features updates on specific topics collated by expert Topic Editors. Clinical Therapeutics is read by a large international audience of scientists and clinicians in a variety of research, academic, and clinical practice settings. Articles are indexed by all major biomedical abstracting databases.