Abstract
Objectif
Plusieurs travaux expérimentaux sur des nerfs isolés ont montré que l’inhibition sélective des canaux sodés évoquée par les anesthésiques locaux était potentialisée par l’alcalinisation du bain de conservation. Ce changement de pH augmentait la proportion de la forme non ionisée et modifiait favorablement les caractéristiques du bloc nerveux dont la latence et la puissance. L’alcalinisation in vitro des anesthésiques locaux a été étudiée in vivo depuis les années 1970, les principaux bénéfices cliniques attendus étant une diminution de la latence du bloc anesthésique et une augmentation de leur puissance. Cette étude avait pour objectif de vérifier si les études cliniques confirmaient cette action in vivo.
Source
Les auteurs de ce travail de revue de la littérature ont relevé les articles pertinents à l’alcalinisation publiés dans les principaux journaux nords-américains et européens d’anesthésiologie et de pharmacologie publiés depuis 1965.
Constatations principales
Les bénéfices attendus soit la diminution de la latence et l’augmentation de la puissance du bloc ne se vérifient pas de façon convaincante in vivo. L’ajout de NaHCO3 peut en outre produire une précipitation.
Conclusions
Les résultats des cliniques sont trop discordants à ce jour pour que cette technique soit recommandée en pratique quotidienne.
Abstract
Purpose
In vitro studies have demonstrated the potential advantages of alkalinization on anaesthetic activity, by decreasing the ratio of ionized to nonionized molecules, thereby permitting more rapid penetration of local anaesthetic through biological membranes, thus decreasing the onset time. The proportion of each form depends on the pKa of the agent and the ultimate pH of the solution. When NaHCO3 is mixed with local anaesthetics, CO2 is produced. Carbon dioxide has been reported to enhance local anaesthetic action by diffusion trapping of the cationic form in pH gradient combined with a direct depressant action of CO2. The purpose of this study was to examine if clinical studies confirmed the in vitro action of alkalinisation.
Source
The literature pertinent to alkalinization of local anaesthetics published in the major anaesthesia and pharmacology journals of North America and Europe.
Principal findings
While in vitro studies have demonstrated potential advantages for alkalinization on anaesthetic activity, clinical studies have shown that alkalinization of local anaesthetics produces inconsistent results. For bupivacaine and etidocaine, alkalinization of local anaesthetic solution can produce precipitation, thus limiting the feasibility of increasing the pH.
Conclusions
On the basis of this review, routine alkalinization of local anaesthetics is not recommended.
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Chassard, D., Berrada, K. & Boulétreau, P. Alcalinisation des anesthésiques locaux: théoriquement justifiée mais inutile cliniquement. Can J Anaesth 43, 384–393 (1996). https://doi.org/10.1007/BF03011719
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DOI: https://doi.org/10.1007/BF03011719