QUANTITATIVE ASSESSMENT OF DIFFERENTIAL SENSORY NERVE BLOCK AFTER LIDOCAINE SPINAL-ANESTHESIA
QUANTITATIVE ASSESSMENT OF DIFFERENTIAL SENSORY NERVE BLOCK AFTER LIDOCAINE SPINAL-ANESTHESIA
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DOI：
10.1097/00000542-199501000-00009
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发表时间：
1995-01-01
期刊：
影响因子：
8.8
通讯作者：
CARPENTER, RL
中科院分区：
文献类型：
--
作者：
LIU, S;KOPACZ, DJ;CARPENTER, RL
背景：最近的技术允许定量和选择性测量A β，A δ和C纤维神经传递。为了进一步了解生理学的差异阻滞后，利多卡因脊髓麻醉，这些不同的纤维的功能随着时间的推移进行了定量测量，这些测量与回归麻醉针刺，触摸，冷，和耐受强直电流（相当于手术切口）。方法：6名志愿者接受利多卡因脊髓麻醉50毫克利多卡因（5%葡萄糖）。在脊髓麻醉前和脊髓麻醉后每10分钟在L2-L3（膝上内侧）测定分别刺激A β、A δ和C纤维的2，000、250和5 Hz的皮肤电流感知阈值。脊髓麻醉后每5分钟评估皮节针刺、触摸和寒冷水平。强直电刺激的耐受性进行了评估，在L2-L3每10分钟后脊髓anesthesias.Results：差分块证明了感觉触摸，针刺，冷在L2-L3的顺序返回。A β、A δ和C纤维功能的恢复分别与触觉（R（2）= 0.7，p = 0.03）、针刺（R（2）= 0.75，p = 0.02）和冷（R（2）= 0.67，p = 0.04）的感觉恢复相关。手术麻醉耐受性的丧失对应于A β电流感知阈值恢复至基线，而A δ和C纤维的电流感知阈值仍增加至大于基线（p = 0.025）。结论：脊髓麻醉期间的差异性感觉阻滞是由于A β，A δ和C纤维的不同恢复曲线。通过电刺激模型评估，A β电流感知阈值恢复至基线与手术麻醉持续时间相关。
Background: Recent technology allows for quantitative and selective measurement of A beta, A delta, and C fiber nerve transmission. To gain further insight into the physiology of differential block after lidocaine spinal anesthesia, the function of these different fibers was quantitatively measured over time, and these measurements were correlated with regression of anesthesia to pinprick, touch, cold, and tolerance of tetanic electrical current (equivalent to surgical incision).Methods: Six volunteers received lidocaine spinal anesthesia with 50 mg lidocaine (5% in dextrose). Cutaneous current perception thresholds at 2,000, 250, and 5 Hz, which stimulate A beta, A delta, and C fibers, respectively, were determined at L2-L3 (medial aspect above knee) before and every 10 min after spinal anesthesia. Dermatomal levels to pinprick, touch, and cold were assessed every 5 min after spinal anesthesia. Tolerance to tetanic electrical stimulus was assessed at L2-L3 every 10 min after spinal anesthesia.Results: Differential block was demonstrated by the sequential return of sensation to touch, pinprick, and cold at L2-L3. Recovery of function of A beta, A delta, and C fibers correlated with return of sensation to touch (R(2) = 0.7, p = 0.03), pinprick (R(2) = 0.75, p = 0.02), and cold (R(2) = 0.67, p = 0.04) respectively. Loss of tolerance of surgical anesthesia corresponded to return of A beta current perception thresholds to baseline, whereas current perception thresholds for A delta and C fibers were still increased to greater than baseline (p = 0.025).Conclusions: Differential sensory block during spinal anesthesia is due to different recovery profiles of A beta, A delta, and C fibers. Return of A beta current perception thresholds to baseline correlated with duration of surgical anesthesia as assessed with an electrical stimulation model.