The effect of epidural saline injection on analgesic level during combined spinal and epidural anesthesia assessed clinically and myelographically
The effect of epidural saline injection on analgesic level during combined spinal and epidural anesthesia assessed clinically and myelographically
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DOI：
10.1097/00000539-199711000-00024
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发表时间：
1997-11-01
影响因子：
5.7
通讯作者：
Kitajima, T
中科院分区：
文献类型：
--
作者：
Takiguchi, T;Okano, T;Kitajima, T
由于容量效应，椎管内麻醉后硬膜外注射生理盐水可能比单独椎管内麻醉产生更高水平的镇痛效果。本研究的目的是阐明椎管内麻醉后硬膜外注射生理盐水引起的容量效应。择期手术中采用腰硬联合麻醉的患者 20 例，L4-5 间隙腰麻 10 分钟后镇痛水平未到达手术区域，随机分为两组。对照组（n = 10）不接受硬膜外盐水注射。生理盐水组 (n = 10) 在脊髓麻醉后 10 分钟通过 L2-3 或 L3-4 间隙的硬膜外导管接受 10 吨生理盐水。生理盐水组椎管内麻醉后15、20 min镇痛水平显着高于对照组（P < 0.05）。接下来，我们使用两名成年志愿者通过脊髓造影检查了硬膜外注射盐水的容量效应。在两名志愿者中，在腰椎硬膜外注射生理盐水的同时，注射到腰椎蛛网膜下腔的造影剂的上层水平开始增加，从L3到达L1，从L2到达T12。注射生理盐水后，蛛网膜下腔直径缩小至小于25%。我们得出的结论是，腰部硬膜外注射生理盐水可提高脊髓麻醉后 10 分钟的镇痛水平，这可能是由于容量效应。意义：在这项研究中，通过手术患者和志愿者，我们确定，由于容量效应，腰麻后 10 分钟腰部硬膜外注射生理盐水溶液比单独使用腰麻可产生更高的镇痛水平。
An epidural injection of physiological saline solution after spinal anesthesia may produce a higher level of analgesia than spinal anesthesia alone because of a volume effect. The purpose of this study was to clarify the volume effect caused by epidural injection of saline after spinal anesthesia. Twenty patients undergoing combined spinal and epidural anesthesia for elective surgery whose analgesic levels did not reach the surgical regions 10 min after spinal anesthesia at the L4-5 interspace were randomly assigned to two groups. The control group (n = 10) received no epidural saline injection. The saline group (n = 10) received 10 mt of saline through an epidural catheter at the L2-3 or L3-4 interspace 10 min after spinal anesthesia. In the saline group, the levels of analgesia 15 and 20 min after spinal anesthesia were significantly higher than those in the control group (P < 0.05). Next, we examined the volume effect of epidural injection of saline with myelography using two adult volunteers. In both volunteers, the upper level of the contrast medium, which was injected in the lumbar subarachnoid space, began to increase concurrently with lumbar epidural injection of saline, reaching from L3 to L1 and from L2 to T12. The diameter of the subarachnoid space diminished to less than 25% after injection of saline. We conclude that lumbar epidural injection of saline increases the analgesic level 10 min after spinal anesthesia, probably because of a volume effect. Implications:In this study, using surgical patients and volunteers, we determined that a lumbar epidural injection of physiological saline solution 10 min after spinal anesthesia produces a higher analgesic level than spinal anesthesia alone because of a volume effect.