Lidocaine Concentration in Cerebrospinal Fluid after Epidural Administration A Comparison between Epidural and Combined Spinal-Epidural Anesthesia
Lidocaine Concentration in Cerebrospinal Fluid after Epidural Administration A Comparison between Epidural and Combined Spinal-Epidural Anesthesia
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DOI：
10.1097/aln.0b013e31819daf15
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发表时间：
2009-05-01
期刊：
影响因子：
8.8
通讯作者：
Goto, Takahisa
中科院分区：
文献类型：
--
作者：
Kamiya, Yoshinori;Kikuchi, Tatsuaki;Goto, Takahisa
背景资料：在本研究中，在硬膜外注射利多卡因后10分钟，在有或没有预先脊麻的情况下，测量不同间隙的脑脊液（CSF）中利多卡因的浓度，以探讨预先脑膜穿刺对硬膜外注射局麻药的CSF浓度的影响。60例计划接受腰麻-硬膜外联合麻醉的患者被随机分配到先接受腰麻硬膜外利多卡因组（Epi组）。每组被分为三个亚组，其中硬膜外插管和脊髓穿刺的部位被一个、三个或五个间隙分开（分别为1组、H组和111组）。术中注入1%利多卡因10 ml后10 min，从L4-L5间隙采集CSF。Epi组在硬膜外注射利多卡因后、腰麻前采集脑脊液。CSEA组于腰3 ~ L4间隙行腰麻，硬膜外腔置管，术后硬膜外腔注入利多卡因，取脑脊液。在两组中，随着硬膜外注射部位与CSF收集部位的接近度增加，CSF中的利多卡因浓度显著升高。CSEA组和Epi组之间的CSF利多卡因浓度在设置1中没有显着差异，虽然利多卡因浓度显着较高，CSEA组II和III patients.Conclusion：利多卡因浓度在CSF中是相似的，或没有预先硬膜外给药部位下的脑膜穿刺。
Background: In this study, lidocaine concentrations in cerebrospinal fluid (CSF) at different interspaces were measured with or without preceding spinal anesthesia, 10 min after epidural injection of lidocaine, to investigate the effects of preceding meningeal puncture on CSF concentrations of epidurally administered local anesthetic.Methods: Sixty patients scheduled to receive combined spinal-epidural anesthesia were randomly allocated to receive either spinal anesthesia first (group CSEA) or epidural lidocaine first (group Epi). Each group was divided into three subgroups in which the site of epidural cannulation and spinal tap were separated by one, three, or five interspaces (sets 1, H, and 111, respectively). CSF was collected from the L4-L5 interspace 10 min after 10 ml lidocaine, 1%, was administered epidurally. In group Epi, CSF was collected after epidural administration of lidocaine and before spinal anesthesia. In group CSEA, spinal anesthesia was performed at the L3-L4 interspace after epidural cannulation and epidural lidocaine was administered postoperatively, after which CSF was sampled.Results. Lidocaine concentrations in CSF were significantly higher with increasing proximity of epidural injection site to CSF collection site in both groups. There were no significant differences in CSF lidocaine concentrations between group CSEA and group Epi in set 1, although lidocaine concentrations were significantly higher in group CSEA set II and III patients.Conclusion: Lidocaine concentration in CSF was similar with or without preceding meningeal puncture beneath the epidural administration site.