Spinal Anesthesia: Volume or Concentration—What Matters?
Spinal Anesthesia: Volume or Concentration—What Matters?
复制标题
脊髓麻醉：容量还是浓度——哪个重要？
DOI：
10.1136/rapm-00115550-199621020-00007
复制
发表时间：
1995
影响因子：
5.1
通讯作者：
D. Lambert
中科院分区：
文献类型：
--
作者：
A. A. J. V. Zundert;R. Grouls;H. Korsten;D. Lambert
背景和目的研究了定剂量蛛网膜下腔利多卡因的体积和浓度对感觉和运动麻醉产生的程度和持续时间的影响，以及脑脊液（CSF）利多卡因浓度随时间的变化。方法在一项前瞻性研究中，40名美国麻醉学会（ASA） 2或3级的患者被分为五组，分别接受70mg盐酸利多卡因蛛网膜下剂量0.5、1、2、5或10%溶液。采用19.5号Periquick针（Pajunk, Germany）在L3-L4间隙穿刺硬脑膜，24号导管插入蛛网膜下腔3- 4cm。在注射局麻药时，患者保持侧卧位，然后转为仰卧位。在5、10、15、20、30、40、50和60分钟测量麻醉水平和运动阻滞，然后每隔15分钟测量一次，直到麻醉效果停止。在针刺和运动阻滞测量的同时采集脑脊液样本。结果注射后5 min，各组均观察到T4或T5中位感觉阻滞高度。感觉障碍完全恢复的平均总时间为139 ~ 152分钟，而下肢运动障碍完全恢复的平均总时间为100 ~ 122分钟。各组间差异无统计学意义（P < 0.05）。所有患者注射利多卡因后10分钟运动阻滞完成。注射后5分钟，10%组脑脊液平均利多卡因浓度最高（与其他4组比较P < 0.001）。在15分钟时，0.5%组和10%组之间发现唯一的统计学差异（P = 0.026）。20分钟时，各组脑脊液利多卡因浓度相似（P < 0.05）。结论恒定剂量的70 mg蛛网膜下腔利多卡因，尽管注射浓度和体积范围极广，但其针刺镇痛水平、运动阻滞程度和脊髓麻醉持续时间相同。尽管所有患者接受了相同剂量的利多卡因，但5,10,15分钟时脑脊液浓度不同，且与注射溶液浓度直接相关。20分钟时，各组脑脊液浓度相似。这些结果表明利多卡因在脑脊液中的分布相对均匀。
Background and Objectives An investigation was made of the effects of volume and concentration of a constant dose of subarachnoid lidocaine on the extent and duration of sensory and motor anesthesia produced, as well as of the lidocaine concentration of the cerebrospinal fluid (CSF) as a function of time. Methods In a prospective study, 40 American Society of Anesthesiologists (ASA) status 2 or 3 patients were assigned to one of five groups, who received a 70-mg subarachnoid dose of lidocaine hydrochloride as a 0.5, 1, 2, 5, or 10% solution. Dural puncture was performed at the L3-L4 interspace with a 19.5-gauge Periquick needle (Pajunk, Germany), and a 24-gauge catheter was inserted 3-4 cm into the subarachnoid space. The patient remained in the lateral position during injection of the local anesthetic and was then turned to the supine horizontal position. The level of anesthesia and the motor block were measured at 5, 10, 15, 20, 30, 40, 50, and 60 minutes and then at 15-minute intervals until the effect of the anesthesia had ceased. Samples of CSF were collected at the same times that the pinprick and motor block measurements were made. Results Five minutes after injection, a median sensory block height of T4 or T5 was observed in all groups. The range of mean total times to complete recovery of the sensory blocks was 139-152 minutes, while that for the motor blocks of the lower extremities was 100-122 minutes. The values were similar in all groups (P > .05). The motor block was complete in all patients 10 minutes after the lidocaine injection. Five minutes after injection, the mean CSF lidocaine concentration was highest in the 10% group (P < .001 vs. the other four groups). At 15 minutes, the only statistical difference was found between the 0.5% and the 10% group (P = .026). At 20 minutes, the CSF lidocaine concentrations were similar in all groups (P > .05). Conclusions A constant 70-mg dose of subarachnoid lidocaine produced the same pinprick level of analgesia, degree of motor block, and duration of spinal anesthesia in spite of being injected over an extremely broad range of concentrations and volumes. Despite the fact that all patients received the same dose of lidocaine, the CSF concentrations at 5, 10, and 15 minutes were different and directly related to the concentration of the solution injected. At 20 minutes, the CSF concentrations were similar in all groups. These results indicate a relatively uniform distribution of lidocaine in the CSF for all solutions tested.