Factors affecting the spread of bupivacaine in the adult thoracic paravertebral space
Factors affecting the spread of bupivacaine in the adult thoracic paravertebral space
复制标题
DOI：
10.1046/j.1365-2044.2003.03189_1.x
复制
发表时间：
2003-07-01
期刊：
影响因子：
10.7
通讯作者：
McGurgan, P
中科院分区：
文献类型：
--
作者：
Cheema, S;Richardson, J;McGurgan, P
在接受椎旁神经阻滞治疗慢性疼痛的患者中，研究了影响布比卡因在椎旁间隙扩散的因素。每隔2周重复注射0.5%布比卡因、10-15毫升加去甲氧美酮80毫克，最多注射4次。一名盲人观察者在每次注射后以5分钟的间隔绘制出躯干两侧因寒冷而失去感觉的后续分布。年龄、性别、身高和体重与阻滞无关；注入量、布比卡因质量、既往后外侧切开和放射造影剂扩散也不相关。在同一患者中，每隔2周重复注射一次会导致不同程度的扩散，而这些扩散是相互无关的。95%的患者达到阻断高峰的时间为40min。一剂布比卡因可产生安全但不可预测的阻滞。物理特性和解剖学因素可能是布比卡因在椎旁间隙扩散的关键决定因素。这种单次注射技术可能更好地被恢复到较老的多水平注射技术所取代。
Factors affecting the spread of bupivacaine in the paravertebral space were investigated in patients undergoing paravertebral nerve blocks for the treatment of chronically painful conditions. Injections of bupivacaine 0.5%, 10-15 ml mixed with depomedrone up to 80 mg were repeated at 2-wk intervals up to a maximum of four times. A blinded observer mapped out the subsequent distribution of sensory loss to cold on both sides of the torso at 5-min intervals after each injection. Age, sex, height and weight did not correlate with the block; nor did injectate volume, mass of bupivacaine, previous posterolateral thoractomy and spread of radiocontrast. Injections repeated at 2-wk intervals in the same patient resulted in different degrees of spread that were unrelated to one another. Time to peak onset of blockade was 40 min in 95% of patients. A single bolus of bupivacaine produces a safe but unpredictable block. Yet to be defined physical properties and anatomical factors are probably key determinants of the spread of bupivacaine in the paravertebral space. This single bolus technique may be better supplanted by a reversion to the older multiple level injection technique.