Sakura S, Sumi M, Yamada Y, Saito Y, Kosaka Y
Department of Anaesthesiology, Shimane Medical University, Izumo City, Japan.
Br J Anaesth. 1998 Nov;81(5):718-22. doi: 10.1093/bja/81.5.718.
We have examined sensory block during lumbar epidural anaesthesia using a cutaneous current perception threshold (CPT) sensory testing device in 20 patients who received 10 ml of either 1% or 2% lidocaine (lignocaine). CPT at 2000, 250 and 5 Hz stimulation at the trigeminal (V), ninth thoracic (T9) and second lumbar (L2) dermatomes, and dermatomal levels of block to light touch, temperature and pinprick discrimination were measured before and every 5 min until 60 min after epidural lidocaine. There were significant differences between 1% and 2% epidural lidocaine in all CPT at T9 and L2, in addition to maximal cephalad spread of the three sensory modalities. After 2% lidocaine, all CPT increased significantly at T9 and L2. In contrast, only at 250 and 5 Hz for L2 did epidural block with 1% lidocaine produce significant increases in CPT. Maximal level of loss of touch sensation after 1% lidocaine was significantly lower than that of cold and pinprick sensations. We conclude that the dose of lidocaine affected intensity of sensory block during lumbar epidural anaesthesia. In addition, differential neural block resulting from epidural anaesthesia appeared to be associated with a differential effect on nerve fibres of different sizes.
我们使用皮肤电流感觉阈值（CPT）感觉测试设备，对20例接受10毫升1%或2%利多卡因（赛罗卡因）的患者在腰段硬膜外麻醉期间的感觉阻滞情况进行了检查。在硬膜外注射利多卡因前及注射后每5分钟直至60分钟，测量三叉神经（V）、胸9（T9）和腰2（L2）皮节在2000、250和5赫兹刺激下的CPT，以及轻触觉、温度觉和针刺觉辨别感觉阻滞的皮节水平。在T9和L2的所有CPT以及三种感觉模式的最大头端扩散方面，1%和2%硬膜外利多卡因之间存在显著差异。注射2%利多卡因后，T9和L2的所有CPT均显著增加。相比之下，1%利多卡因硬膜外阻滞仅在L2的250和5赫兹时使CPT产生显著增加。1%利多卡因后触觉丧失的最大水平显著低于冷觉和针刺觉。我们得出结论，利多卡因的剂量影响腰段硬膜外麻醉期间感觉阻滞的强度。此外，硬膜外麻醉导致的不同神经阻滞似乎与对不同大小神经纤维的不同影响有关。
