Nakayama M, Yamamoto J, Ichinose H, Yamamoto S, Kanaya N, Namiki A
Sapporo Medical University School of Medicine, Department of Anesthesiology, Japan.
Eur J Anaesthesiol. 2002 Nov;19(11):808-11. doi: 10.1017/s0265021502001308.
The effects of altering the concentration of a local anaesthetic on the development of epidural anaesthesia in pregnant females are unclear. We compared the anaesthetic effects of a constant dose of two different concentrations of epidural lidocaine for Caesarean section.
After Institutional Review Board approval and informed consent, patients undergoing elective Caesarean section were randomized to receive either lidocaine 1% 30 mL (+epinephrine 5 microg mL(-1)) or lidocaine 2% 15 mL (+epinephrine 5 microg mL(-1)) (n = 20 each) for epidural anaesthesia at the L1-L2 interspace. The spread of the sensory block to pinprick and the degree of motor block (modified Bromage scale) were measured at 5, 10, 15, 20 and 30 min after injection.
No significant differences in the progression of analgesia and motor block were observed at any time between 1 and 2% lidocaine. The maximum cephalad spread was observed 30 min after injection; the median was at T4 (range T3-T5) and at T4 (range T3-T6) for lidocaine 1 and 2%, respectively.
The same doses but different volumes of lidocaine 1 and 2% produced comparable anaesthetic effects in pregnant females. The effects of epidural anaesthesia depend primarily on the total dose of the local anaesthetic.
改变局部麻醉药浓度对妊娠女性硬膜外麻醉效果的影响尚不清楚。我们比较了剖宫产术中两种不同浓度的恒量硬膜外利多卡因的麻醉效果。
经机构审查委员会批准并获得知情同意后，择期剖宫产患者被随机分为两组，分别于L1-L2间隙接受硬膜外麻醉，一组给予1%利多卡因30 mL（+肾上腺素5 μg/mL），另一组给予2%利多卡因15 mL（+肾上腺素5 μg/mL）（每组n = 20）。在注射后5、10、15、20和30分钟测量针刺感觉阻滞的范围及运动阻滞程度（改良Bromage评分）。
1%和2%利多卡因在任何时间的镇痛和运动阻滞进展均无显著差异。注射后30分钟观察到最大头侧扩散范围；1%利多卡因的中位数在T4（范围T3-T5），2%利多卡因的中位数在T4（范围T3-T6）。
相同剂量但不同体积的1%和2%利多卡因在妊娠女性中产生了相当的麻醉效果。硬膜外麻醉效果主要取决于局部麻醉药的总剂量。
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