Bodily M N, Carpenter R L, Owens B D
Department of Anesthesiology, Virginia Mason Medical Center, Seattle, WA 98111.
Can J Anaesth. 1992 Oct;39(8):770-3. doi: 10.1007/BF03008286.
The efficacy of subarachnoid injection of 8 ml lidocaine 0.5% was assessed in ten outpatients having perirectal surgery in the jackknife position. This solution is hypobaric, with a baricity 0.9985 +/- 0.0003 (mean +/- SD). Injections were made with the patient in the surgical position (with the upper torso at a 15 degrees downward inclination). Sensory level was tested by pinprick. Times to two-segment regression, to complete resolution of sensory analgesia, to urination, and to discharge from the recovery room were recorded. All injections produced effective anaesthesia for surgery. Lidocaine 0.5% behaves clinically as a hypobaric solution. Dermatomal levels remained low (T11 to L5) while the patients were in the surgical position (head down), but rose two to six dermatomes if the patient's head was elevated after surgery. Time to two-segment regression was 97 +/- 36 min, time until regression to S1 was 116 +/- 22 min, time to complete resolution of sensory blockade was 151 +/- 23 min, time to urination was 197 +/- 64 min, and time to discharge from the recovery room was 205 +/- 45 min. Lidocaine 0.5% provides effective spinal anaesthesia of short duration appropriate for outpatient surgical procedures. Dermatomal sensory spread of anaesthesia, and our measurements of specific gravity, indicate that this solution is hypobaric. It appears that changes in position can alter the spread of analgesia for at least one hour after injection and, thus, we caution against elevating the patient's head in the immediate postoperative period.
对10例采用折刀位进行直肠周围手术的门诊患者，评估了蛛网膜下腔注射8毫升0.5%利多卡因的效果。该溶液为低比重溶液，比重为0.9985±0.0003（均值±标准差）。在患者处于手术体位（上半身向下倾斜15度）时进行注射。通过针刺测试感觉平面。记录两段回归时间、感觉镇痛完全消退时间、排尿时间和从恢复室出院时间。所有注射均产生了有效的手术麻醉效果。0.5%利多卡因在临床上表现为低比重溶液。当患者处于手术体位（头低位）时，皮节平面保持较低（T11至L5），但如果术后抬高患者头部，皮节平面会上升两到六个皮节。两段回归时间为97±36分钟，回归至S1的时间为116±22分钟，感觉阻滞完全消退时间为151±23分钟，排尿时间为197±64分钟，从恢复室出院时间为205±45分钟。0.5%利多卡因可提供适用于门诊手术的短时效有效脊髓麻醉。麻醉的皮节感觉扩散以及我们对比重的测量表明该溶液为低比重溶液。似乎注射后至少一小时内，体位变化会改变镇痛范围，因此，我们提醒术后即刻不要抬高患者头部。
