Yoos Jessica R, Kopacz Dan J
Department of Anesthesiology, Virginia Mason Clinic, Seattle, Washington.
Anesth Analg. 2005 Feb;100(2):566-572. doi: 10.1213/01.ANE.0000143356.17013.A1.
Ambulatory surgery continues to increase nationwide. Because spinal lidocaine is associated with transient neurologic symptoms, many clinicians have switched to small-dose bupivacaine for outpatient spinal anesthesia. However, bupivacaine often produces inadequate surgical anesthesia and has an unpredictable duration. Preservative-free 2-chloroprocaine (2-CP) has reemerged as an alternative for outpatient spinal anesthesia. We designed this double-blind, randomized, crossover, volunteer study to compare 40 mg of 2-CP with small-dose (7.5 mg) bupivacaine with measures of pinprick anesthesia, motor strength, tolerance to tourniquet and electrical stimulation, and simulated discharge criteria. Peak block height (2-CP average T7 [range T3-10]; bupivacaine average T9 [range T4-L1]), regression to L1 (2-CP 64 +/- 10 versus bupivacaine 87 +/- 41 min), and tourniquet tolerance (2-CP 52 +/- 11 versus bupivacaine 60 +/- 27 min) did not differ between drugs (P = 0.15, 0.12, and 0.40, respectively). However, time to simulated discharge (including time to complete block regression, ambulation, and spontaneous voiding) was significantly longer with bupivacaine (2-CP 113 +/- 14, bupivacaine 191 +/- 30 min, P = 0.0009). No subjects reported transient neurologic symptoms or other side effects. We conclude that spinal 2-CP provides adequate duration and density of block for ambulatory surgical procedures, and has significantly faster resolution of block and return to ambulation compared with 7.5 mg of bupivacaine.
门诊手术在全国范围内持续增加。由于脊髓利多卡因与短暂性神经症状相关,许多临床医生已改用小剂量布比卡因进行门诊脊髓麻醉。然而,布比卡因常常产生的手术麻醉效果不足,且作用持续时间不可预测。无防腐剂的2-氯普鲁卡因(2-CP)已重新成为门诊脊髓麻醉的一种替代药物。我们设计了这项双盲、随机、交叉、志愿者研究,以比较40毫克2-CP与小剂量(7.5毫克)布比卡因在针刺麻醉、运动强度、止血带耐受性和电刺激以及模拟出院标准方面的情况。药物之间的峰值阻滞高度(2-CP平均T7 [范围T3 - 10];布比卡因平均T9 [范围T4 - L1])、回归至L1的时间(2-CP为64±10分钟,布比卡因87±41分钟)以及止血带耐受性(2-CP为52±11分钟,布比卡因60±27分钟)并无差异(P分别为0.15、0.12和0.40)。然而,布比卡因组模拟出院时间(包括阻滞消退完成时间、行走和自主排尿时间)明显更长(2-CP为113±14分钟,布比卡因191±30分钟,P = 0.0009)。没有受试者报告短暂性神经症状或其他副作用。我们得出结论,脊髓注射2-CP为门诊手术提供了足够的阻滞持续时间和密度,与7.5毫克布比卡因相比,其阻滞消退和恢复行走的速度明显更快。
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