Hanks R Kyle, Pietrobon Ricardo, Nielsen Karen C, Steele Susan M, Tucker Marcy, Warner David S, King Kathryn P, Klein Stephen M
School of Medicine, and Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA.
Anesth Analg. 2006 Feb;102(2):588-92. doi: 10.1213/01.ane.0000189552.85175.db.
The physiologic changes that occur with advancing age and their effect on the duration of peripheral nerve blocks have yet to be defined. We prospectively studied the duration of sciatic nerve block using mepivacaine in younger and older patients. Eighty ASA physical status I-III patients, aged 18-35 (n = 40) or 55-80 (n = 40) yr, having outpatient knee arthroscopy with a femoral block and a standardized sciatic nerve block were enrolled; 37 in each group completed the study. All patients received a Labat sciatic nerve block using 20 mL of 1.0% mepivacaine with 0.1 mEq/mL sodium bicarbonate and 1:400,000 (2.5 microg/mL) epinephrine and a femoral nerve block. The duration of sensory block (sensation of pinprick, temperature, and vibration), motor block (plantar and dorsi flexion), and complete sensory and motor block in the sciatic nerve distribution of the operative extremity were measured. The time for complete return of both sensory and motor function was longer in the older group, 329 +/- 47 min compared with 306 +/- 46 min (mean +/- sd) in the younger group (P = 0.04). The difference was small under the conditions of this study and would not be perceived clinically. Age also increased the time to return of vibratory sensation (younger = 292 +/- 58 min, older = 257 +/- 50 min; P = 0.007). The other measurements did not differ between groups. We conclude that age may affect peripheral nerve blocks and that more investigation is needed to determine the pharmacologic, physiologic, and chronologic factors behind these findings.
随着年龄增长而发生的生理变化及其对外周神经阻滞持续时间的影响尚未明确。我们前瞻性地研究了在年轻和老年患者中使用甲哌卡因进行坐骨神经阻滞的持续时间。80例美国麻醉医师协会（ASA）身体状况为I-III级、年龄在18-35岁（n = 40）或55-80岁（n = 40）的患者，因门诊膝关节镜手术接受了股神经阻滞和标准化的坐骨神经阻滞；每组37例患者完成了研究。所有患者均接受了使用20 mL含0.1 mEq/mL碳酸氢钠和1:400,000（2.5 μg/mL）肾上腺素的1.0%甲哌卡因进行的拉巴特坐骨神经阻滞以及股神经阻滞。测量了感觉阻滞（针刺、温度和振动感觉）、运动阻滞（足跖屈和背屈）以及手术肢体坐骨神经分布区域的完全感觉和运动阻滞的持续时间。老年组感觉和运动功能完全恢复的时间更长，分别为329±47分钟，而年轻组为306±46分钟（平均值±标准差）（P = 0.04）。在本研究条件下，差异较小，临床难以察觉。年龄也增加了振动感觉恢复的时间（年轻组 = 292±58分钟，老年组 = 257±50分钟；P = 0.007）。其他测量结果在两组之间无差异。我们得出结论，年龄可能影响外周神经阻滞，需要更多研究来确定这些发现背后的药理学、生理学和时间因素。
