Stevens R A, Chester W L, Artuso J D, Bray J G, Nellestein J A
Department of Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Reg Anesth. 1991 Jul-Aug;16(4):199-203.
The incidence, character and treatment of backache associated with epidural anesthesia (EA) using 3% chloroprocaine (2-CP, Nesacaine-MPF) were observed in ten volunteers undergoing a study of the effects of EA upon plasma catecholamines. Three levels of epidural analgesia were sequentially sought, T10, T4 and C8, in ascending order. Each block was allowed to fully dissipate prior to the next injection. For the first, second and third injections, 15-20 ml, 25-35 ml and 52-60 ml, respectively, of 3% 2-CP were injected via an epidural catheter. Mean total volume of 2-CP injected was 103 ml (range, 92-115 ml) over seven hours. Back pain was first reported after as little as 15 ml (mean +/- SEM, 24.0 +/- 3.9 ml; range, 15-45 ml). The pain was described as a dull ache deep in the lumbar back, ranging in severity from mild to severe. No profound spasm of the erector spinae muscles was observed. Mean verbal analog scale pain scores after regression of the first, second and third blocks were 2.2, 4.3 and 6.5, respectively. Epidural fentanyl (100-200 micrograms) was effective in providing rapid relief of the pain. Large doses or possibly repeated injections of epidural Nesacaine-MPF are associated with an increased incidence and severity of postanesthesia lumbar back pain.
在一项关于硬膜外麻醉（EA）对血浆儿茶酚胺影响的研究中，观察了10名志愿者使用3%氯普鲁卡因（2 - CP，耐乐品 - MPF）进行EA时背痛的发生率、特征及治疗情况。按升序依次寻求三个硬膜外镇痛平面，即T10、T4和C8。在下一次注射前，让每个阻滞充分消退。对于第一次、第二次和第三次注射，分别通过硬膜外导管注入15 - 20 ml、25 - 35 ml和52 - 60 ml的3% 2 - CP。7小时内注入2 - CP的平均总量为103 ml（范围92 - 115 ml）。在注入仅15 ml（平均±标准误，24.0±3.9 ml；范围15 - 45 ml）后就首次报告背痛。疼痛被描述为下腰部深处的隐痛，严重程度从轻度到重度不等。未观察到竖脊肌的严重痉挛。第一次、第二次和第三次阻滞消退后的平均视觉模拟评分疼痛分数分别为2.2、4.3和6.5。硬膜外注射芬太尼（100 - 200微克）能有效快速缓解疼痛。大剂量或可能重复注射硬膜外耐乐品与麻醉后下腰痛的发生率和严重程度增加有关。
