Kamphuis Ed T, Kuipers Peter W, van Venrooij Ger E, Kalkman Cor J
Department of Anesthesiology, Rijnstate Ziekenhuis, Postbus 9555, 6800 TA Arnhem, The Netherlands.
Anesth Analg. 2008 Dec;107(6):2073-8. doi: 10.1213/ane.0b013e318187bc0e.
Spinal local anesthetics interrupt the micturition reflex; bladder function remains impaired until sensory block had regressed to the S3 segment. Intrathecal opioids cause dose-dependent suppression of detrusor contractility. We studied the effects of spinal anesthesia with a combination of lidocaine and sufentanil on lower urinary tract function.
Filling cystometry was performed in 10 healthy young male patients undergoing elective lower limb orthopedic surgery. After baseline recordings, each patient received spinal anesthesia with 100 mg hyperbaric lidocaine combined with 20 microg sufentanil. In the postoperative phase, regressions of sensory and motor block were recorded and urodynamic measurements continued until the patient could void spontaneously without residual volume in the bladder.
The mean (SD) time to recovery of urge was 240 (37) min after spinal injection, but no patient was able to void at that time. Six patients experienced urge at the previously observed maximum bladder capacity when the sensory block had regressed to the second sacral segment (S2), in four patients to S3. Despite this urge, no detrusor contraction was recorded. The patients were able to completely empty the bladder 332 (52) min after spinal injection. The average time difference between recovery of urge and return of normal bladder emptying was 90 min.
Bladder contractility returns much later than recovery of sensory function in sacral dermatomes (S3) when hyperbaric lidocaine combined with sufentanil is used for spinal anesthesia.
脊髓局部麻醉药会中断排尿反射；膀胱功能在感觉阻滞消退至S3节段之前一直受损。鞘内注射阿片类药物会导致逼尿肌收缩力呈剂量依赖性抑制。我们研究了利多卡因和舒芬太尼联合脊髓麻醉对下尿路功能的影响。
对10例接受择期下肢骨科手术的健康年轻男性患者进行膀胱测压。在记录基线数据后，每位患者接受100mg高压利多卡因联合20μg舒芬太尼的脊髓麻醉。在术后阶段，记录感觉和运动阻滞的消退情况，并持续进行尿动力学测量，直到患者能够自主排尿且膀胱无残余尿量。
脊髓注射后平均（标准差）恢复尿意的时间为240（37）分钟，但此时没有患者能够排尿。6例患者在感觉阻滞消退至第二骶节段（S2）时，在之前观察到的最大膀胱容量时出现尿意，4例患者在感觉阻滞消退至S3时出现尿意。尽管有这种尿意，但未记录到逼尿肌收缩。患者在脊髓注射后332（52）分钟能够完全排空膀胱。恢复尿意与膀胱正常排空恢复之间的平均时间差为90分钟。
当使用高压利多卡因联合舒芬太尼进行脊髓麻醉时，膀胱收缩力的恢复比骶部皮节（S3）感觉功能的恢复要晚得多。
