Kamiya Yoshinori, Kikuchi Tatsuaki, Inagawa Gaku, Miyazaki Hiroshi, Miura Masashi, Morita Satoshi, Goto Takahisa
Department of Anesthesiology, Chigasaki Municipal Hospital, Chigasaki, Kanagawa, Japan.
Anesthesiology. 2009 May;110(5):1127-32. doi: 10.1097/ALN.0b013e31819daf15.
In this study, lidocaine concentrations in cerebrospinal fluid (CSF) at different interspaces were measured with or without preceding spinal anesthesia, 10 min after epidural injection of lidocaine, to investigate the effects of preceding meningeal puncture on CSF concentrations of epidurally administered local anesthetic.
Sixty patients scheduled to receive combined spinal-epidural anesthesia were randomly allocated to receive either spinal anesthesia first (group CSEA) or epidural lidocaine first (group Epi). Each group was divided into three subgroups in which the site of epidural cannulation and spinal tap were separated by one, three, or five interspaces (sets I, II, and III, respectively). CSF was collected from the L4-L5 interspace 10 min after 10 ml lidocaine, 1%, was administered epidurally. In group Epi, CSF was collected after epidural administration of lidocaine and before spinal anesthesia. In group CSEA, spinal anesthesia was performed at the L3-L4 interspace after epidural cannulation and epidural lidocaine was administered postoperatively, after which CSF was sampled.
Lidocaine concentrations in CSF were significantly higher with increasing proximity of epidural injection site to CSF collection site in both groups. There were no significant differences in CSF lidocaine concentrations between group CSEA and group Epi in set I, although lidocaine concentrations were significantly higher in group CSEA set II and III patients.
Lidocaine concentration in CSF was similar with or without preceding meningeal puncture beneath the epidural administration site.
在本研究中，在硬膜外注射利多卡因后10分钟，测量有无先行脊髓麻醉情况下不同椎间隙脑脊液（CSF）中的利多卡因浓度，以研究先行的脑膜穿刺对硬膜外给予局部麻醉药脑脊液浓度的影响。
60例计划接受腰麻 - 硬膜外联合麻醉的患者被随机分配，分别先接受脊髓麻醉（CSEA组）或先接受硬膜外利多卡因（Epi组）。每组再分为三个亚组，其中硬膜外置管部位与腰穿部位相隔一个、三个或五个椎间隙（分别为I组、II组和III组）。在硬膜外给予1% 10 ml利多卡因10分钟后，从L4 - L5椎间隙采集脑脊液。在Epi组，在硬膜外给予利多卡因后且在脊髓麻醉前采集脑脊液。在CSEA组，在硬膜外置管后于L3 - L4椎间隙进行脊髓麻醉，术后给予硬膜外利多卡因，之后采集脑脊液样本。
两组中，随着硬膜外注射部位与脑脊液采集部位距离的缩短，脑脊液中的利多卡因浓度显著升高。在I组中，CSEA组和Epi组脑脊液利多卡因浓度无显著差异，尽管CSEA组II组和III组患者的利多卡因浓度显著更高。
在硬膜外给药部位下方，有无先行脑膜穿刺时脑脊液中的利多卡因浓度相似。
