Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Mc Laughlin Pavilion 2-405, 399 Bathurst Street, Toronto, ON, M5T-2S8, Canada.
Can J Anaesth. 2010 Jan;57(1):32-8. doi: 10.1007/s12630-009-9207-6. Epub 2009 Oct 24.
The foremost limitation of local anesthetic solutions for spinal anesthesia in the outpatient setting is prolonged motor blockade and delayed ambulation. The purpose of this study was to determine if the addition of intrathecal fentanyl to low-dose spinal mepivacaine provides adequate anesthesia with shorter duration of functional motor blockade for ambulatory knee surgery compared with spinal mepivacaine alone.
Following institutional review board approval and informed consent, 34 patients undergoing unilateral knee arthroscopy were enrolled in this study. The patients were randomly assigned to receive either 30 mg of isobaric mepivacaine 1.5% plus fentanyl 10 microg (M + F group) or 45 mg of isobaric mepivacaine 1.5% alone (M group) intrathecally. Postoperatively, the times to achieve sensory block regression to the S1 dermatome and to attain functional motor block recovery enabling ambulation were recorded. All assessments were blinded.
The time to completion of Phase I recovery was shorter in the M + F group (104.6 +/- 28.4 min) than in the M group (129.1 +/- 30.4 min; P = 0.023). Regression of sensory blockade to S1 was earlier in the M + F group (118.4 +/- 53.5 min) than in the M group (169.7 +/- 38.9 min; P = 0.003). Patients in the M + F group (176.4 +/- 40.3 min) were able to ambulate significantly earlier than those in the M group (205.6 +/- 31.4 min; P = 0.025). No cases of transient or persistent neurological dysfunction were noted.
When compared with 45 mg isobaric mepivacaine 1.5%, an intrathecal dose of 30 mg isobaric mepivacaine 1.5% plus 10 microg fentanyl produces reliable anesthesia, hastens block regression, shortens stay in Phase I recovery, and enables earlier ambulation for patients undergoing unilateral knee arthroscopy (Registration no. NCT00803725).
在门诊环境下，局部麻醉溶液用于脊髓麻醉的最主要限制是运动阻滞时间延长和活动延迟。本研究的目的是确定鞘内给予芬太尼是否可以与单独使用低剂量脊髓甲哌卡因相比，为膝关节手术提供足够的麻醉，且运动阻滞的功能持续时间更短。
在获得机构审查委员会批准和知情同意后，34 名接受单侧膝关节镜检查的患者被纳入本研究。这些患者被随机分配接受 30mg 等比重甲哌卡因 1.5%加芬太尼 10μg（M+F 组）或 45mg 等比重甲哌卡因 1.5%（M 组）鞘内注射。术后记录达到感觉阻滞消退至 S1 皮节和达到可进行活动的功能运动阻滞恢复的时间。所有评估均为盲法。
M+F 组（104.6+/-28.4 分钟）完成第 I 相恢复的时间短于 M 组（129.1+/-30.4 分钟；P=0.023）。M+F 组感觉阻滞消退至 S1 的时间早于 M 组（118.4+/-53.5 分钟）（169.7+/-38.9 分钟；P=0.003）。M+F 组（176.4+/-40.3 分钟）患者能够更早地进行活动，而 M 组（205.6+/-31.4 分钟；P=0.025）。未观察到一过性或持续性神经功能障碍。
与 45mg 等比重甲哌卡因 1.5%相比，鞘内给予 30mg 等比重甲哌卡因 1.5%加 10μg 芬太尼可产生可靠的麻醉效果，加快阻滞消退，缩短第 I 相恢复时间，并使接受单侧膝关节镜检查的患者更早活动（注册号：NCT00803725）。
