Department of Anesthesiology, Kaunas University of Medicine Hospital, Kaunas, LT 50009, Lithuania.
J Clin Anesth. 2009 Nov;21(7):474-81. doi: 10.1016/j.jclinane.2008.11.014.
To produce selective spinal anesthesia for adult anorectal surgery.
Double-blinded, randomized, controlled trial.
Operating room and postoperative recovery area.
152 adult, consecutive ASA physical status I, II, and III patients.
After patients underwent dural puncture in the sitting position at L3-L4 or L4-L5, 0.5% hyperbaric bupivacaine was injected over two minutes: Group S7.5 received 1.5 mL, Group S5 received 1.0 mL, and Group S4 0.8 mL. After sitting for 10 minutes, patients were positioned for surgery.
Rate of success, level and duration of sensory and motor block, time to voiding and ambulation, complications, and quality of anesthesia according to the patient and medical staff, were recorded.
Spinal block had a 98% rate of success. Mean level of sensory block was 10.4 +/- 1.7, 7.4 +/- 2.2, and 7.0 +/- 1.8 dermatomes in Groups S7.5, S5, and S4 (P < 0.01 S7.5 vs S5, and S7.5 vs S4). Mean duration of sensory block was 310.5 +/- 42.6, 255.9 +/- 43.7, and 228.8 +/- 34.8 min in Groups S7.5, S5, and S4 (P < 0.01 S7.5 vs S5, S7.5 vs S4, and S5 vs S4). Motor block was Bromage score 2-3 in 70.5% of Group S7.5 patients versus Bromage score 0-1 in 97.3% of Group S5 and 92.1% of Group S4 patients (P < 0.05).
A dose of 4 mg of hyperbaric bupivacaine produces a similar level of sensory and motor block as a 5 mg dose but with shorter duration and faster recovery.
为成人肛肠手术提供选择性椎管内麻醉。
双盲、随机、对照试验。
手术室和术后恢复区。
152 例连续 ASA 体格状况 I、II 和 III 级的成年患者。
患者取坐位在 L3-L4 或 L4-L5 行硬脊膜穿刺后，于 2 分钟内注入 0.5%重比重布比卡因：S7.5 组 1.5 mL，S5 组 1.0 mL，S4 组 0.8 mL。坐位 10 分钟后，患者改手术位。
记录成功率、感觉和运动阻滞的水平和持续时间、排尿和活动时间、并发症以及患者和医务人员对麻醉质量的评价。
脊髓阻滞成功率为 98%。S7.5、S5 和 S4 组感觉阻滞的平均水平分别为 10.4±1.7、7.4±2.2 和 7.0±1.8 个皮节（P<0.01 S7.5 与 S5 及 S7.5 与 S4 相比）。S7.5、S5 和 S4 组感觉阻滞的平均持续时间分别为 310.5±42.6、255.9±43.7 和 228.8±34.8 min（P<0.01 S7.5 与 S5、S7.5 与 S4 及 S5 与 S4 相比）。S7.5 组 70.5%的患者运动阻滞为 Bromage 评分 2-3，而 S5 组 97.3%和 S4 组 92.1%的患者运动阻滞为 Bromage 评分 0-1（P<0.05）。
4 mg 重比重布比卡因剂量产生的感觉和运动阻滞水平与 5 mg 剂量相似，但持续时间更短，恢复更快。
