Liu Fu-Chao, Liou Jiin-Tarng, Day Yuan-Ji, Li Allen H, Yu Huang-Ping
Department of Anesthesiology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Gueishan Township, Taoyuan County 333, Taiwan (R.O.C.).
Chang Gung Med J. 2009 Nov-Dec;32(6):643-9.
Administration of local anesthetics at body temperature has been reported to shorten the onset time of regional block; however, studies examining the effects of warmed lidocaine on the onset of epidural anesthesia are limited. Here, we ascertain whether warming lidocaine solution to body temperature shortens the time to onset of epidural anesthesia.
Eighty patients were randomly allocated into two groups of equal size. Both received 16 ml of lidocaine solution injected via the epidural route at the L4- 5 interspace, with one group receiving the solution at room temperature (RT, 18 degrees Celsius) and the other receiving the solution warmed to body temperature (BT, 36 degrees Celsius). Sensory blocks at the T10, T12, and L3 dermatomes, perianal region, and upper level dermatomes were assessed by pinprick and their onset times recorded. Patients with incomplete anal sensory block were excluded.
Seventy-seven patients were included for analysis. The pH value of the local anesthetic solution was significantly increased at BT compared to RT (6.57 +/- 0.11 vs. 6.47 +/- 0.11, p < 0.05). Significantly shorter onset times of sensory block were observed at the T12 (10.03 +/- 3.55 vs. 11.71 +/- 3.76 min) and L3 (7.49 +/- 3.19 vs. 9.92 +/- 3.46 min) dermatomes for the BT compared to the RT group (p < 0.005). The onset time of sensory block at the anal region was also shorter in the BT than the RT group (11.54 +/- 4.35 vs. 12.50 +/- 4.06 min, p < 0.05). No differences between groups with respect to gender, age, height, weight, visual analogue pain score, upper sensory level, or adverse events were observed.
Administration of lidocaine at BT compared to RT shortens the onset time of sensory block in epidural anesthesia with no associated adverse effects.
据报道，在体温下使用局部麻醉剂可缩短区域阻滞的起效时间；然而，研究温热利多卡因对硬膜外麻醉起效影响的研究有限。在此，我们确定将利多卡因溶液加热至体温是否能缩短硬膜外麻醉的起效时间。
80例患者被随机分为两组，每组人数相等。两组均通过硬膜外途径在L4 - 5间隙注射16 ml利多卡因溶液，一组接受室温（RT，18摄氏度）的溶液，另一组接受加热至体温（BT，36摄氏度）的溶液。通过针刺评估T10、T12和L3皮节、肛周区域及上位皮节的感觉阻滞情况，并记录其起效时间。肛门感觉阻滞不完全的患者被排除。
77例患者纳入分析。与RT组相比，BT组局部麻醉剂溶液的pH值显著升高（6.57±0.11对6.47±0.11，p<0.05）。与RT组相比，BT组在T12（10.03±3.55对11.71±3.76分钟）和L3（7.49±3.19对9.92±3.46分钟）皮节的感觉阻滞起效时间显著缩短（p<0.005）。BT组肛门区域的感觉阻滞起效时间也比RT组短（11.54±4.35对12.50±4.06分钟，p<0.05）。两组在性别、年龄、身高、体重、视觉模拟疼痛评分（VAS）、上位感觉平面或不良事件方面未观察到差异。
与室温下使用利多卡因相比，体温下使用利多卡因可缩短硬膜外麻醉感觉阻滞的起效时间，且无相关不良反应。
