Department of Anaesthesia and Pain Medicine, Flinders Medical Centre, Bedford Park, SA 5042, Australia.
Br J Anaesth. 2011 Feb;106(2):183-8. doi: 10.1093/bja/aeq272. Epub 2010 Oct 14.
Prospective data on the use of prilocaine for ambulatory spinal anaesthesia remain limited. We compared the behaviour and characteristics of subarachnoid block using prilocaine and fentanyl with that of bupivacaine and fentanyl.
In a prospective, double-blind, randomized controlled trial, 50 patients undergoing elective ambulatory arthroscopic knee surgery received subarachnoid anaesthesia, with either prilocaine 20 mg and fentanyl 20 µg (Group P) or plain bupivacaine 7.5 mg and fentanyl 20 µg (Group B). Primary endpoints included times for onset of maximum sensory block level and regression of sensory block to L4, and also motor block at 1 and 2 h, and levels of haemodynamic stability. Comparisons between the groups were made by χ² test for proportions and the Mann-Whitney test for ordinal data. Time-to-event data were analysed by the Mann-Whitney test for uncensored data or the logrank test for censored data.
At 2 h, motor block in Group P had fully resolved in 86% of patients, compared with 27% in Group B (P<0.001). Median time to regression of sensory block to L4 was significantly shorter in Group P (97 min) than in Group B (280 min) (P<0.001). A clinically significant decrease in arterial pressure was more common in Group B (73%) than in Group P (32%) (P=0.004). Two patients in Group P required conversion to general anaesthesia, but for reasons unrelated to prilocaine itself.
The combination of prilocaine and fentanyl is a better alternative to that of low-dose bupivacaine and fentanyl, for spinal anaesthesia in ambulatory arthroscopic knee surgery.
有关轻比重布比卡因复合芬太尼用于门诊椎管内麻醉的前瞻性数据仍然有限。我们比较了轻比重布比卡因复合芬太尼与布比卡因复合芬太尼用于蛛网膜下腔阻滞的行为和特点。
在一项前瞻性、双盲、随机对照试验中，50 例行择期门诊膝关节镜手术的患者接受了蛛网膜下腔麻醉，分别使用 20mg 普鲁卡因和 20μg 芬太尼（P 组）或布比卡因 7.5mg 和 20μg 芬太尼（B 组）。主要终点包括最大感觉阻滞水平起效时间和感觉阻滞至 L4 的消退时间，以及 1 小时和 2 小时的运动阻滞程度，以及血液动力学稳定性水平。通过 χ²检验比较组间比例，通过 Mann-Whitney 检验比较等级数据。通过 Mann-Whitney 检验分析无删失数据的时间到事件数据，通过对数秩检验分析删失数据的时间到事件数据。
2 小时时，P 组 86%的患者运动阻滞完全缓解，而 B 组仅为 27%（P<0.001）。P 组感觉阻滞消退至 L4 的中位时间明显短于 B 组（97 分钟比 280 分钟）（P<0.001）。B 组（73%）比 P 组（32%）更常见动脉压有临床意义的下降（P=0.004）。P 组有 2 例患者需要转为全身麻醉，但与普鲁卡因本身无关。
轻比重布比卡因复合芬太尼用于门诊膝关节镜手术的蛛网膜下腔麻醉是一种比低剂量布比卡因复合芬太尼更好的选择。
