Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland.
Eur J Anaesthesiol. 2012 Jan;29(1):22-7. doi: 10.1097/EJA.0b013e32834a11be.
Low-dose mixture of hyperbaric bupivacaine and fentanyl is commonly used in day-case spinal anaesthesia. Using hyperbaric articaine, the onset may be faster and duration more predictable than with bupivacaine-fentanyl. We compared these two spinal anaesthetics for inguinal herniorrhaphy.
Adult patients were randomised to spinal anaesthesia with hyperbaric articaine 84 mg (group A, n = 40) or hyperbaric bupivacaine 7 mg along with fentanyl 10 μg (group B+F, n = 40). A blinded observer tested the block characteristics. Aiming at sensory block spread to T10 dermatome, the operating table was tilted head-end up or down 10° (once or twice), as required. Postoperative telephone interviews were performed.
All patients in group A had a sensory block to T10 in a median time of 4 (range 2-20) min. In group B+F, the median onset time of T10 analgesia was 10 (2-30) min (P < 0.001), but T10 analgesia was not reached in seven of 40 B+F patients. A head-up tilt was needed in 37 of 40 group A patients to prevent from too extensive cephalad spread of block, and 34 of 40 group B+F patients needed a head-down tilt to enhance cephalad spread of analgesia. To treat hypotension, 6.4 mg of ephedrine was required, on average, in group A and 1.8 = mg in group B+F (P = 0.01). Median time to recovery from sensory block was significantly shorter in group A (2.5 h) than in group B+F (3 h; P = 0.002). General anaesthesia was needed in three patients (group A, two patients: sensory block too short; group B+F, one patient: sensory block too limited).
Hyperbaric articaine leads to faster onset of block and faster recovery than bupivacaine along with fentanyl. Hypotension is more common with articaine. The onset and extension of the spinal block are unpredictable when using these techniques.
小剂量重比重布比卡因和芬太尼混合液常用于日间手术的椎管内麻醉。与布比卡因-芬太尼相比，使用重比重盐酸阿替卡因起效更快，作用持续时间更可预测。我们比较了这两种椎管内麻醉用于腹股沟疝修补术的效果。
成年患者随机分为蛛网膜下腔麻醉重比重盐酸阿替卡因 84 mg 组（A 组，n = 40）或重比重布比卡因 7 mg 加芬太尼 10 μg 组（B+F 组，n = 40）。一位盲法观察者测试阻滞特征。为了使感觉阻滞达到 T10 皮节，根据需要将手术台头端向上或向下倾斜 10°（一次或两次）。术后通过电话进行访谈。
A 组所有患者中位时间 4 分钟（范围 2-20 分钟）达到 T10 感觉阻滞。B+F 组 T10 镇痛的中位起效时间为 10 分钟（2-30 分钟）（P < 0.001），但 40 例 B+F 患者中有 7 例未达到 T10 镇痛。为防止阻滞平面过于广泛向头侧扩散，40 例 A 组患者中有 37 例需要头高位倾斜，而 40 例 B+F 患者中有 34 例需要头低位倾斜以增强镇痛的向头侧扩散。为治疗低血压，A 组平均需要 6.4 mg 麻黄碱，B+F 组需要 1.8 = mg（P = 0.01）。A 组感觉阻滞恢复中位时间明显短于 B+F 组（2.5 小时比 3 小时；P = 0.002）。3 例患者（A 组 2 例：感觉阻滞太短；B+F 组 1 例：感觉阻滞太局限）需要全身麻醉。
重比重盐酸阿替卡因的阻滞起效快于布比卡因-芬太尼，恢复也更快。阿替卡因引起的低血压更常见。使用这些技术时，脊髓阻滞的起始和扩展不可预测。
