Schröder W, Schwagmeier R, Schmidt A, Nolte H
Institut für Anaesthesiologie, Klinikum Minden.
Reg Anaesth. 1990 Sep;13(7):168-71.
The effect of spinal anesthesia with barbotage versus without barbotage on the spread of analgesia was investigated. For comparison, hyper- and isobaric bupivacaine 0.5% with adrenaline 1:200,000 was used. MATERIAL AND METHODS. Barbotage was accomplished as follows: after lumbar puncture 0.5 ml CSF was aspirated into the local anesthetic solution, followed by reinjection of 1.0 ml of the solution. This process was repeated six times. Sixty patients who were scheduled for urological or lower limb surgery under spinal anesthesia were selected for this study. Patients were each arbitrarily assigned to one of four groups (isobaric and hyperbaric, without and with barbotage). RESULTS. There was no statistically significant difference in the maximum level of sensory analgesia. The mean maximum level of sensory analgesia reached T9 (group 1), T8 (group 2), T9 (group 3) and T8 (group 4). Time to highest dermatome was significantly shorter with barbotage (groups 1-4: 19.0 min, 13.0 min, 18.7 min, 12.3 min). Times for regression of analgesia to T12 (mean maximum duration) were 142 (+/- 54.9) min, 164 (+/- 29.7) min, 130 (+/- 40.4) min and 144 (+/- 36.2) min (groups 1-4). Motor block grade 3 (Bromage) was achieved in significantly shorter times with barbotage than without. The shortest onset time was recorded with isobaric bupivacaine. The onset time of a complete motor block was 12.5 (+/- 5.5) min in group 1, 6.1 (+/- 2.9) min in group 2, 15.8 (+/- 4.7) min in group 3, and 11.7 (+/- 5.1) min in group 4. CONCLUSIONS. The results showed no significant differences between the maximum segmental sensory levels or duration of anesthesia observed with isobaric and with hyperbaric bupivacaine (with and without barbotage). Sufficient analgesia was obtained with barbotage and without barbotage. Uncontrolled cephalad spread of spinal anesthesia was not observed. Barbotage has the advantage of shortening time for spread to highest dermatome and the time to onset of complete motor block.
研究了有回抽与无回抽的脊髓麻醉对镇痛平面扩散的影响。为作比较，使用了含1:200,000肾上腺素的0.5%等比重和重比重布比卡因。材料与方法。回抽操作如下：腰椎穿刺后，将0.5 ml脑脊液吸入局部麻醉溶液中，然后再注入1.0 ml该溶液。此过程重复6次。本研究选取了60例计划在脊髓麻醉下进行泌尿外科或下肢手术的患者。患者被随机分配到四组之一（等比重和重比重，无回抽和有回抽）。结果。感觉镇痛的最高平面无统计学显著差异。感觉镇痛的平均最高平面在第1组达到T9、第2组达到T8、第3组达到T9、第4组达到T8。有回抽时到达最高皮节的时间显著缩短（第1 - 4组：19.0分钟、13.0分钟、18.7分钟、12.3分钟）。镇痛消退至T12的时间（平均最长持续时间）在第1 - 4组分别为142（±54.9）分钟、164（±29.7）分钟、130（±40.4）分钟和144（±36.2）分钟。有回抽时达到3级运动阻滞（布罗米奇分级）的时间明显短于无回抽时。等比重布比卡因的起效时间最短。第1组完全运动阻滞的起效时间为12.5（±5.5）分钟，第2组为6.1（±2.9）分钟，第3组为15.8（±4.7）分钟，第4组为11.7（±5.1）分钟。结论。结果显示，等比重和重比重布比卡因（有回抽和无回抽）在最大节段感觉平面或麻醉持续时间方面无显著差异。有回抽和无回抽均能获得充分镇痛。未观察到脊髓麻醉向头端的无控制扩散。回抽的优点是缩短了扩散至最高皮节的时间以及完全运动阻滞的起效时间。
