Kopacz D J, Mulroy M F
Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington 98111.
Reg Anesth. 1990 Jan-Feb;15(1):19-25.
Lumbar epidural anesthesia with 20 ml of either 3% 2-chloroprocaine (C), 1.5% lidocaine (L), or 1.5% mepivacaine (M) with epinephrine was studied in 84 outpatients undergoing surgery (extracorporeal shock wave lithotripsy (ESWL]. The average duration of the procedure was 31.9 minutes. The total duration of sensory anesthesia was 133 +/- 28 minutes (C), 182 +/- 38 (L), and 247 +/- 42 (M) (p less than 0.05). Times to discharge were 269 +/- 62 minutes (C), 284 +/- 62 (L), and 357 +/- 71 (M). The time to discharge with M, almost six hours, was significantly longer than with C or L. There was a trend to an increasing rate of unplanned overnight hospital admission with increasing duration of the local anesthetic drug employed. Continuous epidural anesthesia with C, L or M appears safe and effective for outpatient surgical procedures such as ESWL. In contrast to previous understanding, mepivacaine produces significantly longer anesthesia and recovery times and may not be optimal for outpatient epidural use.
在84例接受体外冲击波碎石术（ESWL）的门诊手术患者中，研究了使用含肾上腺素的20毫升3%氯普鲁卡因（C）、1.5%利多卡因（L）或1.5%甲哌卡因（M）进行腰段硬膜外麻醉的情况。手术的平均时长为31.9分钟。感觉麻醉的总时长分别为：氯普鲁卡因组133±28分钟，利多卡因组182±38分钟，甲哌卡因组247±42分钟（p<0.05）。出院时间分别为：氯普鲁卡因组269±62分钟，利多卡因组284±62分钟，甲哌卡因组357±71分钟。甲哌卡因组的出院时间近6小时，明显长于氯普鲁卡因组和利多卡因组。随着所用局部麻醉药时长增加，非计划内过夜住院率有上升趋势。使用氯普鲁卡因、利多卡因或甲哌卡因进行持续硬膜外麻醉，对于ESWL这类门诊手术似乎安全有效。与之前的认知相反，甲哌卡因产生的麻醉和恢复时间明显更长，可能并非门诊硬膜外使用的最佳选择。
