Etezadi Farhad, Karimi Yarandi Kourosh, Ahangary Aylar, Shokri Hajar, Imani Farsad, Safari Saeid, Khajavi Mohammad Reza
Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Anesth Pain Med. 2013 Spring;2(4):154-8. doi: 10.5812/aapm.6916. Epub 2013 Mar 26.
The incidence of transient neurologic symptoms (TNS) after spinal anesthesia with lidocaine is reported as high as 40%.
This prospective clinical trial was designed to determine the incidence of TNS in patients who underwent spinal anesthesia with two different needles, in two different surgical positions.
The present randomized clinical trial was conducted on 250 patients (ASA I-II), who were candidates for surgery in supine or lithotomy positions. According to the needle type (Sprotte or Quincke) and local anesthetics (lidocaine and bupivacaine) all patients were randomly divided into four groups. After performing spinal anesthesia in sitting position, the position was changed into supine or lithotomy, according to surgical procedure. The patients were observed for complications of spinal anesthesia during the first five post-operative days. The primary end-point for this trial was to recognize the incidence of TNS among the four groups. Our secondary objective was to evaluate the effect of patient's position, needle type, and duration of surgery on the development of TNS following spinal anesthesia.
TNS was most commonly observed when lidocaine was used as anesthetic drug (P = 0.003). The impact of needle type, was not significant (P = 0.7). According to multivariate analysis, the duration of surgery was significantly lower in cases suffering from TNS (P = 0.04). Also, the risk of TNS increased following surgeries performed in lithotomy position (P = 0.00).
According to the results of this clinical study, spinal anesthesia with lidocaine, and the lithotomy position in surgery increased the risk of TNS.
据报道，利多卡因蛛网膜下腔麻醉后短暂性神经症状（TNS）的发生率高达40%。
本前瞻性临床试验旨在确定在两种不同手术体位下使用两种不同穿刺针进行蛛网膜下腔麻醉的患者中TNS的发生率。
本随机临床试验纳入了250例（ASA I-II级）拟行仰卧位或截石位手术的患者。根据穿刺针类型（Sprotte针或Quincke针）和局部麻醉药（利多卡因和布比卡因）将所有患者随机分为四组。坐位实施蛛网膜下腔麻醉后，根据手术步骤将体位改为仰卧位或截石位。术后前五天观察患者蛛网膜下腔麻醉的并发症。本试验的主要终点是确定四组中TNS的发生率。次要目标是评估患者体位、穿刺针类型和手术时间对蛛网膜下腔麻醉后TNS发生的影响。
当使用利多卡因作为麻醉药物时，最常观察到TNS（P = 0.003）。穿刺针类型的影响不显著（P = 0.7）。多因素分析显示，发生TNS的患者手术时间显著缩短（P = 0.04）。此外，截石位手术时TNS的风险增加（P = 0.00）。
根据本临床研究结果，利多卡因蛛网膜下腔麻醉及手术中的截石位会增加TNS的风险。
