Manassero A, Bossolasco M, Ugues S, Bailo C, Liarou C, Coletta G
S. Croce e Carle Hospital, Cuneo, Italy -
Minerva Anestesiol. 2014 Jun;80(6):685-91. Epub 2013 Nov 13.
Hyperbaric 2% prilocaine produces a faster onset and shorter duration of spinal anesthesia than a plain solution. The anesthetic profile could be improved by restricting the block to the operative side. We compared unilateral versus conventional bilateral spinal anesthesia with hyperbaric 2% prilocaine in day-case patients undergoing unilateral inguinal herniorrhaphy.
Eighty patients were randomly assigned to receive either conventional bilateral (N.=40) or unilateral (N.=40) spinal anesthesia with 50 mg hyperbaric prilocaine 2%. In the unilateral group, lateral decubitus was maintained for 10 minutes. Sensory and motor block courses, time to first micturition, and side effects were recorded.
On the operated side, the highest sensory block was T8 (T12-T2) in the unilateral and T9 (T11-T4) in the bilateral group (P=0.0328); the time to motor (115 ± 26 min in the unilateral and 108 ± 24 min in the bilateral groups, P=0.2350) and sensory (156 ± 30 min in the unilateral and 158 ± 26 min in the bilateral groups, P=0.7550) block resolution was similar in both groups. On the non-operated side, the unilateral group had a faster motor (64 ± 48, P<0.001) and sensory (120 ± 47, P<0.001) time to block resolution than the conventional group. Restricted unilateral motor and sensory block was achieved in 30% and 12.5% of patients, respectively. Time to voiding was shorter in the unilateral than in the conventional group (220 ± 47 vs. 249 ± 51 min, respectively, P=0.0104). There were no significant differences in adequacy for surgery and side effects between the groups.
In day-case inguinal herniorrhaphy, attempting unilateral spinal anesthesia with 50 mg hyperbaric 2% prilocaine produced faster time to voiding.
与普通溶液相比，2% 高压布比卡因产生的脊髓麻醉起效更快、持续时间更短。通过将阻滞限制在手术侧，麻醉效果可能会得到改善。我们比较了在日间接受单侧腹股沟疝修补术的患者中，单侧与传统双侧脊髓麻醉使用 2% 高压布比卡因的情况。
80 例患者被随机分配接受 50 毫克 2% 高压布比卡因的传统双侧（N = 40）或单侧（N = 40）脊髓麻醉。在单侧组，侧卧位维持 10 分钟。记录感觉和运动阻滞过程、首次排尿时间及副作用。
在手术侧，单侧组最高感觉阻滞平面为 T8（T12 - T2），双侧组为 T9（T11 - T4）（P = 0.0328）；两组运动（单侧组 115 ± 26 分钟，双侧组 108 ± 24 分钟，P = 0.2350）和感觉（单侧组 156 ± 30 分钟，双侧组 158 ± 26 分钟，P = 0.7550）阻滞消退时间相似。在非手术侧，单侧组运动（64 ± 48，P < 0.001）和感觉（120 ± 47，P < 0.001）阻滞消退时间比传统组更快。分别有 30% 和 12.5% 的患者实现了受限的单侧运动和感觉阻滞。单侧组排尿时间比传统组短（分别为 220 ± 47 分钟和 249 ± 51 分钟，P = 0.0104）。两组之间手术充分性和副作用无显著差异。
在日间腹股沟疝修补术中，尝试使用 50 毫克 2% 高压布比卡因进行单侧脊髓麻醉可使排尿时间更快。
