Kim Hyo-Jin, Kim Won Ho, Lim Hyung Woo, Kim Jie Ae, Kim Duk-Kyung, Shin Byung Seop, Sim Woo Seog, Hahm Tae Soo, Kim Chung Su, Lee Sangmin M
Department of Anesthesiology and Pain Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
PLoS One. 2015 Apr 21;10(4):e0124264. doi: 10.1371/journal.pone.0124264. eCollection 2015.
The influence of body-mass index (BMI) on spinal anesthesia is still controversial, with discrepant results reported in previous studies. To compare spinal anesthesia in obese and non-obese subjects, the anesthesia profiles in patients who underwent spinal anesthesia using intrathecal hyperbaric bupivacaine were compared. A total of 209 patients undergoing elective total knee replacement arthroplasty (TKRA) surgery under spinal anesthesia were divided into an NO (non-obese) group (BMI < 30 kg/m2, n = 141) and an O (obese) group (BMI ≥ 30 kg/m2, n = 68). Anesthesia was deemed successful if a bilateral T12 sensory block occurred within 15 minutes of intrathecal drug administration, and if the level of sensory block was higher than T12 when the surgery ended. Logistic regression analysis with multiple variables known to influence spinal anesthesia was performed to identify which parameters independently determined the spinal anesthesia outcome. Similar doses of bupivacaine were administered to the NO and O groups. The incidence of anesthesia failure was significantly lower in the O group [n = 43 (30.5%) in the NO group vs. n = 10 (18.9%) in the O group, p = 0.014]. The independent predictors for successful anesthesia in all patients were dose of hyperbaric bupivacaine [odds ratio (OR) 2.12, 95% CI: 1.64-2.73] and obese status (BMI ≥ 30 kg/m2, OR 2.86, 95% CI: 1.25-6.52). Time to first report of postoperative pain and time to first self-void were significantly longer in the O group. These results suggest that the duration of block with hyperbaric bupivacaine is prolonged in obese patients and obesity is independently associated with spinal anesthesia outcomes, as is bupivacaine dosage. A further study enrolling patients with morbid obesity and using a fixed bupivacaine dosage is required to confirm the effect of obesity on spinal anesthesia.
体重指数（BMI）对脊髓麻醉的影响仍存在争议，以往研究报告的结果不一。为比较肥胖与非肥胖受试者的脊髓麻醉情况，对使用鞘内高压布比卡因进行脊髓麻醉的患者的麻醉情况进行了比较。共有209例在脊髓麻醉下接受择期全膝关节置换术（TKRA）的患者被分为NO（非肥胖）组（BMI < 30 kg/m²，n = 141）和O（肥胖）组（BMI≥30 kg/m²，n = 68）。如果在鞘内给药后15分钟内出现双侧T12感觉阻滞，且手术结束时感觉阻滞平面高于T12，则认为麻醉成功。对已知影响脊髓麻醉的多个变量进行逻辑回归分析，以确定哪些参数独立决定脊髓麻醉结果。NO组和O组给予相似剂量的布比卡因。O组麻醉失败的发生率显著较低[NO组n = 43（30.5%），O组n = 10（18.9%），p = 0.014]。所有患者麻醉成功的独立预测因素是高压布比卡因剂量[比值比（OR）2.12，95%可信区间：1.64 - 2.73]和肥胖状态（BMI≥30 kg/m²，OR 2.86，95%可信区间：1.25 - 6.52）。O组术后首次报告疼痛的时间和首次自行排尿的时间明显更长。这些结果表明，肥胖患者使用高压布比卡因的阻滞时间延长，肥胖与脊髓麻醉结果独立相关，布比卡因剂量也是如此。需要进一步纳入病态肥胖患者并使用固定布比卡因剂量的研究来证实肥胖对脊髓麻醉的影响。
