Nydahl P A, Axelsson K, Philipson L, Leissner P, Larsson P G
Department of Anaesthesia, Orebro Medical Centre Hospital, Sweden.
Acta Anaesthesiol Scand. 1989 Oct;33(7):597-604. doi: 10.1111/j.1399-6576.1989.tb02974.x.
In a double-blind study young volunteers randomly received 20 ml of mepivacaine 2%, bupivacaine 0.5% or etidocaine 1.5% epidurally, all solutions with adrenaline. The mean cephalad spread of pin-prick analgesia was equal (T10) in the groups, but the duration was longest for bupivacaine and etidocaine. The motor blockade of the rectus abdominis muscles was assessed quantitatively by rectified integrated electromyographic recordings (RIEMG) and as number of turns in EMG recordings [changes in the direction (rise/fall) of the EMG; TURNS] from three different segmental levels, T7, T9 and T11. The motor blockade of the quadriceps muscles was estimated by EMG recordings simultaneously with muscle force measurements at maximal isometric knee extension. Motor blockade was also evaluated by the Bromage scale. There was good correlation (correlation coefficient 0.91) between RIEMG values and muscle force in knee extension during epidural anaesthesia. TURNS showed a non-linear relationship to isometric force during epidural anaesthesia and added no further information. At the lower parts of the abdomen (T11), etidocaine gave more profound and longer motor blockade than mepivacaine. For quadriceps muscle function, motor blockade was almost complete with all three local anaesthetics; the duration of maximum motor blockade was short (45-60 min) for mepivacaine, but about 5 h with etidocaine. At the time when the Bromage scale indicated complete regression of motor blockade, the muscle force of knee extension was only 30% and the quadriceps RIEMG 35% of control values and 1-3 h remained until the time of mobilization.(ABSTRACT TRUNCATED AT 250 WORDS)
在一项双盲研究中，年轻志愿者被随机硬膜外注射20毫升2%的甲哌卡因、0.5%的布比卡因或1.5%的依替卡因，所有溶液均含肾上腺素。三组针刺镇痛的平均向头端扩散范围相同（T10），但布比卡因和依替卡因的持续时间最长。通过整流整合肌电图记录（RIEMG）定量评估腹直肌的运动阻滞，并从T7、T9和T11三个不同节段水平评估肌电图记录中的转向次数[肌电图方向（上升/下降）变化；TURNS]。通过肌电图记录并同时在最大等长膝关节伸展时测量肌肉力量来评估股四头肌的运动阻滞。运动阻滞也通过布罗麻量表进行评估。硬膜外麻醉期间，RIEMG值与膝关节伸展时的肌肉力量之间存在良好的相关性（相关系数0.91）。TURNS在硬膜外麻醉期间与等长力量呈非线性关系，且未提供更多信息。在腹部下部（T11），依替卡因比甲哌卡因产生更显著、更持久的运动阻滞。对于股四头肌功能，三种局部麻醉药的运动阻滞几乎都完全起效；甲哌卡因最大运动阻滞的持续时间较短（45 - 60分钟），但依替卡因约为5小时。当布罗麻量表显示运动阻滞完全消退时，膝关节伸展的肌肉力量仅为对照值的30%，股四头肌RIEMG为35%，直到能够活动还需要1 - 3小时。（摘要截断于250字）
