Biji K P, Sunil M, Ramadas K T
Department of Anaesthesiology, Government Medical College, Kozhikode, Kerala, India.
Department of Anaesthesiology, Government Medical College, Thrissur, Kerala, India.
Anesth Essays Res. 2017 Jul-Sep;11(3):642-646. doi: 10.4103/0259-1162.204207.
Hypobaric spinal anesthesia is advantageous for unilateral lower extremity fractures as it obviates pain of lying on fractured limb for performing subarachnoid block.
This study compares block characteristics and complications of three different baricities of constant dose intrathecal hypobaric levobupivacaine to determine an optimum baricity.
One-twenty American Society of Anesthesiologists Physical Status 1 and 2 patients aged 18-65 years undergoing unilateral lower limb surgeries were divided into three equal groups for this prospective cohort study.
To 2 mL intrathecal 0.5% isobaric levobupivacaine (10 mg), 0.4 mL, 0.6 mL, and 0.8 mL of distilled water were added in Groups A, B, and C, respectively. Baricities of Groups A, B, and C are 0.999294, 0.998945, and 0.998806, respectively. Development of sensory and motor block was assessed by the pinprick method and Bromage scale, respectively. The total duration of analgesia and complications were noted.
Mean, standard error, one-way ANOVA, and Bonferroni were used to analyze quantitative variables; proportions and Chi-square tests for qualitative variables.
Demographic parameters, motor block of operated limb, and complications were comparable. Group C had the fastest onset of sensory block (10.10 min) and maximum duration of analgesia (478.97 min; < 0.001); but high sensory levels in 48.7%. Group B had T sensory level in 92.5%; onset comparable to Group C ( = 0.248), and reasonable duration of analgesia (332.50 min). Group A had inadequate sensory levels, slow onset, and early regression.
Group B (baricity - 0.998945) has better block characteristics among three groups compared.
低压脊髓麻醉对于单侧下肢骨折患者具有优势，因为它避免了在进行蛛网膜下腔阻滞时因患侧肢体卧位引起的疼痛。
本研究比较三种不同比重的恒量鞘内注射低压左旋布比卡因的阻滞特性和并发症，以确定最佳比重。
本前瞻性队列研究将120例年龄在18 - 65岁、美国麻醉医师协会身体状况分级为1级和2级、接受单侧下肢手术的患者分为三组，每组人数相等。
分别向2 mL鞘内注射用0.5%等比重左旋布比卡因（10 mg）中加入0.4 mL、0.6 mL和0.8 mL蒸馏水，A、B、C组分别使用。A、B、C组的比重分别为0.999294、0.998945和0.998806。分别采用针刺法和布罗米奇量表评估感觉和运动阻滞的发生情况。记录镇痛总时长和并发症。
采用均值、标准误、单因素方差分析和邦费罗尼检验分析定量变量；采用比例和卡方检验分析定性变量。
人口统计学参数、患侧肢体的运动阻滞及并发症情况具有可比性。C组感觉阻滞起效最快（10.10分钟），镇痛持续时间最长（478.97分钟；P < 0.001），但48.7%出现高感觉平面。B组92.5%出现T感觉平面，起效与C组相当（P = 0.248），镇痛持续时间合理（332.50分钟）。A组感觉平面不足、起效缓慢且消退较早。
在比较的三组中，B组（比重 - 0.998945）具有更好的阻滞特性。
