Kanai Akifumi, Niki Yuriko, Hayashi Norihito, Maeda Shinji, Horie Kazunobu, Okamoto Hirotsugu
Department of Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Japan.
Department of Anesthesiology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan.
Anesth Pain Med. 2019 Sep 18;9(5):e91216. doi: 10.5812/aapm.91216. eCollection 2019 Oct.
Predicting the spread of anesthesia after intrathecal injection of plain local anesthetics is challenging owing to both patient and anesthesiologist-related factors.
This study aimed to examine the initial patient-reported sensory changes during intrathecal injections and used multi-level analyses to examine the relationships between these changes and other major factors affecting the spread of anesthesia.
The participants were 120 consecutive patients with the American Society of Anesthesiologists status I and II, who were scheduled for open repair of inguinal hernias under spinal anesthesia. Lumbar puncture was performed at the midline of the L3 - L4 vertebrae and 3 mL of 0.5% isobaric bupivacaine was administered at 0.25 mL/s. The onset, dermatome, and side of the initial subjective sensory changes (ISSCs) were assessed by patient report. The extent of sensory loss to ice and pinprick stimuli, the degree of motor block in lower extremities, blood pressure, and heart rate were examined at 5-minutes intervals for 20 minutes after intrathecal injection.
All patients reported ISSCs after 9 (4, 18) seconds [median (minimum, maximum)] of the intrathecal injection onset. In 66.7% of the patients, ISSCs occurred in the L1 - L5 dermatomes. Three patients experienced pain during the early intraoperative period, and described ISSCs in the sacral dermatome. Height, mean blood pressure, and ISSCs were significantly correlated with sensory loss. Faster onset, lower dermatome, and floor-side of ISSCs predicted a narrower area of sensory loss, with dermatome as the most important indicator.
Our findings demonstrate that ISSC, primarily based on dermatome, is a significant predictor for spinal anesthesia spread.
由于患者和麻醉医生相关因素，预测鞘内注射普通局部麻醉药后麻醉的扩散具有挑战性。
本研究旨在检查鞘内注射期间患者最初报告的感觉变化，并使用多层次分析来检查这些变化与影响麻醉扩散的其他主要因素之间的关系。
参与者为120例连续的美国麻醉医师协会身体状况I级和II级患者，他们计划在脊髓麻醉下进行腹股沟疝开放修补术。在L3 - L4椎骨中线进行腰椎穿刺，并以0.25 mL/s的速度注入3 mL 0.5%等比重布比卡因。通过患者报告评估初始主观感觉变化（ISSCs）的发作、皮节和侧别。鞘内注射后20分钟内，每隔5分钟检查一次对冰和针刺刺激的感觉丧失程度、下肢运动阻滞程度、血压和心率。
所有患者在鞘内注射开始后9（4，18）秒[中位数（最小值，最大值）]报告了ISSCs。66.7%的患者ISSCs发生在L1 - L5皮节。3例患者在术中早期经历疼痛，并描述骶部皮节有ISSCs。身高、平均血压和ISSCs与感觉丧失显著相关。ISSCs发作更快、皮节更低和在地面侧预测感觉丧失区域更窄，其中皮节是最重要的指标。
我们的研究结果表明，主要基于皮节的ISSC是脊髓麻醉扩散的重要预测指标。
