剖宫产术中蛛网膜下腔注射0.5%布比卡因后抽取0.2 ml脑脊液再注入对感觉和运动阻滞的评估效果：一项随机临床试验
Evaluation Effect of Aspiration of 0.2 ml of Cerebrospinal Fluid After Completion of Injection 0.5% Bupivacaine and Reinjection Into Subarachnoid Space on Sensory and Motor Block in Cesarean Section: A Randomized Clinical Trial.
作者信息
Manouchehrian Nahid, Miri Zahra, Esna-Ashari Farzaneh, Rahimi-Bashar Farshid
机构信息
Anesthesia and Critical Care Department, Hamadan University of Medical Sciences, Hamadan, Iran.
Department of Family and Community Medicine, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
出版信息
Front Med (Lausanne). 2022 Mar 25;9:816974. doi: 10.3389/fmed.2022.816974. eCollection 2022.
BACKGROUND
Spinal anesthesia (SPA) is the most common type of anesthesia administered for cesarean section. The main aim of this study was to evaluate the effect of aspiration of CSF (0.2 mL) immediately after SPA with hyperbaric 0.5% bupivacaine on the extent of sensory and motor block.
METHODS
In this clinical trial, 60 women at ≥37 weeks of gestation and aged between 18 and 46 years, candidate for cesarean delivery under spinal anesthesia were randomly allocated into two equal groups ( = 30). Group A (CSF-aspiration group) received the spinal anesthesia with 10 mg of hyperbaric 0.5% bupivacaine with aspiration of 0.2 ml of CSF. Group B (no-CSF-aspiration group) received only 10 mg of 0.5% hyperbaric bupivacaine. Pin-prick analgesia and motor block were tested during the induction.
RESULTS
The mean maximum level of analgesia was T6 in each group. Although the mean time to reach the maximum level of anesthesia (4.43 ± 5.14 vs. 2.76 ± 2.04, = 0.107) and to reach T10 level (50.56 ± 11.51 vs. 49.10 ± 13.68, = 0.665) in the CSF-aspiration group is longer than the non-CSF-aspiration group, but this differences were not significant. There were no significant between-group differences regarding sensory and motor block quality ( = 0.389) or failed SPA (four cases in CSF-aspiration group vs. two cases in no-CSF-aspiration group, = 0.389). The incidence of bradycardia, hypotension, headache, vomiting and nausea were similar in both groups ( > 0.05). In addition, the difference in hemodynamic parameters between the two groups over times was not statistically significant.
CONCLUSION
Our finding indicated that the aspiration of 0.2 ml of CSF after injection of spinal anesthesia with hyperbaric 0.5% bupivacaine does not seem to affect the extent of sensory and motor block, success rate, or outcome after SPA in cesarean section.
CLINICAL TRIAL REGISTRATION
[https://www.irct.ir/search/result?query=IRCT20120915010841N25], identifier [IRCT20120915010841N25].
背景
脊髓麻醉（SPA）是剖宫产最常用的麻醉方式。本研究的主要目的是评估在蛛网膜下腔注射0.5%重比重布比卡因后立即抽取0.2 mL脑脊液对感觉和运动阻滞程度的影响。
方法
在这项临床试验中，60例妊娠≥37周、年龄在18至46岁之间、拟行脊髓麻醉下剖宫产的女性被随机分为两组（每组n = 30）。A组（脑脊液抽吸组）接受10 mg 0.5%重比重布比卡因脊髓麻醉并抽取0.2 ml脑脊液。B组（非脑脊液抽吸组）仅接受10 mg 0.5%重比重布比卡因。诱导期间测试针刺镇痛和运动阻滞情况。
结果
每组的平均最大镇痛平面均为T6。尽管脑脊液抽吸组达到最大麻醉平面的平均时间（4.43±5.14 vs. 2.76±2.04，P = 0.107）和达到T10平面的平均时间（50.56±11.51 vs. 49.10±13.68，P = 0.665）比非脑脊液抽吸组长，但这些差异无统计学意义。在感觉和运动阻滞质量方面（P = 0.389）或脊髓麻醉失败率方面（脑脊液抽吸组4例 vs. 非脑脊液抽吸组2例，P = 0.389），两组之间无显著差异。两组心动过缓、低血压、头痛、呕吐和恶心的发生率相似（P>0.05）。此外，两组间不同时间点的血流动力学参数差异无统计学意义。
结论
我们的研究结果表明，在蛛网膜下腔注射0.5%重比重布比卡因后抽取0.2 ml脑脊液似乎不影响剖宫产脊髓麻醉后的感觉和运动阻滞程度、成功率或结局。
临床试验注册
[https://www.irct.ir/search/result?query=IRCT20120915010841N25]，标识符[IRCT20120915010841N25]
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