Zhao Yan-Ping, Zhang Xu-Feng, Qian Jing, Xiao Fei, Chen Xin-Zhong
From the Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Anesthesia, Jiaxing University Affiliated Women and Children Hospital; Jiaxing City, China.
Anesth Analg. 2025 Feb 1;140(2):437-443. doi: 10.1213/ANE.0000000000007095. Epub 2024 Jun 13.
Increasing the temperature of intrathecal local anesthetics has been shown to increase the speed of onset and block height of spinal anesthesia. However, how this influences dose requirement has not been fully quantified. The aim of this study was to determine and compare the effective dose for anesthesia for cesarean delivery in 50% of patients (ED 50 ) of intrathecal bupivacaine given at temperatures of 37 °C (body temperature) or 24 °C (room temperature).
Eighty healthy parturients having elective cesarean delivery under combined spinal-epidural anesthesia were randomly assigned to receive intrathecal hyperbaric bupivacaine stored at 37 °C (body temperature group) or 24 °C (room temperature group). The first subject in each group received a bupivacaine dose of 10 mg. The dose for each subsequent subject in each group was varied with an increment or decrement of 1 mg based on the response (effective or noneffective) of the previous subject. Patients for whom the dose was noneffective received epidural supplementation after data collection with lidocaine 2% as required until anesthesia was sufficient for surgery. Values for ED 50 were calculated using modified up-down sequential analysis with probit analysis applied as a backup sensitivity analysis. These values were compared and the relative mean potency was calculated.
The ED 50 (mean [95% confidence interval, CI]) of intrathecal hyperbaric bupivacaine was lower in the body temperature group (6.7 [5.7-7.6] mg) compared with the room temperature group (8.1 [7.7-8.6] mg) ( P < .05). The relative potency ratio for intrathecal bupivacaine for the room temperature group versus the body temperature group was 0.84 (95% CI, 0.77-0.93).
Warming hyperbaric bupivacaine to body temperature reduced the dose requirement for spinal anesthesia for cesarean delivery by approximately 16% (95% CI, 7%-23%).
已有研究表明，提高鞘内局部麻醉药的温度可加快腰麻的起效速度和阻滞平面高度。然而，这对剂量需求的影响尚未得到充分量化。本研究的目的是确定并比较在37℃（体温）或24℃（室温）下给予鞘内布比卡因时，剖宫产麻醉50%患者所需的有效剂量（ED50）。
80例择期剖宫产且采用腰麻-硬膜外联合麻醉的健康产妇被随机分为两组，分别接受储存在37℃的鞘内高压布比卡因（体温组）或24℃的鞘内高压布比卡因（室温组）。每组的第一名受试者接受10mg布比卡因剂量。根据前一名受试者的反应（有效或无效），每组后续受试者的剂量以1mg的增量或减量进行调整。对剂量无效的患者，在收集数据后根据需要用2%利多卡因进行硬膜外补充，直至麻醉足以进行手术。采用改良上下序贯分析法计算ED50值，并将概率分析作为备用敏感性分析。比较这些值并计算相对平均效价。
与室温组（8.1[7.7-8.6]mg）相比，体温组鞘内高压布比卡因的ED50（均值[95%置信区间，CI]）较低（6.7[5.7-7.6]mg）（P<.05）。室温组与体温组鞘内布比卡因的相对效价比为0.84（95%CI，0.77-0.93）。
将高压布比卡因加热至体温可使剖宫产腰麻的剂量需求降低约16%（95%CI，7%-23%）。
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