Bion J F
Anaesthesia. 1984 Jun;39(6):554-9. doi: 10.1111/j.1365-2044.1984.tb07361.x.
Twenty nine patients with acute war injuries of the lower limbs or perineum were anaesthetised with intrathecal bupivacaine. Eleven patients (38%) were shocked on arrival with systolic arterial blood pressures less than 90 mmHg; in three the blood pressure was unrecordable . All patients were resuscitated and ready for surgery within 30 minutes of arrival at the field hospital. Hypotension occurred two minutes after injection of bupivacaine in three of the eleven shocked patients, but was corrected with fluids and metaraminol without difficulty. Patients with a fever were found to be less likely to develop hypotension. The early onset of hypotension and the necessity for a head-down tilt gives bupivacaine a significant advantage over hyperbaric agents, and the technique can be recommended.
29例下肢或会阴部急性战伤患者接受了鞘内布比卡因麻醉。11例患者（38%）入院时休克，收缩动脉血压低于90mmHg；3例血压无法记录。所有患者在抵达野战医院后30分钟内均接受了复苏并准备好进行手术。11例休克患者中有3例在注射布比卡因后两分钟出现低血压，但通过补液和间羟胺不难纠正。发现发热患者发生低血压的可能性较小。低血压的早期发生以及需要头低脚高位使得布比卡因相对于高压剂具有显著优势，该技术值得推荐。
