Seow L T, Lips F J, Cousins M J
Anaesth Intensive Care. 1983 May;11(2):97-102. doi: 10.1177/0310057X8301100201.
In a prospective double-blind study, single-dose lumbar epidural blockade was administered to 60 healthy patients undergoing lower abdominal surgery, the patients lying in the lateral position only during the time of injection of the local anaesthetic. Solutions used were bupivacaine HCl 0.5%, lignocaine HCl 2% and lignocaine-bupivacaine mixtures in the ratios of 1:3, 1:1 and 3:1 by volume. Data were pooled and analysed for the effects of posture on epidural blockade. Using skin temperature as a criterion of sympathetic blockade, onset of blockade was more rapid and there was more prolonged blockade on the dependent side. Initial onset of sensory blockade was faster on the dependent side by 1 minute and 3.1 minutes for partial and complete blockade, respectively. Mean duration of sensory blockade was longer in the dependent dermatomes for partial (14, SD 7, minutes, T6-L4) and complete blockade (20, SD 6, minutes, T8-L3) respectively. Initial onset of complete motor blockade was 5 minutes more rapid on the dependent side, with mean myotome score consistently greater at all time intervals on the dependent side. Our study therefore suggests that a more efficacious sensory and motor blockade could be achieved by lying the patient on the operative side during the administration of the epidural and injection of the local anaesthestic solution close to the operative dermatomes.
在一项前瞻性双盲研究中，对60例接受下腹部手术的健康患者进行单剂量腰段硬膜外阻滞，患者仅在注射局部麻醉剂时取侧卧位。使用的溶液为0.5%盐酸布比卡因、2%盐酸利多卡因以及体积比为1:3、1:1和3:1的利多卡因 - 布比卡因混合液。汇总并分析数据以研究体位对硬膜外阻滞的影响。以皮肤温度作为交感神经阻滞的标准，阻滞起效在受压侧更快，且阻滞持续时间更长。感觉阻滞的初始起效在受压侧更快，部分阻滞和完全阻滞分别快1分钟和3.1分钟。部分阻滞（T6 - L4，平均14分钟，标准差7分钟）和完全阻滞（T8 - L3，平均20分钟，标准差6分钟）时，感觉阻滞在受压皮节的平均持续时间更长。完全运动阻滞的初始起效在受压侧快5分钟，在所有时间间隔内，受压侧的平均肌节评分始终更高。因此，我们的研究表明，在硬膜外给药和在靠近手术皮节注射局部麻醉溶液时，让患者取手术侧卧位可实现更有效的感觉和运动阻滞。
