Gosteli P, Van Gessel E, Gamulin Z
Department of Anesthesia, University Hospital, Geneva, Switzerland.
Anesth Analg. 1995 Jul;81(1):104-9. doi: 10.1097/00000539-199507000-00021.
We examined the onset and the quality of sensory and motor block of the lumbosacral roots during epidural anesthesia performed for foot or ankle surgery with lidocaine HCl, pH adjusted, or carbonated lidocaine in a randomized, double-blind study. Forty-five patients received 20 mL of one of three solutions: control group (n = 15), 20 mL of 2% lidocaine with epinephrine (5 micrograms/mL) plus 2 mL of NaCl 0.9% (pH 4.58 +/- 0.10); pH adjusted group (n = 15) 20 mL of lidocaine with epinephrine (5 micrograms/mL) plus 2 mL of 8.4% sodium bicarbonate (pH 6.47 +/- 0.16); and carbonated group (n = 15) 20 mL of 1.73% carbonated lidocaine with epinephrine (5 micrograms/mL) plus 2 mL of 0.9% NaCl (pH 6.42 +/- 0.04). Onset time of sensory block of the L4-S1 roots and maximum cephalad spread were similar in the three groups. Surgical anesthesia was significantly poorer with lidocaine HCl compared to the carbonated solution with eight patients requiring fentanyl supplementation versus one in the carbonated group. Complete motor block was observed in eight patients of the carbonated group compared to three in the pH adjusted group (P < 0.01) and one in the control group (P < 0.005). Lidocaine venous blood levels were comparable in the three groups. When compared to lidocaine HCl, only carbonated lidocaine, but not the pH adjusted solution, significantly improved epidural block of the L4-S1 roots.
在一项随机双盲研究中，我们使用盐酸利多卡因（pH值调整）或碳酸利多卡因，对接受足部或踝部手术的患者进行硬膜外麻醉，研究了腰骶神经根感觉和运动阻滞的起效时间及质量。45例患者接受20 mL三种溶液之一：对照组（n = 15），20 mL含肾上腺素（5微克/毫升）的2%利多卡因加2 mL 0.9%氯化钠（pH 4.58±0.10）；pH值调整组（n = 15），20 mL含肾上腺素（5微克/毫升）的利多卡因加2 mL 8.4%碳酸氢钠（pH 6.47±0.16）；碳酸组（n = 15），20 mL含肾上腺素（5微克/毫升）的1.73%碳酸利多卡因加2 mL 0.9%氯化钠（pH 6.42±0.04）。三组L4 - S1神经根感觉阻滞的起效时间和最大头端扩散相似。与碳酸溶液相比，盐酸利多卡因的手术麻醉效果明显较差，有8例患者需要补充芬太尼，而碳酸组为1例。碳酸组有8例患者出现完全运动阻滞，pH值调整组为3例（P < 0.01），对照组为1例（P < 0.005）。三组利多卡因静脉血水平相当。与盐酸利多卡因相比，只有碳酸利多卡因能显著改善L4 - S1神经根的硬膜外阻滞，而pH值调整溶液则不能。
