Nolte H, Stark P
Anaesthesist. 1979 Jan;28(1):1-4.
Isobaric bupivacaine 0.5% with adrenaline 1:200,000 was used for spinal anaesthesia. The influence of dose (mg) and volume (ml) on segmental spread and duration of spinal block was investigated. Bupivacaine 10 or 15 mg was injected in 2 or 3 ml of solution. The segmental spread and duration of analgesic block was tested at certain time intervals. The results showed that: 1. an increase in dose is not followed by a larger segmental spread or longer duration of analgesic block, 2. the increase of the volume injected is followed by an increase in segmental spread of analgesic block. This is independent of the concentration of the local anaesthetic, 3. the segmental regression of analgesic block starts in the cephalad segments. Therefore, higher spread of analgesic block provides prolonged analgesia in the lower segments. The results of this investigation are controversal in relation to the reports in the literature of the last two decades. The increase in dosage of the local anaesthetic did not increase the segmental spread and duration of analgesia. Only the volume injected is responsible for an increase in segmental spread of analgesia. Of course the concentration of the local anaesthetic injected has to be at least the minimal concentration necessary to result in a sensory nerve block.
使用含1:200,000肾上腺素的0.5%等比重布比卡因进行脊髓麻醉。研究了剂量（毫克）和容量（毫升）对脊髓阻滞节段扩散和持续时间的影响。将10毫克或15毫克布比卡因注入2毫升或3毫升溶液中。在特定时间间隔测试镇痛阻滞的节段扩散和持续时间。结果表明：1. 剂量增加并不会导致更大的节段扩散或更长的镇痛阻滞持续时间；2. 注入容量增加会导致镇痛阻滞节段扩散增加，这与局部麻醉剂的浓度无关；3. 镇痛阻滞的节段性消退从头部节段开始。因此，更高的镇痛阻滞扩散可使下部节段的镇痛时间延长。本研究结果与过去二十年文献报道存在争议。局部麻醉剂剂量增加并未增加节段扩散和镇痛持续时间。只有注入容量会导致镇痛节段扩散增加。当然，注入的局部麻醉剂浓度必须至少为产生感觉神经阻滞所需的最低浓度。
