Standl T, Beck H
Department of Anesthesiology, University Hospital Eppendorf, Hamburg, Germany.
Reg Anesth. 1994 Jul-Aug;19(4):231-6.
Many factors have an impact on the outcome of continuous spinal anesthesia (CSA) with small-bore catheters. Recent publications of neurologic complications after CSA suggest that the local anesthetic as well as the microspinal catheter influence the analgesic effect in CSA. This prospective study was designed to evaluate the influence of the subarachnoid position of 28-gauge spinal catheters on the speed of onset of analgesia and on the dose of plain bupivacaine 0.5% required for a block at the level of T-10 in CSA.
Sixty-eight patients (mean age 61.7 +/- 6.4 years) received CSA using a 22-gauge Quincke needle (Kendall, Mansfield, MA) and a 28-gauge spinal catheter. After initial injection of 2.5 mL (minimum) up to a maximum of 5 mL of supplemental doses of plain bupivacaine 0.5%, the time of onset of analgesia at the level of T-10 and the dose of local anesthetics required for this block were determined. The subarachnoid catheter position was examined radiographically by a dye supported conventional anteroposterior roentgenogram of the lumbar spine on the first day after the operation.
The onset time of analgesia and the dose of plain bupivacaine 0.5% required for the block at the level of T-10 were significantly dependent on the subarachnoid position of the microcatheters (P < .01), but not on the level of the lumbar dural puncture (P = .29, P = .69). In patients with cranially running catheters or catheters with the tip at the level of the puncture site, analgesia onset was faster and required doses of bupivacaine were smaller than in patients with caudally running catheters.
The subarachnoid position of a 28-gauge microcatheter is an important factor with regard to the effectiveness (e.g., onset time of analgesia and dose requirement) of CSA using plain bupivacaine 0.5%.
许多因素会影响使用细导管的连续脊麻（CSA）的效果。近期关于CSA后神经并发症的出版物表明，局部麻醉药以及微脊麻导管会影响CSA的镇痛效果。本前瞻性研究旨在评估28号脊麻导管在蛛网膜下腔的位置对镇痛起效速度以及在CSA中T-10节段阻滞所需的0.5%布比卡因原液剂量的影响。
68例患者（平均年龄61.7±6.4岁）使用22号昆克针（肯德尔公司，马萨诸塞州曼斯菲尔德）和28号脊麻导管接受CSA。在最初注射至少2.5 mL至最大5 mL的0.5%布比卡因原液补充剂量后，确定T-10节段镇痛起效时间以及该阻滞所需的局部麻醉药剂量。术后第一天通过染料辅助的腰椎常规前后位X线片对蛛网膜下腔导管位置进行影像学检查。
T-10节段阻滞的镇痛起效时间和所需的0.5%布比卡因原液剂量显著取决于微导管在蛛网膜下腔的位置（P <.01），但不取决于腰段硬膜穿刺水平（P =.29，P =.69）。与导管向尾端走行的患者相比，导管向头端走行或导管尖端位于穿刺部位水平的患者镇痛起效更快，所需布比卡因剂量更小。
对于使用0.5%布比卡因原液的CSA的有效性（如镇痛起效时间和剂量需求）而言，28号微导管在蛛网膜下腔的位置是一个重要因素。
