氯普鲁卡因硬膜外麻醉后背痛。

Back pain after epidural anesthesia with chloroprocaine.

作者信息

Stevens R A, Urmey W F, Urquhart B L, Kao T C

机构信息

Hospital for Special Surgery, Cornell University Medical College, New York, New York.

出版信息

Anesthesiology. 1993 Mar;78(3):492-7. doi: 10.1097/00000542-199303000-00013.

DOI:10.1097/00000542-199303000-00013

PMID:8457050

Abstract

BACKGROUND

Chloroprocaine has been associated with severe back pain after epidural anesthesia. Factors proposed to contribute to this problem are: 1) the preservative disodium ethylenediaminetetraacetic acid (EDTA), 2) large volumes of chloroprocaine, 3) low pH of chloroprocaine, and 4) local infiltration with chloroprocaine.

METHODS

Using a prospective, balanced, randomized study design, 100 patients aged 18-65 yr who were undergoing outpatient knee surgery during continuous epidural anesthesia received one of five local anesthetics (all containing epinephrine 1:200,000). Group I received a bolus of 30 ml 2% lidocaine, followed by 10 ml every 45 min. Group II received 15 ml of 3% chloroprocaine (containing EDTA), plus 5 ml every 45 min. Group III received 30 ml of 3% chloroprocaine plus 10 ml every 45 min. Group IV received 30 ml of 3% chloroprocaine (containing metabisulfite as the preservative but no EDTA) plus 10 ml every 45 min. Group V received 30 ml of 3% chloroprocaine with the pH adjusted to 7.3, plus 10 ml every 45 min. After the anesthesia dissipated and before any analgesic agents were given, the patients were asked to rank maximum knee and back pain on a visual analog scale (0-10) and to give a description of back pain. A telephone interview was conducted 24 h after surgery to determine if back pain returned. Back pain scoring was assessed using a verbal analog scale.

RESULTS

After dissipation of anesthesia, the back pain reported by patients fell into two distinct categories. Type 1 pain was described commonly as superficial and localized to the site of needle insertion. There was no difference among groups in incidence of type 1 pain. Type 2 pain was described as deep, aching, burning, and poorly localized in the lumbar region (5% of the patients in group I, 10% in groups II and IV, 50% in group III, and 25% in group V). The incidence of type 2 pain was significantly greater in group III than in groups I, II, or IV. Group III also had a significantly greater mean visual analog scale pain score (types 1 and 2) than all other groups.

CONCLUSIONS

Large doses (> or = 40 ml) of chloroprocaine containing EDTA resulted in a greater incidence of deep burning lumbar back pain. Using 25 ml or less of the same solution resulted in an incidence of both types 1 and 2 postepidural anesthesia back pain similar to that in the lidocaine control group.

摘要

背景

氯普鲁卡因与硬膜外麻醉后严重背痛有关。据认为导致该问题的因素有：1）防腐剂乙二胺四乙酸二钠（EDTA）；2）大剂量氯普鲁卡因；3）氯普鲁卡因的低pH值；4）氯普鲁卡因局部浸润。

方法

采用前瞻性、均衡、随机研究设计，100例年龄在18 - 65岁接受持续硬膜外麻醉下门诊膝关节手术的患者接受五种局部麻醉药之一（均含1:200,000肾上腺素）。第一组给予30 ml 2%利多卡因推注，随后每45分钟给予10 ml。第二组给予15 ml 3%氯普鲁卡因（含EDTA），加每45分钟5 ml。第三组给予30 ml 3%氯普鲁卡因加每45分钟10 ml。第四组给予30 ml 3%氯普鲁卡因（含焦亚硫酸钠作为防腐剂但不含EDTA）加每45分钟10 ml。第五组给予30 ml pH值调至7.3的3%氯普鲁卡因加每45分钟10 ml。在麻醉消退后且未给予任何镇痛药之前，要求患者用视觉模拟评分法（0 - 10）对膝关节和背部的最大疼痛进行评分，并描述背痛情况。术后24小时进行电话随访以确定背痛是否复发。背痛评分采用语言模拟评分法进行评估。

结果

麻醉消退后，患者报告的背痛分为两种不同类型。1型疼痛通常被描述为表浅且局限于穿刺部位。1型疼痛的发生率在各组间无差异。2型疼痛被描述为深部、酸痛、灼痛且在腰部定位不清（第一组5%的患者，第二组和第四组10%，第三组50%，第五组25%）。第三组2型疼痛的发生率显著高于第一组、第二组或第四组。第三组的平均视觉模拟评分法疼痛评分（1型和2型）也显著高于所有其他组。