Singh H, Yang J, Thornton K, Giesecke A H
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas 75235-9068, USA.
Can J Anaesth. 1995 Nov;42(11):987-91. doi: 10.1007/BF03011070.
The purpose of investigation was to study the effect of intrathecal fentanyl on the onset and duration of hyperbaric bupivacaine-induced spinal block in adult male patients. Forty-three patients undergoing lower extremity or genitourinary surgery were enrolled to receive either 13.5 mg hyperbaric bupivacaine 0.75% + 0.5 ml CSF it, (Group I) or 13.5 mg hyperbaric bupivacaine 0.75% + 25 micrograms fentanyl it, (Group II) according to a randomized assessor-blind protocol. The onset and duration of sensory block were assessed by pinching the skin with forceps in the midclavicular line bilaterally every two minutes for first twenty minutes and then every five to ten minutes. Similarly, the onset and duration of motor block were assessed and graded at the same time intervals using the criteria described by Bromage. The time required for two sensory segment regression and sensory regression to L1 dermatome was 74 +/- 18 and 110 +/- 33 min vs 93 +/- 22 and 141 +/- 37 min in Groups I and II, respectively (P < 0.05). Intrathecal fentanyl did not enhance the onset of sensory or motor block, or prolong the duration of bupivacaine-induced motor spinal block. Fewer patients demanded pain relief in the fentanyl-treated group than in the control group in the early postoperative period (19% vs 59%; P < 0.05). Episodes of hypotension were more frequent in the fentanyl-treated group than in the control group (43% vs 14%; P < 0.05). We conclude that fentanyl, 25 micrograms it, prolonged the duration of bupivacaine-induced sensory block (sensory regression to L1 dermatone) by 28% and reduced the analgesic requirement in the early postoperative period following bupivacaine spinal block.
本研究的目的是探讨鞘内注射芬太尼对成年男性患者中高压布比卡因诱导的脊髓阻滞的起效时间和持续时间的影响。43例接受下肢或泌尿生殖系统手术的患者，根据随机评估者盲法方案，分别接受13.5mg 0.75%高压布比卡因+0.5ml脑脊液鞘内注射（I组）或13.5mg 0.75%高压布比卡因+25μg芬太尼鞘内注射（II组）。在最初的20分钟内，每两分钟用镊子双侧夹捏锁骨中线处的皮肤来评估感觉阻滞的起效时间和持续时间，之后每五到十分钟评估一次。同样，使用Bromage描述的标准，在相同的时间间隔评估运动阻滞的起效时间和持续时间并进行分级。I组和II组中感觉阻滞消退两个节段和感觉消退至L1皮节所需的时间分别为74±18分钟和110±33分钟，以及93±22分钟和141±37分钟（P<0.05）。鞘内注射芬太尼并未加快感觉或运动阻滞的起效，也未延长布比卡因诱导的运动性脊髓阻滞的持续时间。在术后早期，芬太尼治疗组中需要镇痛的患者少于对照组（19%对59%；P<0.05）。芬太尼治疗组低血压发作比对照组更频繁（43%对14%；P<0.05）。我们得出结论，鞘内注射25μg芬太尼可使布比卡因诱导的感觉阻滞（感觉消退至L1皮节）的持续时间延长28%，并降低布比卡因脊髓阻滞后早期的镇痛需求。
