Koscielniak-Nielsen Z J, Stens-Pedersen H L, Kjaerbo E J
Department of Anaesthesia, National University Hospital, Rigshospitalet, Copenhagen, Denmark.
Acta Anaesthesiol Scand. 1995 Nov;39(8):1048-52. doi: 10.1111/j.1399-6576.1995.tb04227.x.
Intra-arterial regional anaesthesia (IARA) for hand surgery is an old, forgotten technique. One of the causes of low popularity may be a scalding sensation in the hand during intra-arterial injection of lignocaine, which may be caused by low pH of lignocaine's solution. In this randomized, double-blind study, normal (pH 5.2-5.3) or alkalinized (pH 7.2-7.3) preservative-free 0.5% lignocaine 1.5 mg kg-1 was injected into the radial arteries of forty adult patients to produce anaesthesia for ambulatory hand surgery. Scalding sensation in the hand during intra-arterial injection (VAS) was less pronounced with alkalinized lignocaine (P = 0.04). The time of onset and regression of analgesia was similar in both groups. Four patients in group 1 (normal lignocaine) and six patients in group 2 (alkalinized lignocaine) needed supplemental analgesia at the start of surgery (NS). Cannulation time, operating conditions, motor blockade, surgical-, and tourniquet pain scores (VAS) and patient's acceptance were similar. Three patients (two in group 1 and one in group 2) had minor systemic adverse effects after tourniquet release (NS). Nine patients in group 1 and seven in group 2 developed minor bruises after cannulation (NS). No other sequelae of intra-arterial injections were observed. We conclude that alkalinized 0.5% lignocaine was less painful on injection than normal lignocaine and should be preferred for intra-arterial anaesthesia for hand surgery.
用于手部手术的动脉内区域麻醉（IARA）是一种古老且被遗忘的技术。其不受欢迎的原因之一可能是在动脉内注射利多卡因时手部会有烧灼感，这可能是由于利多卡因溶液的低pH值所致。在这项随机双盲研究中，将正常（pH 5.2 - 5.3）或碱化（pH 7.2 - 7.3）的无防腐剂0.5%利多卡因1.5 mg·kg⁻¹注入40名成年患者的桡动脉，以用于门诊手部手术的麻醉。碱化利多卡因在动脉内注射时手部的烧灼感（视觉模拟评分法）不太明显（P = 0.04）。两组的镇痛起效时间和消退时间相似。第1组（正常利多卡因）有4名患者和第2组（碱化利多卡因）有6名患者在手术开始时需要补充镇痛（无统计学差异）。置管时间、手术条件、运动阻滞、手术和止血带疼痛评分（视觉模拟评分法）以及患者接受度相似。3名患者（第1组2名，第2组1名）在松开止血带后出现轻微全身不良反应（无统计学差异）。第1组9名患者和第2组7名患者在置管后出现轻微瘀斑（无统计学差异）。未观察到动脉内注射的其他后遗症。我们得出结论，碱化的0.5%利多卡因注射时比正常利多卡因疼痛轻，在手外科手术的动脉内麻醉中应优先选用。
