Tetzlaff J E, O'Hara J, Bell G, Grimm K, Yoon H J
Department of General Anesthesiology, Cleveland Clinic Foundation, Ohio 44195, USA.
Reg Anesth. 1995 Nov-Dec;20(6):533-7.
Although the majority of elective lumbar spine surgical procedures are performed under general anesthesia, successful use of spinal and epidural anesthesia has been reported. This study was designed to evaluate the influence of baricity on the performance of spinal anesthesia for lumbar spine surgery.
The study was performed on 53 demographically similar American Society of Anesthesiologists status 1 and 2 patients who were randomly assigned to receive spinal anesthesia with 15 mg of bupivacaine along with 0.2 mg of epinephrine as either 3 ml 0.5% plain bupivacaine (I group) or 2 ml 0.75% bupivacaine (Sensorcaine Spinal, Astra, Westborough, MA) premixed in 8.25% glucose (H group). All blocks were placed with a 22-gauge Quincke needle (Becton Dickinson, Franklin Lakes, NJ) at the L3-L4 interspace with the patient in the sitting position. Subsequent data, collected by a blinded observer, included onset of motor and sensory anesthesia, highest sensory level achieved, maximum changes in heart rate and blood pressure, need for treatment of heart rate or blood pressure decreases, failed blocks, and need for supplemental local anesthetic injection to complete incision or wound closure.
The time to onset for complete motor and sensory block was significantly longer in the I group. The maximum sensory level achieved was higher in the H group, and the maximum drop in blood pressure and number of interventions to treat heart rate and blood pressure were greater in the H group. There were two failed blocks, which were repeated successfully, in the H group. The need for local anesthetic infiltration of the wound with incision and closure was greater in the H group.
Plain bupivacaine is superior to hyperbaric bupivacaine for spinal anesthesia for elective lumbar spine surgery.
尽管大多数择期腰椎手术是在全身麻醉下进行的，但也有报道称脊髓麻醉和硬膜外麻醉的使用取得了成功。本研究旨在评估比重对腰椎手术脊髓麻醉效果的影响。
对53例人口统计学特征相似的美国麻醉医师协会1级和2级患者进行研究，这些患者被随机分配接受脊髓麻醉，其中15毫克布比卡因与0.2毫克肾上腺素混合，分别为3毫升0.5%普通布比卡因（I组）或2毫升0.75%布比卡因（Sensorcaine Spinal，阿斯特拉公司，马萨诸塞州韦斯特伯勒）与8.25%葡萄糖预混（H组）。所有阻滞均在患者坐位时于L3-L4间隙用22号Quincke针（BD公司，新泽西州富兰克林湖）进行。随后由一名盲法观察者收集的数据包括运动和感觉麻醉的起效时间、达到的最高感觉平面、心率和血压的最大变化、治疗心率或血压下降的必要性、阻滞失败情况以及完成切口或伤口缝合所需补充局部麻醉剂注射的情况。
I组完全运动和感觉阻滞的起效时间明显更长。H组达到的最高感觉平面更高，H组血压的最大降幅以及治疗心率和血压的干预次数更多。H组有两例阻滞失败，但再次实施成功。H组在切口和缝合时伤口局部麻醉剂浸润的需求更大。
对于择期腰椎手术的脊髓麻醉，普通布比卡因优于重比重布比卡因。
