Pollock J E, Neal J M, Stephenson C A, Wiley C E
Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington 98111, USA.
Anesthesiology. 1996 Jun;84(6):1361-7. doi: 10.1097/00000542-199606000-00012.
There is considerable controversy regarding the role of subarachnoid 5% hyperbaric lidocaine in the syndrome transient radicular irritation (TRI). This randomized, double-blinded, prospective study was designed to determine the incidence of TRI and identify factors possibly contributing to its development.
One hundred fifty-nine ASA physical status 1 or 2 patients undergoing outpatient knee arthroscopy or unilateral inguinal hernia repair were prospectively randomized to receive spinal anesthesia with 5% hyperbaric lidocaine with epinephrine (60 mg with 0.2 mg epinephrine for arthroscopy or 75 mg with 0.2 mg epinephrine for hernia repair), 2% isobaric lidocaine without epinephrine (60 mg for arthroscopy or 75 mg for hernia repair), or 0.75% hyperbaric bupivacaine without epinephrine (7.5 mg for arthroscopy or 9.0 mg for hernia repair) in a double-blinded fashion. On the 3rd postoperative day, patients were contacted by a blinded investigator and questioned regarding the incidence of postoperative complications including TRI, defined as back pain with radiation down one or both buttocks or legs occurring within 24 h after surgery. Postoperatively, time from injection to block resolution, ambulation, voiding, and ready for discharge were recorded by a postanesthesia care unit nurse blinded to the group assignment.
The incidence of TRI was greater in patients receiving lidocaine than in those receiving bupivacaine (16% vs. 0%; P = 0.003). There was no difference in the incidence of TRI between the patients receiving 5% hyperbaric lidocaine with epinephrine and those receiving 2% isobaric lidocaine without epinephrine (16% vs. 16%; P = 0.98). The incidence of TRI was greater in patients undergoing arthroscopy than in those undergoing hernia repair (13% vs. 5%; P = 0.04). There was no difference in discharge times in patients receiving bupivacaine versus those receiving hyperbaric lidocaine with epinephrine (292 vs. 322 min; P = 0.61).
The incidence of TRI is greater with lidocaine than bupivacaine, decreasing the lidocaine concentration to 2% does not prevent TRI, and surgical position may be an important contributing factor. Discharge times at our institution are not different when equipotent doses of 0.75% hyperbaric bupivacaine or 5% hyperbaric lidocaine with 0.2 mg epinephrine are used in ambulatory patients undergoing spinal anesthesia.
关于蛛网膜下腔5%高压利多卡因在短暂性神经根刺激综合征（TRI）中的作用存在相当大的争议。本随机、双盲、前瞻性研究旨在确定TRI的发生率，并识别可能导致其发生的因素。
159例美国麻醉医师协会（ASA）身体状况为1或2级的患者，计划接受门诊膝关节镜检查或单侧腹股沟疝修补术，被前瞻性随机分为三组，以双盲方式分别接受含肾上腺素的5%高压利多卡因（膝关节镜检查用60mg加0.2mg肾上腺素，疝修补术用75mg加0.2mg肾上腺素）、不含肾上腺素的2%等比重利多卡因（膝关节镜检查用60mg，疝修补术用75mg）或不含肾上腺素的0.75%高压布比卡因（膝关节镜检查用7.5mg，疝修补术用9.0mg）进行脊髓麻醉。术后第3天，由一位不知情的研究者联系患者，询问术后并发症的发生率，包括TRI，TRI定义为术后24小时内出现的下背部疼痛并向下放射至一侧或双侧臀部或腿部。术后，由对分组不知情的麻醉后护理单元护士记录从注射到阻滞消退、行走、排尿及准备出院的时间。
接受利多卡因的患者TRI发生率高于接受布比卡因的患者（16%比0%；P = 0.003）。接受含肾上腺素的5%高压利多卡因的患者与接受不含肾上腺素的2%等比重利多卡因的患者之间TRI发生率无差异（16%比16%；P = 0.98）。接受膝关节镜检查的患者TRI发生率高于接受疝修补术的患者（13%比5%；P = 0.04）。接受布比卡因的患者与接受含肾上腺素的高压利多卡因的患者出院时间无差异（292分钟比322分钟；P = 0.61）。
利多卡因导致TRI的发生率高于布比卡因，将利多卡因浓度降至2%并不能预防TRI，手术体位可能是一个重要的促成因素。在接受脊髓麻醉的门诊患者中，使用等效剂量的0.75%高压布比卡因或含0.2mg肾上腺素的5%高压利多卡因时，我们机构的出院时间没有差异。
