Van Zundert A A, Grouls R J, Korsten H H, Lambert D H
Department of Anesthesiology, Catharina Hospital, Eindhoven, The Netherlands.
Reg Anesth. 1996 Mar-Apr;21(2):112-8.
An investigation was made of the effects of volume and concentration of a constant dose of subarachnoid lidocaine on the extent and duration of sensory and motor anesthesia produced, as well as of the lidocaine concentration of the cerebrospinal fluid (CSF) as a function of time.
In a prospective study, 40 American Society of Anesthesiologists (ASA) status 2 or 3 patients were assigned to one of five groups, who received a 70-mg subarachnoid dose of lidocaine hydrochloride as a 0.5, 1, 2, 5, or 10% solution. Dural puncture was performed at the L3-L4 interspace with a 19.5-gauge Periquick needle (Pajunk, Germany), and a 24-gauge catheter was inserted 3-4 cm into the subarachnoid space. The patient remained in the lateral position during injection of the local anesthetic and was then turned to the supine horizontal position. The level of anesthesia and the motor block were measured at 5, 10, 15, 20, 30, 40, 50, and 60 minutes and then at 15-minute intervals until the effect of the anesthesia had ceased. Samples of CSF were collected at the same times that the pinprick and motor block measurements were made.
Five minutes after injection, a median sensory block height of T4 or T5 was observed in all groups. The range of mean total times to complete recovery of the sensory blocks was 139-152 minutes, while that for the motor blocks of the lower extremities was 100-122 minutes. The values were similar in all groups (P > .05). The motor block was complete in all patients 10 minutes after the lidocaine injection. Five minutes after injection, the mean CSF lidocaine concentration was highest in the 10% group (P < .001 vs. the other four groups). At 15 minutes, the only statistical difference was found between the 0.5% and the 10% group (P = .026). At 20 minutes, the CSF lidocaine concentrations were similar in all groups (P > .05).
A constant 70-mg dose of subarachnoid lidocaine produced the same pinprick level of analgesia, degree of motor block, and duration of spinal anesthesia in spite of being injected over an extremely broad range of concentrations and volumes. Despite the fact that all patients received the same dose of lidocaine, the CSF concentrations at 5, 10, and 15 minutes were different and directly related to the concentration of the solution injected. at 20 minutes, the CSF concentrations were similar in all groups. These results indicate a relatively uniform distribution of lidocaine in the CSF for all solutions tested.
研究蛛网膜下腔注射恒定剂量利多卡因的容量和浓度对所产生的感觉及运动麻醉范围和持续时间的影响，以及脑脊液（CSF）中利多卡因浓度随时间的变化情况。
在一项前瞻性研究中，40例美国麻醉医师协会（ASA）分级为2或3级的患者被分为五组，分别接受0.5%、1%、2%、5%或10%溶液形式的70mg蛛网膜下腔剂量的盐酸利多卡因。使用19.5号Periquick针（德国Pajunk公司）在L₃-L₄椎间隙进行硬膜穿刺，并将一根24号导管插入蛛网膜下腔3-4cm。在注射局部麻醉药期间患者保持侧卧位，然后转为仰卧水平位。在5、10、15、20、30、40、50和60分钟时测量麻醉平面和运动阻滞情况，之后每隔15分钟测量一次，直至麻醉效果消失。在进行针刺和运动阻滞测量的同时采集脑脊液样本。
注射后5分钟，所有组均观察到感觉阻滞平面中位数在T₄或T₅。感觉阻滞完全恢复的平均总时间范围为139-152分钟，下肢运动阻滞的平均总时间范围为100-122分钟。所有组的值相似（P>.05）。利多卡因注射后10分钟所有患者的运动阻滞均完全。注射后5分钟，10%组的脑脊液利多卡因浓度最高（与其他四组相比，P<.001）。15分钟时，仅在0.5%组和10%组之间发现统计学差异（P = .026）。20分钟时，所有组的脑脊液利多卡因浓度相似（P>.05）。
尽管蛛网膜下腔注射的利多卡因浓度和容量范围极广，但恒定的70mg剂量产生的针刺镇痛水平、运动阻滞程度和脊髓麻醉持续时间相同。尽管所有患者接受的利多卡因剂量相同，但在5、10和15分钟时脑脊液浓度不同，且与注射溶液的浓度直接相关。20分钟时，所有组的脑脊液浓度相似。这些结果表明，对于所有测试溶液，利多卡因在脑脊液中的分布相对均匀。
