Urmey W F, Stanton J, Bassin P, Sharrock N E
Department of Anesthesiology, Hospital for Special Surgery, Cornell University Medical College, New York, NY 10021, USA.
Anesth Analg. 1997 Feb;84(2):337-41. doi: 10.1097/00000539-199702000-00017.
The use of Whitacre spinal needles results in directional flow out of the needle aperture, diverting local anesthetic from the longitudinal axis of the needle. Thus, a change in orientation of the needle aperture would be expected to result in a different local anesthetic distribution in the subarachnoid space. We studied 40 outpatients undergoing elective knee arthroscopy under spinal anesthesia with 60 mg plain lidocaine 2% in a prospective, double-blinded manner. Patients were randomly assigned to either Group I (needle aperture oriented in a cephalad direction throughout intrathecal injection) or Group II (aperture directed caudally). Onset and offset of sensory and motor block were analyzed at frequent intervals. Times to completion of ambulatory milestones, including discharge, were recorded. Group I was characterized by a higher sensory level (T 3.4 +/- 1.3 vs T 6.6 +/- 2.8, P < 0.001). Group I had significantly shorter duration of lumbar sensory anesthesia (149.2 +/- 30.6 min vs 177.8 +/- 23.5 min, P < 0.01) and motor blockade (117.6 +/- 26.1 min vs 150.0 +/- 22.8 min, P < 0.001). Mean time to outpatient discharge was approximately 32 min shorter in Group I. The orientation of the Whitacre needle aperture exerts a major influence on sensory level, as well as the duration of isobaric lidocaine spinal anesthesia.
使用惠特克脊柱穿刺针会使局部麻醉药从针孔定向流出，从而使局部麻醉药偏离针的纵轴方向。因此，可以预期针孔方向的改变会导致蛛网膜下腔内局部麻醉药的分布有所不同。我们以前瞻性、双盲的方式研究了40例在脊髓麻醉下接受择期膝关节镜检查的门诊患者，使用的是60毫克2%的普通利多卡因。患者被随机分为I组（在整个鞘内注射过程中针孔朝头侧方向）或II组（针孔朝尾侧方向）。定期分析感觉和运动阻滞的起效和消退情况。记录达到包括出院在内的门诊里程碑的时间。I组的特点是感觉平面较高（T 3.4 +/- 1.3 对比 T 6.6 +/- 2.8，P < 0.001）。I组的腰段感觉麻醉持续时间明显较短（149.2 +/- 30.6分钟对比177.8 +/- 23.5分钟，P < 0.01），运动阻滞持续时间也明显较短（117.6 +/- 26.1分钟对比150.0 +/- 22.8分钟，P < 0.001）。I组的平均门诊出院时间大约短32分钟。惠特克针孔的方向对感觉平面以及等比重利多卡因脊髓麻醉的持续时间有重大影响。
