Koscielniak-Nielsen Z J, Hesselbjerg L
Department of Anaesthesia and Intensive Therapy, National University Hospital, Rigshospitalet, Copenhagen, Denmark.
Acta Anaesthesiol Scand. 1997 Feb;41(2):197-203. doi: 10.1111/j.1399-6576.1997.tb04665.x.
Intra-arterial regional anaesthesia (IARA) may be useful for ambulatory hand surgery in patients with poor veins. This randomized, double-blind study assessed which of the three doses of lignocaine gives the optimal analgesia with a minimum of adverse effects.
A preservative-free, alkalinized 0.5% lignocaine 1, 2 or 2.89 mg/kg body weight was injected into the radial arteries of 60 adult patients, allocated to three equal groups, to produce anaesthesia for carpal tunnel releases, capsulotomies, tenosynovectomies, palmar fasciectomies, Z-plastics, arthroplastics, arthrodeses etc.
Surgical analgesia and motor block were best in group 3 (P < 0.01), whereas injection and tourniquet pain scores were similar in the three groups. Onset of analgesia was similar in all groups, and varied between 2 and 15 min. Cannulation time, surgery start time and tourniquet time were also similar in all groups, as were operating conditions and patient's acceptance of the method. No significant cardiovascular changes were observed after tourniquet release in any of the groups. Plasma lignocaine concentrations were lowest in group 1 (1 mg/kg) (P < 0.001). Five patients in group 1, seven in group 2 and seventeen in group 3 developed small bruises at the cannulation site (P < 0.001). Six patients (two in group 1, three in group 2 and one in group 3) had minor symptoms of lignocaine toxicity after tourniquet release (NS). No other complications were observed.
The highest dose of lignocaine produces best surgical analgesia, without increasing the risk of toxicity. However, many patients receiving this dose will develop bruises at the injection site, and an occasional patient may need supplemental analgesia.
对于静脉条件差的患者，动脉内区域麻醉（IARA）可能有助于门诊手部手术。这项随机双盲研究评估了三种剂量的利多卡因中哪一种能在产生最小不良反应的情况下提供最佳镇痛效果。
将不含防腐剂、碱化的0.5%利多卡因按1、2或2.89mg/kg体重分别注入60例成年患者的桡动脉，这些患者被平均分为三组，用于腕管松解术、关节囊切开术、腱鞘滑膜切除术、掌腱膜切除术、Z成形术、关节成形术、关节融合术等手术的麻醉。
第3组的手术镇痛和运动阻滞效果最佳（P<0.01），而三组的注射痛和止血带疼痛评分相似。所有组的镇痛起效时间相似，在2至15分钟之间。所有组的插管时间、手术开始时间和止血带时间也相似，手术条件和患者对该方法的接受程度同样如此。在任何一组中，止血带松开后均未观察到明显的心血管变化。第1组（1mg/kg）的血浆利多卡因浓度最低（P<0.001）。第1组有5例患者、第2组有7例患者、第3组有17例患者在插管部位出现小瘀斑（P<0.001）。6例患者（第1组2例、第2组3例、第3组1例）在止血带松开后出现轻微的利多卡因毒性症状（无统计学意义）。未观察到其他并发症。
最高剂量的利多卡因可产生最佳的手术镇痛效果，且不增加毒性风险。然而，许多接受该剂量的患者会在注射部位出现瘀斑，偶尔有患者可能需要补充镇痛。
