Ben-David B, Solomon E, Levin H, Admoni H, Goldik Z
Department of Anesthesia, Herzlia-Haifa (Horev) Medical Center, Israel.
Anesth Analg. 1997 Sep;85(3):560-5. doi: 10.1097/00000539-199709000-00014.
Recent concern regarding lidocaine neurotoxicity has prompted efforts to find alternatives to lidocaine spinal anesthesia. Small-dose dilute bupivacaine spinal anesthesia yields a comparably rapid recovery profile but may provide insufficient anesthesia. By exploiting the synergism between intrathecal opioids and local anesthetics, it may be possible to augment the spinal anesthesia without prolonging recovery. Fifty patients undergoing ambulatory surgical arthroscopy were randomized into two groups receiving spinal anesthesia with 3 ml 0.17% bupivacaine in 2.66% dextrose without (Group I) or with (Group II) the addition of 10 microg fentanyl. Median block levels reached T7 and T8, respectively (P = not significant [NS]). Mean times to two-segment regression, S2 regression, time out of bed, time to urination, and time to discharge were 53 vs 67 min (P < 0.01), 120 vs 146 min (P < 0.05), 146 vs 163 min (P = NS), 169 vs 177 min (P = NS), and 187 vs 195 min (P = NS) respectively. Motor blockade was similar between groups, but sensory blockade was significantly more intense in Group II (P < 0.01). Six of 25 blocks failed in Group I, whereas none failed in Group II. The addition of 10 microg fentanyl to spinal anesthesia with dilute small-dose bupivacaine intensifies and increases the duration of sensory blockade without increasing the intensity of motor blockade or prolonging recovery to micturition or street fitness.
Concerns about the neurotoxicity of lidocaine have prompted efforts to find alternatives to lidocaine spinal anesthesia. We studied 50 patients undergoing ambulatory surgical arthroscopy and found that although small-dose bupivacaine alone is inadequate for this procedure, the addition of fentanyl makes it reliable.
近期对利多卡因神经毒性的关注促使人们努力寻找利多卡因脊髓麻醉的替代方法。小剂量稀释布比卡因脊髓麻醉可产生类似的快速恢复情况，但可能提供的麻醉效果不足。通过利用鞘内阿片类药物和局部麻醉药之间的协同作用，有可能在不延长恢复时间的情况下增强脊髓麻醉效果。50例行门诊手术关节镜检查的患者被随机分为两组，分别接受在2.66%葡萄糖溶液中加入3毫升0.17%布比卡因的脊髓麻醉，其中一组（I组）不加，另一组（II组）加入10微克芬太尼。中位阻滞平面分别达到T7和T8（P=无显著差异[NS]）。达到两段消退、S2消退、下床时间、排尿时间和出院时间的平均时间分别为53分钟对67分钟（P<0.01）、120分钟对146分钟（P<0.05）、146分钟对163分钟（P=NS）、169分钟对177分钟（P=NS）和187分钟对195分钟（P=NS）。两组之间运动阻滞相似，但II组感觉阻滞明显更强（P<0.01）。I组25次阻滞中有6次失败，而II组无一失败。在小剂量稀释布比卡因脊髓麻醉中加入10微克芬太尼可增强并延长感觉阻滞持续时间，而不会增加运动阻滞强度或延长排尿或恢复日常活动的时间。
对利多卡因神经毒性的担忧促使人们努力寻找利多卡因脊髓麻醉的替代方法。我们研究了50例行门诊手术关节镜检查的患者，发现虽然单独使用小剂量布比卡因对该手术来说不够，但加入芬太尼后使其变得可靠。
