Liguori G A, Zayas V M, Chisholm M F
Department of Anesthesiology, Hospital for Special Surgery, Cornell Medical College, New York, New York 10021, USA.
Anesthesiology. 1998 Mar;88(3):619-23. doi: 10.1097/00000542-199803000-00010.
Spinal anesthesia with lidocaine is ideal for ambulatory surgery because of its short duration of action. However, transient neurologic symptoms (TNS) occur in 0-40% of patients. The incidence of TNS with mepivacaine, which has a similar duration of action, is unknown.
Sixty ambulatory patients undergoing knee arthroscopy received spinal anesthesia in a randomized, double-blinded manner, with either 45 mg 1.5% mepivacaine or 60 mg 2% lidocaine. An L3-L4 midline approach was used with a 27-gauge Whitacre needle and a 20-gauge introducer. The local anesthetic was injected over approximately 30 s with the aperture of the Whitacre needle in a cephalad direction. Two to 4 days after operation, each patient was questioned about the development of TNS. In addition, the two groups were compared for time to regression of sensory and motor blockade and time to discharge milestones.
Three patients receiving lidocaine were lost to follow-up. None of the 30 patients in the mepivacaine group developed TNS, whereas 6 of 27 (22%) in the lidocaine group did (P = 0.008). Time to regression to the L5 sensory level and to complete resolution of motor block were similar in both groups. The times to discharge milestones were also comparable.
The incidence of TNS is greater with 2% lidocaine than with 1.5% mepivacaine for patients having unilateral knee arthroscopy under spinal anesthesia. Mepivacaine seems to be a promising alternative to lidocaine for outpatient surgical procedures because of its similar duration of action. Further studies are warranted to determine the optimal dose of intrathecal mepivacaine for ambulatory surgery and the incidence of TNS with other doses and concentrations of intrathecal mepivacaine.
利多卡因用于脊髓麻醉因作用时间短而适用于门诊手术。然而，0%至40%的患者会出现短暂性神经症状（TNS）。作用时间相似的甲哌卡因导致TNS的发生率尚不清楚。
60例行膝关节镜检查的门诊患者以随机、双盲方式接受脊髓麻醉，分别给予45mg 1.5%甲哌卡因或60mg 2%利多卡因。采用L3-L4中线入路，使用27G的惠特克针和20G的导引针。将局部麻醉药在约30秒内注入，惠特克针的开口朝头侧方向。术后2至4天，询问每位患者TNS的发生情况。此外，比较两组感觉和运动阻滞消退时间以及出院关键时间。
3例接受利多卡因的患者失访。甲哌卡因组的30例患者均未发生TNS，而利多卡因组的27例中有6例（22%）发生TNS（P = 0.008）。两组恢复至L5感觉水平和运动阻滞完全消退的时间相似。出院关键时间也相当。
对于脊髓麻醉下行单侧膝关节镜检查的患者，2%利多卡因导致TNS的发生率高于1.5%甲哌卡因。由于作用时间相似，甲哌卡因似乎是门诊手术中利多卡因的一个有前景的替代药物。有必要进一步研究以确定门诊手术鞘内注射甲哌卡因的最佳剂量以及其他剂量和浓度的鞘内甲哌卡因导致TNS的发生率。
