两种不同区域麻醉技术用于单侧腿部手术的心血管效应。

Cardiovascular effects of two different regional anaesthetic techniques for unilateral leg surgery.

作者信息

Fanelli G, Casati A, Aldegheri G, Beccaria P, Berti M, Leoni A, Torri G

机构信息

Department of Anaesthesiology and Intensive Care, IRCCS H San Raffaele, University of Milan, Italy.

出版信息

Acta Anaesthesiol Scand. 1998 Jan;42(1):80-4. doi: 10.1111/j.1399-6576.1998.tb05084.x.

DOI:10.1111/j.1399-6576.1998.tb05084.x

PMID:9527749

Abstract

BACKGROUND

Cardiovascular function was assessed in 20 ASA I-II patients, scheduled for elective orthopaedic surgery with tourniquet in order to compare the haemodynamic changes induced by unilateral spinal anaesthesia and combined sciatico-femoral nerve block.

METHODS

After baseline measurement of cardiovascular parameters, patients were randomized to receive unilateral spinal anaesthesia or combined sciatico-femoral nerve block. Spinal anaesthesia was obtained by 8 mg of hyperbaric bupivacaine 0.5% slowly injected (speed=0.02 ml s[-1]) through a 25-G Whitacre spinal needle with the bevel orientated towards the dependent side and patients lying on their operated side for 15 min (group S, n=10). Combined sciatico-femoral nerve block was obtained by 7 mg kg(-1) of mepivacaine 2% (group NB, n=10). Haemodynamic variables were recorded 5, 10, 15, and 30 min after anaesthetic injection before surgery was started.

RESULTS

Anthropometric data, duration of surgery and acceptability of anaesthetic techniques were similar in the 2 groups. In 8 patients of group S, spinal block was restricted to the operated side (pinprick test and Bromage scale), while the other 2 patients developed bilateral spinal block after being turned supine. NB patients showed no haemodynamic changes during the study, whereas patients in group S showed a small but significant decrease of mean arterial blood pressure (P<0.002 vs baseline and P<0.04 vs NB), cardiac index (P<0.01 vs baseline and P<0.01 vs NB), and stroke volume index (P<0.01 vs baseline and P<0.01 vs NB).

CONCLUSION

Both sciatico-femoral and unilateral spinal blockade provide adequate anaesthesia for unilateral leg surgery with tourniquet. The former technique affects cardiovascular performance less than the latter one.

摘要

背景

对20例拟行择期骨科手术并使用止血带的美国麻醉医师协会（ASA）I-II级患者的心血管功能进行评估，以比较单侧脊麻和坐骨-股神经联合阻滞引起的血流动力学变化。

方法

在对心血管参数进行基线测量后，将患者随机分为接受单侧脊麻或坐骨-股神经联合阻滞两组。通过25G Whitacre脊麻针缓慢注射（速度=0.02 ml s[-1]）8 mg 0.5%的重比重布比卡因获得脊麻，针斜面朝向下方，患者取手术侧卧位15分钟（S组，n=10）。通过注射7 mg kg(-1)的2%甲哌卡因获得坐骨-股神经联合阻滞（NB组，n=10）。在开始手术前，于麻醉注射后5、10、15和30分钟记录血流动力学变量。

结果

两组患者的人体测量数据、手术时间和麻醉技术的可接受性相似。S组8例患者的脊麻局限于手术侧（针刺试验和布罗麻分级），而另外2例患者在转为仰卧位后出现双侧脊麻。NB组患者在研究期间血流动力学无变化，而S组患者的平均动脉血压（与基线相比P<0.002，与NB组相比P<0.04）、心脏指数（与基线相比P<0.01，与NB组相比P<0.01）和每搏量指数（与基线相比P<0.01，与NB组相比P<0.01）出现轻微但显著的下降。