Frey K, Holman S, Mikat-Stevens M, Vazquez J, White L, Pedicini E, Sheikh T, Kao T C, Kleinman B, Stevens R A
Department of Anesthesiology, Loyola University Medical Center, Maywood, Illinois 60153, USA.
Reg Anesth Pain Med. 1998 Mar-Apr;23(2):159-63. doi: 10.1097/00115550-199823020-00008.
Surgical procedures previously considered too lengthy for the ambulatory surgery setting are now being performed during spinal anesthesia. The complete recovery profile of tetracaine and bupivacaine are now of interest but are not available in the literature. This study was conducted to compare times to ambulation, voiding, and complete block resolution, as well as the incidence of back and radicular pain, after spinal anesthesia with lidocaine, bupivacaine, and tetracaine.
Twelve adult volunteers underwent spinal anesthesia on three separate occasions with three local anesthetics (lidocaine 100 mg, bupivacaine 15 mg, and tetracaine 15 mg in hyperbaric solutions) in random order and in a double-blind fashion. A 24-gauge Sprotte spinal needle was placed at the L2-3 interspace. The level of analgesia to pinprick was determined moving cephalad in the midclavicular line until a dermatome was reached at which the prick felt as sharp as over an unblocked dermatome. One dermatome caudad to this point was recorded every 5 minutes as the level of analgesia. We also recorded the times to voiding, unassisted ambulation, and complete resolution of sacral anesthesia.
There was no difference between tetracaine and bupivacaine in time taken for two- and four-segment regression of the analgesia level. However, times to ambulation and complete resolution of the block were significantly shorter with bupivacaine then with tetracaine. With lidocaine, times to four-segment regression, ambulation, voiding, and complete regression of the block were significantly shorter than with bupivacaine and tetracaine. Time to two-segment regression did not differ among local anesthetics. Back and radicular pain symptoms were reported by three subjects after lidocaine subarachnoid block but not after tetracaine or bupivacaine.
Among individual subjects, lidocaine exhibited the shortest recovery profile. However, the recovery profiles of the three anesthetics were very variable between subjects. Time to meeting discharge criteria after bupivacaine or tetracaine was faster in a few subjects than that after lidocaine in other subjects. For ambulatory anesthesia, times to two- and four-segment regression do not accurately predict time to readiness for discharge after spinal anesthesia.
以前被认为对于门诊手术时间过长的外科手术，现在可在脊麻期间进行。丁卡因和布比卡因的完全恢复情况目前受到关注，但文献中尚无相关报道。本研究旨在比较利多卡因、布比卡因和丁卡因脊麻后下床活动、排尿及阻滞完全消退的时间，以及背痛和神经根性疼痛的发生率。
12名成年志愿者分三次接受脊麻，每次使用一种局麻药（100mg利多卡因、15mg布比卡因和15mg丁卡因的重比重溶液），随机顺序且采用双盲方式。用24G Sprotte脊麻针于L2 - 3间隙穿刺。在锁骨中线向头侧移动，直至达到痛觉与未阻滞皮节一样尖锐的皮节，以此确定痛觉消失平面。从该平面向尾侧每隔5分钟记录一个皮节作为镇痛平面。我们还记录了排尿、自主下床活动及骶部麻醉完全消退的时间。
丁卡因和布比卡因在镇痛平面两皮节和四皮节消退时间上无差异。然而，布比卡因组下床活动和阻滞完全消退的时间显著短于丁卡因组。利多卡因组，镇痛平面四皮节消退、下床活动、排尿及阻滞完全消退的时间显著短于布比卡因组和丁卡因组。两皮节消退时间在三种局麻药之间无差异。3名受试者在利多卡因蛛网膜下腔阻滞后出现背痛和神经根性疼痛症状，而丁卡因或布比卡因组未出现。
在个体受试者中，利多卡因恢复最快。然而，三种麻醉药在不同受试者间的恢复情况差异很大。少数接受布比卡因或丁卡因麻醉的受试者达到出院标准的时间比另一些接受利多卡因麻醉的受试者更快。对于门诊麻醉，镇痛平面两皮节和四皮节消退时间不能准确预测脊麻后准备出院的时间。
