Axelrod E H, Alexander G D, Brown M, Schork M A
Department of Anesthesiology, Sinai Hospital, Detroit, MI 48235, USA.
J Clin Anesth. 1998 Aug;10(5):404-9. doi: 10.1016/s0952-8180(98)00055-5.
To determine the approximate incidence of transient neurologic symptoms (TNS) [formerly known as transient radicular irritation (TRI)] associated with procaine spinal anesthesia, and whether fentanyl prolongs the duration of procaine spinal anesthesia.
Unrandomized pilot study.
Community teaching hospital.
106 consecutive patients scheduled for spinal anesthesia for procedures anticipated to last less than 90 minutes.
All patients received 5% procaine for spinal anesthesia. Fentanyl 20 micrograms was added for procedures anticipated to last longer than 45 minutes (but less than 90 min). Intraoperatively the adequacy of duration, level, and intensity of anesthesia were observed. Time from injection of local anesthetic until knee-bending was recorded. Three days postoperatively, patients were questioned intensively in an effort to determine whether back pain and/or symptoms consistent with TNS had occurred.
Duration of anesthesia was adequate in all but one instance. The intensity and the sensory level of anesthesia were satisfactory with one exception, a woman who had an unexpectedly low sensory level (L1) after 60 mg of procaine for cerclage, and who was also was the only patients to develop TNS. The incidence of TNS (0.9%) was markedly less than that reported after lidocaine and similar to the incidence observed after bupivacaine. Mild back pain without radiation occurred in 11 patients (10%), an incidence that is similar to that seen after bupivacaine and lidocaine. Compared with procaine alone, the addition of fentanyl significantly (p = 0.0001) prolonged the time to bending knees from 72 minutes to 97 minutes.
Procaine may be a useful alternative to lidocaine for short procedures, and it is less likely to produce TNS. Fentanyl prolongs motor block when added to procaine.
确定与普鲁卡因脊髓麻醉相关的短暂性神经症状（TNS）[以前称为短暂性神经根刺激（TRI）]的大致发生率，以及芬太尼是否会延长普鲁卡因脊髓麻醉的持续时间。
非随机试点研究。
社区教学医院。
106例连续患者，计划接受脊髓麻醉以进行预计持续时间少于90分钟的手术。
所有患者均接受5%普鲁卡因进行脊髓麻醉。对于预计持续时间超过45分钟（但少于90分钟）的手术，添加20微克芬太尼。术中观察麻醉持续时间、平面和强度是否足够。记录从注射局部麻醉药到屈膝的时间。术后三天，对患者进行详细询问，以确定是否发生背痛和/或与TNS一致的症状。
除1例情况外，麻醉持续时间均足够。麻醉强度和感觉平面均令人满意，仅有1例例外，一名女性在接受60毫克普鲁卡因用于宫颈环扎术后感觉平面意外较低（L1），且她也是唯一发生TNS的患者。TNS的发生率（0.9%）明显低于利多卡因报道的发生率，与布比卡因观察到的发生率相似。11例患者（10%）出现无放射痛的轻度背痛，该发生率与布比卡因和利多卡因术后观察到的发生率相似。与单独使用普鲁卡因相比，添加芬太尼显著（p = 0.0001）将屈膝时间从72分钟延长至97分钟。
对于短时间手术，普鲁卡因可能是利多卡因的有用替代药物，且产生TNS的可能性较小。芬太尼添加到普鲁卡因中可延长运动阻滞时间。
