Freedman J M, Li D K, Drasner K, Jaskela M C, Larsen B, Wi S
Department of Anesthesiology, Kaiser-Permanente Medical Center, Santa Rosa, California, USA.
Anesthesiology. 1998 Sep;89(3):633-41. doi: 10.1097/00000542-199809000-00012.
Recent evidence suggests that transient neurologic symptoms commonly follow lidocaine spinal anesthesia. However, information concerning factors that affect their occurrence is limited. Accordingly, to evaluate many potential risk factors, the authors undertook a prospective, multicenter, epidemiologic study.
On a voluntary basis, anesthetists at 15 participating centers forwarded a data sheet on patients who had spinal anesthesia to a research nurse blinded to the details of anesthesia and surgery. A subset was randomly selected for follow-up. The pressure [corrected] of transient neurologic symptoms, defined as leg or buttock pain, was the principal outcome variable. Logistic regression was used to control for potential confounders, and adjusted odds ratios and confidence intervals were used to estimate relative risk.
During a 14-month period, 1,863 patients were studied, of whom 47% received lidocaine, 40% bupivacaine, and 13% tetracaine. Patients given lidocaine were at higher risk for symptoms compared with those receiving bupivacaine (relative risk, 5.1; 95% CI, 2.5 to 10.2) or tetracaine (relative risk, 3.2; 95% CI, 1.04 to 9.84). For patients who received lidocaine, the relative risk of transient neurologic symptoms was 2.6 (95% CI, 1.5 to 4.5) with the lithotomy position compared with other positions, 3.6 (95% CI, 1.9 to 6.8), for outpatients compared with inpatients, and 1.6 (95% CI, 1 to 2.5) for obese (body mass index >30) compared with nonobese patients.
These results indicate that transient neurologic symptoms commonly follow lidocaine spinal anesthesia but are relatively uncommon with bupivacaine or tetracaine. The data identify lithotomy position and outpatient status as important risk factors in patients who receive lidocaine. Among other factors postulated to increase risk, obesity had an effect of borderline statistical significance, whereas age, sex, history of back pain, needle type, and lidocaine dose and concentration failed to affect risk.
最近的证据表明，利多卡因蛛网膜下腔麻醉后常出现短暂性神经症状。然而，关于影响其发生的因素的信息有限。因此，为了评估许多潜在的风险因素，作者进行了一项前瞻性、多中心的流行病学研究。
在自愿的基础上，15个参与中心的麻醉师将一份关于接受蛛网膜下腔麻醉患者的数据表转发给一名对麻醉和手术细节不知情的研究护士。随机选择一个子集进行随访。短暂性神经症状的压力[校正后]，定义为腿部或臀部疼痛，是主要的结局变量。使用逻辑回归来控制潜在的混杂因素，并使用调整后的比值比和置信区间来估计相对风险。
在14个月的时间里，对1863例患者进行了研究，其中47%接受利多卡因，40%接受布比卡因，13%接受丁卡因。与接受布比卡因（相对风险，5.1；95%CI，2.5至10.2）或丁卡因（相对风险，3.2；95%CI，1.04至9.84）的患者相比，接受利多卡因的患者出现症状的风险更高。对于接受利多卡因的患者，与其他体位相比，截石位时短暂性神经症状的相对风险为2.6（95%CI，1.5至4.5），门诊患者与住院患者相比为3.6（95%CI，1.9至6.8），肥胖（体重指数>30）患者与非肥胖患者相比为1.6（95%CI，1至2.5）。
这些结果表明，短暂性神经症状在利多卡因蛛网膜下腔麻醉后很常见，但在布比卡因或丁卡因麻醉后相对少见。数据表明截石位和门诊状态是接受利多卡因患者的重要风险因素。在其他假定会增加风险的因素中，肥胖具有边缘统计学意义的影响，而年龄、性别、背痛史、针型以及利多卡因剂量和浓度均未影响风险。
