0.5% 重比重布比卡因单侧脊髓麻醉的阻滞分布及心血管效应。与双侧脊髓阻滞的临床比较。

Block distribution and cardiovascular effects of unilateral spinal anaesthesia by 0.5% hyperbaric bupivacaine. A clinical comparison with bilateral spinal block.

作者信息

Casati A, Fanelli G, Beccaria P, Aldegheri G, Berti M, Senatore R, Torri G

机构信息

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

出版信息

Minerva Anestesiol. 1998 Jul-Aug;64(7-8):307-12.

PMID:9796239

Abstract

BACKGROUND

A low dose of hyperbaric local anaesthetic solution, pencil point needle and slow speed of intrathecal injection have been reported to obtain a unilateral distribution of spinal anaesthesia. This should also minimize cardiovascular effects of spinal block. The aim of this prospective, randomized, parallel group study was to evaluate cardiac performance during unilateral subarachnoid block and to compare it with that produced by standard bilateral spinal anaesthesia.

METHODS

With Ethic Committee approval and patients' consent we studied 30 ASA I-II patients scheduled for one leg surgery. Dural puncture was performed by 25-G Whitacre needle with patients lying in the lateral position and the side to be operated on dependent. Patients then randomly received 8 mg of 0.5% hyperbaric bupivacaine injected over 80 sec with needle hole orientated towards the dependent side (Unilateral, n = 15), or 15 mg of the same solution injected over 6 sec with needle bevel cranially directed (Control, n = 15). Only patients of the Unilateral group remained in the lateral position for 15 min. Noninvasive Arterial blood pressure, heart rate, stroke volume index and cardiac index were measured before spinal block (baseline) and then at 5, 15, 30 and 45 min; while sensory and motor blocks were evaluated at 15, 30 and 45 min on both sides.

RESULTS

Unilateral spinal anaesthesia was observed in 11 patients of the Unilateral group (73%). Three patients of the Control group (20%) required colloids for intraoperative hypotension. Mean arterial blood pressure and heart rate decreased from baseline only in the Control group (p = 0.001 and p = 0.0003 respectively), while heart rate was decreased in Control even when compared to Unilateral group (p = 0.01). The stroke volume index was unchanged in the two groups (p = 0.22), while the cardiac index showed a 15-20% decrease from baseline in Control group (p = 0.001), with a significant decrease at 30 and 45 min when compared to Unilateral (p = 0.01).

DISCUSSION

The use of 8 mg of 0.5% hyperbaric bupivacaine slowly injected through a directional needle provided a spinal block relatively restricted to the operative side with minimal effects on cardiovascular homeostasis.

摘要

背景

据报道，低剂量的高压局部麻醉溶液、笔尖式针头和缓慢的鞘内注射速度可使脊髓麻醉呈单侧分布。这也应能最大限度地减少脊髓阻滞对心血管的影响。这项前瞻性、随机、平行组研究的目的是评估单侧蛛网膜下腔阻滞期间的心脏功能，并将其与标准双侧脊髓麻醉所产生的心脏功能进行比较。

方法

经伦理委员会批准并获得患者同意后，我们研究了30例计划进行单腿手术的ASA I-II级患者。采用25G Whitacre针进行硬膜穿刺，患者取侧卧位，手术侧在下。然后患者随机接受8mg 0.5%高压布比卡因，在80秒内注射，针孔朝向下方（单侧组，n = 15），或15mg相同溶液在6秒内注射，针斜面朝上（对照组，n = 15）。只有单侧组的患者保持侧卧位15分钟。在脊髓阻滞前（基线）以及之后的5、15、30和45分钟测量无创动脉血压、心率、每搏量指数和心脏指数；同时在15、30和45分钟评估双侧的感觉和运动阻滞情况。

结果

单侧组11例患者（73%）出现单侧脊髓麻醉。对照组3例患者（20%）术中低血压需要输注胶体液。仅对照组的平均动脉血压和心率较基线下降（分别为p = 0.001和p = 0.0003），而与单侧组相比，对照组的心率也下降（p = 0.01）。两组的每搏量指数无变化（p = 0.22），而对照组的心脏指数较基线下降15 - 20%（p = 0.001），与单侧组相比，在30和45分钟时显著下降（p = 0.01）。