下肢手术中蛛网膜下腔注射常规剂量不同浓度的低比重左旋布比卡因的对比研究
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Comparative Study of Constant Dose Intrathecal Hypobaric Levobupivacaine with Varying Baricities in Lower Limb Surgeries
背景与目的:低比重脊髓麻醉对于单侧下肢骨折是有利的，因为它可以消除躺下后由骨折肢体受压后导致的蛛网膜下腔阻滞而引起的疼痛。本研究比较了三种常规剂量不同浓度的低比重左布比卡因的阻滞特征和并发症，以确定选用左布比卡因的最佳浓度。
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方法：120美国麻醉医师学会：将纳入的18-65岁的单侧下肢手术患者分为三组，进行前瞻性群组研究。将0.4mL、0.6mL和0.8mL的蒸馏水分别加入ABC三组的2mL0.5％等比重的左布比卡因（10mg）溶液中，ABC三组得到的左布比卡因浓度分别为0.999294、0.998945和0.998806。通过针刺法和Bromage量表评估感觉和运动的阻滞情况，并记录痛觉缺失和并发症的总持续时间。利用平均值、标准误差、单因素方差分析和Bonferroni来分析定量变量；利用比例和卡方检验分析定性变量。
结果：从人口统计学参数、肢体运动阻滞和并发症几个方面进行比较。C组的感觉阻滞开始得最快（10.10分钟），痛觉缺失的持续时间最长（478.97分钟；P <0.001）；但感觉水平较高（48.7％）。 B组的T10感觉水平为92.5％；感觉阻滞开始时间与C组相当（P = 0.248），痛觉缺失的持续时间合理（332.50分钟）。A组的感觉水平偏低，感觉阻滞开始得迟缓且很快消失。
结论：比起另外两组，B组（浓度：0.998945）有较好的阻滞特征。
Biji KP; Sunil M; Ramadas KT. Comparative Study of Constant Dose Intrathecal Hypobaric Levobupivacaine with Varying Baricities in Lower Limb Surgeries Anesth Essays Res. 11(3):642-646, Jul-Sep 2017
Background: Hypobaric spinal anesthesia is advantageous for unilateral lower extremity fractures as it obviates pain of lying on fractured limb for performing subarachnoid block.AIMS: This study compares block characteristics and complications of three different baricities of constant dose intrathecal hypobaric levobupivacaine to determine an optimum baricity.
Methods: One-twenty American Society of Anesthesiologists Physical Status 1 and 2 patients aged 18-65 years undergoing unilateral lower limb surgeries were divided into three equal groups for this prospective cohort study.To 2 mL intrathecal 0.5% isobaric levobupivacaine (10 mg), 0.4 mL, 0.6 mL, and 0.8 mL of distilled water were added in Groups A, B, and C, respectively. Baricities of Groups A, B, and C are 0.999294, 0.998945, and 0.998806, respectively. Development of sensory and motor block was assessed by the pinprick method and Bromage scale, respectively. The total duration of analgesia and complications were noted.Mean, standard error, one-way ANOVA, and Bonferroni were used to analyze quantitative variables; proportions and Chi-square tests for qualitative variables.
Results:Demographic parameters, motor block of operated limb, and complications were comparable. Group C had the fastest onset of sensory block (10.10 min) and maximum duration of analgesia (478.97 min; P < 0.001); but high sensory levels in 48.7%. Group B had T10 sensory level in 92.5%; onset comparable to Group C (P = 0.248), and reasonable duration of analgesia (332.50 min). Group A had inadequate sensory levels, slow onset, and early regression.
Conclusion:Group B (baricity - 0.998945) has better block characteristics among three groups compared.
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