Small-dose hypobaric lidocaine-fentanyl spinal anesthesia for short duration outpatient laparoscopy .1. A randomized comparison with conventional dose hyperbaric lidocaine

被引:76
作者
Vaghadia, H
McLeod, DH
Mitchell, GWE
Merrick, PM
Chilvers, CR
机构
[1] UNIV BRITISH COLUMBIA,VANCOUVER HOSP & HLTH SCI CTR,DEPT HLTH CARE & EPIDEMIOL,VANCOUVER,BC V5Z 1M9,CANADA
[2] UNIV BRITISH COLUMBIA,VANCOUVER HOSP & HLTH SCI CTR,DEPT GYNAECOL,VANCOUVER,BC V5Z 1M9,CANADA
关键词
D O I
10.1097/00000539-199701000-00011
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
A randomized, single-blind trial of two spinal anesthetic solutions for outpatient laparoscopy was conducted to compare intraoperative conditions and postoperative recovery. Thirty women (ASA physical status I and II) were assigned to one of two groups. Group I patients received a small-dose hypobaric solution of 1% lidocaine 25 mg made up to 3 mt by the addition of fentanyl 25 mu g. Group II patients received a conventional-dose hyperbaric solution of 5% lidocaine 75 mg (in 7.5% dextrose) made up to 3 mt by the addition of 1.5 mt 10% dextrose. All patients received 500 mt of crystalloid preloading. Spinal anesthesia was performed at L2-3 or L3-4 with a 27-gauge Quincke point needle. Surgery commenced when the level of sensory anesthesia reached T-6. Intraoperative hypotension requiring treatment with ephedrine occurred in 54% of Group II patients but not in any Group I patients. Median (range) time for full motor recovery was 50 (0-95) min in Group I patients compared to 90 (50-120) min in Group II patients (P = 0.0005). Sensory recovery also occurred faster in Group I patients (100 +/- 22 min) compared with Group II patients (140 +/- 27 min, P = 0.0001). Postoperative headache occurred in 38% of all patients and 70% of these were postural in nature. Oral analgesia was the only treatment required. Spinal anesthesia did not result in a significant incidence of postoperative backache. On follow-up, 96% said they found spinal needle insertion acceptable, 93% found surgery comfortable, and 90% said they would request spinal anesthesia for laparoscopy in future. Overall, this study found spinal anesthesia for outpatient laparoscopy to have high patient acceptance and a comparable complication rate to other studies. The small-dose hypobaric lidocaine-fentanyl technique has advantages over conventional-dose hyperbaric lidocaine of no hypotension and faster recovery.
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页码:59 / 64
页数:6
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