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[Fundamentals and requirements of peripheral electric nerve stimulation. A contribution to the improvement of safety standards in regional anesthesia]. 外周电神经刺激的基本原理和要求。对提高区域麻醉安全标准的贡献[j]。
Pub Date : 1990-09-01
H Kaiser, H C Niesel, V Hans

The use of a nerve stimulator allows an injection cannula to be located without the cooperation of the patient. Regional anesthesia thus becomes safer because the basic condition "no paresthesia, no anesthesia" becomes irrelevant. In accordance with the basic electrophysiological conditions, a stimulator should have the following properties: (1) adjustable constant current at resistances of 0.5-10 kOhm; (2) monophasic square-wave initial impulse; (3) impulse duration selectable (0.1 ms + 1 ms, and exactly adjustable; (4) impulse amplitude (0-5 mA) exactly adjusted, unequivocal scale graduation or current indicator, in particular in the range of 0.05-1.0 mA; (5) impulse frequency 1-2 (-3) Hz; (6) alarm at high impedance and check on electrical circuit; (7) battery test (indication of battery voltage); (8) unequivocal assignment of load end; (9) high-quality connecting cable and plug; and availability of (10) instructions for use with relevant parameters (tolerated variations, steady-state characteristic curves, etc.).

使用神经刺激器可以在没有患者配合的情况下定位注射套管。区域麻醉因此变得更安全,因为“无感觉异常,无麻醉”的基本条件变得无关紧要。根据基本的电生理条件,刺激器应具有以下特性:(1)在0.5-10欧姆的电阻范围内可调恒流;(2)单相方波初始脉冲;(3)脉冲持续时间可选(0.1 ms + 1 ms,精确可调;(4)脉冲幅度(0-5毫安)精确调节,明确刻度刻度刻度或电流指示,特别是在0.05-1.0毫安范围内;(5)脉冲频率1 ~ 2 (-3)Hz;(6)高阻抗报警及电路检查;(7)电池试验(电池电压指示);(8)明确指定负载端;(9)高质量的连接电缆和插头;(10)相关参数(公差变化、稳态特性曲线等)的使用说明。
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引用次数: 0
[The effect of barbotage on the sensory spread in spinal anesthesia using isobaric and hyperbaric 0.5% bupivacaine]. [刺痛对0.5%布比卡因等压和高压腰麻感觉扩散的影响]。
Pub Date : 1990-09-01
W Schröder, R Schwagmeier, A Schmidt, H Nolte

The effect of spinal anesthesia with barbotage versus without barbotage on the spread of analgesia was investigated. For comparison, hyper- and isobaric bupivacaine 0.5% with adrenaline 1:200,000 was used. MATERIAL AND METHODS. Barbotage was accomplished as follows: after lumbar puncture 0.5 ml CSF was aspirated into the local anesthetic solution, followed by reinjection of 1.0 ml of the solution. This process was repeated six times. Sixty patients who were scheduled for urological or lower limb surgery under spinal anesthesia were selected for this study. Patients were each arbitrarily assigned to one of four groups (isobaric and hyperbaric, without and with barbotage). RESULTS. There was no statistically significant difference in the maximum level of sensory analgesia. The mean maximum level of sensory analgesia reached T9 (group 1), T8 (group 2), T9 (group 3) and T8 (group 4). Time to highest dermatome was significantly shorter with barbotage (groups 1-4: 19.0 min, 13.0 min, 18.7 min, 12.3 min). Times for regression of analgesia to T12 (mean maximum duration) were 142 (+/- 54.9) min, 164 (+/- 29.7) min, 130 (+/- 40.4) min and 144 (+/- 36.2) min (groups 1-4). Motor block grade 3 (Bromage) was achieved in significantly shorter times with barbotage than without. The shortest onset time was recorded with isobaric bupivacaine. The onset time of a complete motor block was 12.5 (+/- 5.5) min in group 1, 6.1 (+/- 2.9) min in group 2, 15.8 (+/- 4.7) min in group 3, and 11.7 (+/- 5.1) min in group 4. CONCLUSIONS. The results showed no significant differences between the maximum segmental sensory levels or duration of anesthesia observed with isobaric and with hyperbaric bupivacaine (with and without barbotage). Sufficient analgesia was obtained with barbotage and without barbotage. Uncontrolled cephalad spread of spinal anesthesia was not observed. Barbotage has the advantage of shortening time for spread to highest dermatome and the time to onset of complete motor block.

研究了腰麻加倒刺与不倒刺对镇痛扩散的影响。相比之下,高、等压布比卡因0.5%,肾上腺素1:20万。材料和方法。腰椎穿刺后,将0.5 ml脑脊液抽入局麻溶液中,再回注局麻溶液1.0 ml。这个过程重复了六次。本研究选择了60例在脊髓麻醉下进行泌尿外科或下肢手术的患者。每个患者被随机分配到四组中的一组(等压组和高压组,无压组和有压组)。结果。两组最大感觉镇痛程度差异无统计学意义。平均最大感觉镇痛水平分别达到T9(1组)、T8(2组)、T9(3组)和T8(4组)。针刺组到达最高皮节的时间明显缩短(1 ~ 4组:19.0 min、13.0 min、18.7 min、12.3 min)。镇痛恢复至T12的时间(平均最长持续时间)分别为142 (+/- 54.9)min、164 (+/- 29.7)min、130 (+/- 40.4)min和144 (+/- 36.2)min(1-4组)。运动阻滞3级(Bromage)在较短的时间内达到。等比重布比卡因的起效时间最短。完全运动阻滞的发生时间为:1组12.5 (+/- 5.5)min, 2组6.1 (+/- 2.9)min, 3组15.8 (+/- 4.7)min, 4组11.7 (+/- 5.1)min。结论。结果显示,等压布比卡因和高压布比卡因(有和没有倒刺)麻醉的最大节段感觉水平或麻醉时间之间没有显着差异。针刺和不针刺均可获得充分的镇痛效果。未观察到脊髓麻醉不受控制的头部扩散。Barbotage的优点是缩短扩散到最高皮节的时间和完全运动阻滞的发生时间。
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引用次数: 0
[A peridural catheter obstructed with glass particles--should a filter always be used in a test dose?]. 【硬膜外导管被玻璃颗粒堵塞——在试验剂量中是否总是使用过滤器?】
Pub Date : 1990-09-01
D Duda
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引用次数: 0
[In electric nerve stimulation can the distance from the nerves be inferred from the intensity of muscle contraction? Possible parameters and sources of error]. 在神经电刺激中,从肌肉收缩的强度可以推断出与神经的距离吗?可能的参数和误差来源]。
Pub Date : 1990-09-01
P März

Electrical nerve stimulation is a useful tool in regional anesthesia; it assists in locating the nerves. This investigation deals with electrical resistances at adhesive electrodes attached to the skin. The influence of external electrical resistance on the stimulating impulse is demonstrated. A new type of nerve stimulator is described; which integrates a measuring device that indicates the electrical impulse actually flowing in the patient. With this device, relationships between stimulating impulse, intensity of muscle contraction, and distance of the puncture cannula from the nerve can be assessed. MATERIALS AND METHODS. The electrical curve I = f (R) was determined using 3 different nerve stimulators (R = 1 - 15k omega). On each of five test persons, five adhesive electrodes were attached to the skin 10 cm apart. The resistance was assessed between these electrodes and a subcutaneously inserted puncture needle. The right and left brachial plexuses of the 5 subjects were punctured, using the axillary approach. A synchronized video camera simultaneously recorded the following values: (1) electrical impulse; (2) corresponding muscle contraction; and (3) the position of the puncture cannula. A scale ranging from 0-5 was applied to define the strength of the muscle contractions. RESULTS. The external resistance as measured under clinical conditions may limit the output impulse of nerve stimulators. In this case, the exerting impulse is lower than that indicated by the appliance. This error can only be identified using an impulse-measuring device. Nerve stimulators not equipped with a measuring device increase the risk of malpuncture, potentially resulting in nerve lesions. Skin resistance at adhesive electrodes varied from patient to patient within a range of 1.1 to 8.2 K omega. Preparing the skin appropriately (wiping with sandpaper) decreased the resistance by only 6% during the first 30 min. Within a distance of 50 cm to the puncture needle, the position of the adhesive electrode did not play a significant role. Axillary puncture of the brachial plexus resulted in the following values: (1) A stimulating impulse (cross-wave) of 1 mA and 1 ms exerted at a distance of 4 mm to the nerve induced a contraction of strength 3. (2) Reducing the impulse at this site by one-half (0.55 mA) resulted in just-visible contractions (strength 1). (3) Advancing the cannula at a stimulating impulse of 0.55 mA inside the neurovascular sheath again produced contractions of strength 3. (4) Performing the puncture with a blunt needle and tracing a distinct resistance, the impulse of 0.6 mA elicited contractions of strength 2. The needle tip was still outside the vascular nerve sheath. If this resistance was overcome and the needle tip lay inside the neurovascular sheath, the impulse could be reduced by one-half (0.32 mA) to produce contractions of strength 2.

神经电刺激是区域麻醉的有效手段;它有助于定位神经。这项研究涉及附着在皮肤上的粘接电极上的电阻。论证了外部电阻对刺激脉冲的影响。介绍了一种新型的神经刺激器;它集成了一个测量装置,可以显示病人体内实际流动的电脉冲。使用该装置,可以评估刺激冲动、肌肉收缩强度和穿刺套管与神经的距离之间的关系。材料和方法。使用3种不同的神经刺激器(R = 1 - 15k ω)测定电曲线I = f (R)。在5名被试者身上,每个人的皮肤上分别贴上5个相距10厘米的粘性电极。在这些电极和皮下插入的穿刺针之间评估电阻。采用腋窝入路穿刺5例患者的左右臂丛。一台同步摄像机同时记录下以下数值:(1)电脉冲;(2)相应的肌肉收缩;(3)穿刺套管的位置。用0-5的刻度来定义肌肉收缩的强度。结果。在临床条件下测量的外部阻力可能会限制神经刺激器的输出脉冲。在这种情况下,施加的冲量小于器具所指示的冲量。这种误差只能通过脉冲测量装置来识别。没有配备测量装置的神经刺激器增加了穿刺不当的风险,可能导致神经损伤。粘附电极上的皮肤电阻在1.1至8.2 K ω的范围内因人而异。在最初的30分钟内,适当地准备皮肤(用砂纸擦拭)仅降低了6%的阻力。在距离穿刺针50厘米的距离内,粘附电极的位置没有起显着作用。腋窝穿刺臂丛的结果如下:(1)在距离神经4mm处施加1ma和1ms的刺激脉冲(交叉波),引起强度3的收缩。(2)将该部位的脉冲减少一半(0.55 mA),导致刚刚可见的收缩(强度为1)。(3)在神经血管鞘内以0.55 mA的刺激脉冲推进套管,再次产生强度为3的收缩。(4)用钝针穿刺,追踪到明显的阻力,0.6 mA的脉冲引起强度为2的收缩。针尖仍在血管神经鞘外。如果克服了这种阻力,针尖位于神经血管鞘内,则脉冲可以减少一半(0.32 mA),从而产生强度为2的收缩。
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引用次数: 0
[No effect of injection volume on sensory and motor blockade in isobaric spinal anesthesia]. [注射量对等压腰麻感觉和运动阻滞无影响]。
Pub Date : 1990-09-01
E Lanz, D Schmitz

The authors were interested to find whether the course of sensory and motor blockade in isobaric spinal anesthesia was determined by the dose or the volume of the anesthetic agent. In a randomized double-blind study in 60 patients, each underwent isobaric spinal anesthesia with 17.5 mg bupivacaine. In three groups of 20 patients, this dose was administered as 3.5 mg bupivacaine 0.5%, 7 ml bupivacaine 0.25% or 10 ml bupivacaine 0.175%. The development, spread and regression of sensory block (anesthesia, analgesia) and motor block (Bromage scale, rectus abdominis muscle test) were determined. The clinical data recorded in the three groups were comparable. The rate of development, the maximal spread or intensity, and the regression of sensory and motor blockade did not differ in the three groups. The only difference was that the complete regression was shorter following 10 ml bupivacaine 0.175% (P less than 0.05). It is therefore concluded that the dose, and not the volume, determines the course of sensory and motor blockade of isobaric spinal anesthesia.

作者感兴趣的是,在等压脊髓麻醉中,感觉和运动阻滞的过程是否由麻醉剂的剂量或体积决定。在一项随机双盲研究中,60名患者接受17.5 mg布比卡因等压脊髓麻醉。在三组20例患者中,该剂量分别为3.5 mg布比卡因0.5%,7 ml布比卡因0.25%或10 ml布比卡因0.175%。观察感觉阻滞(麻醉、镇痛)和运动阻滞(Bromage量表、腹直肌试验)的发展、扩散和消退。三组临床资料具有可比性。三组的发展速度、最大范围或强度、感觉和运动阻断的消退无显著差异。唯一不同的是,当布比卡因浓度为0.175%时,完全回归时间较短(P < 0.05)。因此,我们认为是剂量而不是体积决定了等压脊髓麻醉的感觉和运动阻滞的过程。
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引用次数: 0
[Transient medium- and deep-tone hearing disorders following spinal anesthesia]. [脊髓麻醉后的一过性中、深音听力障碍]。
Pub Date : 1990-08-01
M Dreyer, H Migdal

In a prospective study, 100 patients who underwent general surgical or urological operations under spinal anesthesia were examined to determine whether there was a relation between the anesthesia and postoperative hearing loss. Audiograms were performed preoperatively and as the 1st, 2nd, 3rd, and 5th postoperative days. It was found that 16 patients had impairment of hearing. The average ages of these patients were similar to those of the total population. The hearing loss was typical: only the frequencies between 125 and 2000 Hz were affected. It began on the 2nd day after spinal anesthesia and disappeared within 3 days without special therapy. The cause of this typical hearing loss after spinal anesthesia is a drop in cerebrospinal fluid pressure transmitted to the perilymph via the cochlear aqueduct. The change in the endoperilymphatic pressure difference results in a change in the oscillation of the basilar membrane. Because 16% of patients may suffer hearing loss after spinal anesthesia, it seems reasonable from a medicolegal point of view to explain the possibility of defective hearing to the patient.

在一项前瞻性研究中,对100例在脊髓麻醉下接受普通外科或泌尿外科手术的患者进行检查,以确定麻醉与术后听力损失之间是否存在关系。术前及术后第1、2、3、5天进行听力图。16例患者有听力障碍。这些患者的平均年龄与总人口的年龄相似。听力损失是典型的:只有125和2000赫兹之间的频率受到影响。自脊髓麻醉后第2天发病,无特殊治疗,3天内消失。脊髓麻醉后听力损失的典型原因是脑脊液压力下降,通过耳蜗导水管传递到淋巴管周围。淋巴内压差的变化导致基底膜振荡的变化。由于16%的患者在脊髓麻醉后可能出现听力损失,从医学法律的角度向患者解释听力缺陷的可能性似乎是合理的。
{"title":"[Transient medium- and deep-tone hearing disorders following spinal anesthesia].","authors":"M Dreyer,&nbsp;H Migdal","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In a prospective study, 100 patients who underwent general surgical or urological operations under spinal anesthesia were examined to determine whether there was a relation between the anesthesia and postoperative hearing loss. Audiograms were performed preoperatively and as the 1st, 2nd, 3rd, and 5th postoperative days. It was found that 16 patients had impairment of hearing. The average ages of these patients were similar to those of the total population. The hearing loss was typical: only the frequencies between 125 and 2000 Hz were affected. It began on the 2nd day after spinal anesthesia and disappeared within 3 days without special therapy. The cause of this typical hearing loss after spinal anesthesia is a drop in cerebrospinal fluid pressure transmitted to the perilymph via the cochlear aqueduct. The change in the endoperilymphatic pressure difference results in a change in the oscillation of the basilar membrane. Because 16% of patients may suffer hearing loss after spinal anesthesia, it seems reasonable from a medicolegal point of view to explain the possibility of defective hearing to the patient.</p>","PeriodicalId":77604,"journal":{"name":"Regional-Anaesthesie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1990-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13370795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Maternal and neonatal plasma concentrations of bupivacaine during peridural anesthesia for cesarean section]. [剖宫产术硬膜外麻醉时母婴布比卡因血药浓度]。
Pub Date : 1990-08-01
R Schürg, J Biscoping, B Bachmann-M, V Jovanovic, M Kirschbaum, G Hempelmann

Many anesthesiologists prefer epidural anesthesia for cesarean section because of the potential risks of general anesthesia such as Mendelson's syndrome. For this indication, the local anesthetic of first choice is the long-acting substance bupivacaine. The aim of the following study was to determine maternal and neonatal plasma concentrations of bupivacaine 0.5% following epidural anesthesia for cesarean section in order to give critical statements about the systemic toxicity of the local anesthetic. MATERIALS and METHODS. Central venous blood samples were collected for bupivacaine analysis (gas chromatography) in 15 patients (Table 1) undergoing cesarean section with epidural anesthesia over a period of 60 min after injection of 14 to 23 ml bupivacaine 0.5%. Six of these patients had received the epidural anesthesia earlier to relieve labor pain. Before administering the anesthetic dose, a blood sample was taken to determine the baseline value. Immediately after cord clamping, blood sampling was done to determine bupivacaine concentrations in the umbilical artery and vein. Apgar scores and blood gases were also checked and compared with those of neonates born by cesarean section under general anesthesia. RESULTS. Ten to 15 min following epidural application of 70 to 115 mg bupivacaine (mean = 99 mg), peak plasma concentrations occurred (mean = 0.41 micrograms/ml) The maximum plasma level of 0.7 micrograms/ml bupivacaine was found in a patient who had received epidural anesthesia for pain relief during labor. In this case, the baseline bupivacaine level after several epidural injections (125 mg in 15 h) before the anesthetic dose for cesarean section was 0.2 micrograms/ml. Immediately after delivery the mean plasma bupivacaine concentrations in the umbilical vein and artery were 0.11 micrograms/ml and 0.07 micrograms/ml respectively. Apgar scores and blood gas analyses showed no significant difference between neonates born by cesarean section under regional or general anesthesia. DISCUSSION. Using bupivacaine 0.5% for epidural anesthesia for cesarean section, we found maternal and neonatal plasma concentrations of the local anesthetic far below the accepted threshold level for producing systemic toxic reactions. In contrast to others, we obtained good analgesia and sufficient motor blockade accompanied by low plasma levels. In our opinion, there is no need to use 0.75% bupivacaine, especially since peak plasma concentrations of more than 2 micrograms/ml occur shortly after its epidural administration.

许多麻醉师更倾向于硬膜外麻醉来进行剖宫产手术,因为它有全身麻醉的潜在风险,如门德尔松综合征。对于这种适应症,首选的局麻药是长效物质布比卡因。以下研究的目的是测定剖宫产术硬膜外麻醉后孕妇和新生儿0.5%布比卡因的血浆浓度,以便对局麻药的全身毒性给出关键的陈述。材料和方法。15例剖宫产硬膜外麻醉患者(表1)注射0.5%布比卡因14 ~ 23 ml后,于60 min内采集中心静脉血进行布比卡因分析(气相色谱法)。其中6例患者早前接受硬膜外麻醉以缓解分娩疼痛。在给药前,取血样以确定基线值。脐带夹紧后,立即采血,以确定布比卡因浓度在脐动脉和静脉。还检查了Apgar评分和血气,并与在全身麻醉下剖宫产的新生儿进行了比较。结果。在硬膜外应用70 ~ 115 mg布比卡因(平均99 mg)后10 ~ 15分钟,出现血药浓度峰值(平均0.41微克/毫升),在分娩过程中接受硬膜外麻醉缓解疼痛的患者中发现最高血药浓度为0.7微克/毫升布比卡因。本例剖宫产麻醉剂量前,经数次硬膜外注射(15小时125 mg)后的基线布比卡因水平为0.2微克/毫升。分娩后立即脐静脉和动脉布比卡因平均血浆浓度分别为0.11微克/毫升和0.07微克/毫升。Apgar评分和血气分析显示剖宫产新生儿在区域麻醉和全身麻醉下无显著差异。讨论。在剖宫产术中使用0.5%布比卡因硬膜外麻醉,我们发现产妇和新生儿的血药浓度远低于产生全身毒性反应的可接受阈值。与其他方法相比,我们获得了良好的镇痛效果和充分的运动阻断,并伴有低血浆水平。我们认为,没有必要使用0.75%布比卡因,特别是在硬膜外给药后不久,血药浓度峰值超过2微克/毫升。
{"title":"[Maternal and neonatal plasma concentrations of bupivacaine during peridural anesthesia for cesarean section].","authors":"R Schürg,&nbsp;J Biscoping,&nbsp;B Bachmann-M,&nbsp;V Jovanovic,&nbsp;M Kirschbaum,&nbsp;G Hempelmann","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Many anesthesiologists prefer epidural anesthesia for cesarean section because of the potential risks of general anesthesia such as Mendelson's syndrome. For this indication, the local anesthetic of first choice is the long-acting substance bupivacaine. The aim of the following study was to determine maternal and neonatal plasma concentrations of bupivacaine 0.5% following epidural anesthesia for cesarean section in order to give critical statements about the systemic toxicity of the local anesthetic. MATERIALS and METHODS. Central venous blood samples were collected for bupivacaine analysis (gas chromatography) in 15 patients (Table 1) undergoing cesarean section with epidural anesthesia over a period of 60 min after injection of 14 to 23 ml bupivacaine 0.5%. Six of these patients had received the epidural anesthesia earlier to relieve labor pain. Before administering the anesthetic dose, a blood sample was taken to determine the baseline value. Immediately after cord clamping, blood sampling was done to determine bupivacaine concentrations in the umbilical artery and vein. Apgar scores and blood gases were also checked and compared with those of neonates born by cesarean section under general anesthesia. RESULTS. Ten to 15 min following epidural application of 70 to 115 mg bupivacaine (mean = 99 mg), peak plasma concentrations occurred (mean = 0.41 micrograms/ml) The maximum plasma level of 0.7 micrograms/ml bupivacaine was found in a patient who had received epidural anesthesia for pain relief during labor. In this case, the baseline bupivacaine level after several epidural injections (125 mg in 15 h) before the anesthetic dose for cesarean section was 0.2 micrograms/ml. Immediately after delivery the mean plasma bupivacaine concentrations in the umbilical vein and artery were 0.11 micrograms/ml and 0.07 micrograms/ml respectively. Apgar scores and blood gas analyses showed no significant difference between neonates born by cesarean section under regional or general anesthesia. DISCUSSION. Using bupivacaine 0.5% for epidural anesthesia for cesarean section, we found maternal and neonatal plasma concentrations of the local anesthetic far below the accepted threshold level for producing systemic toxic reactions. In contrast to others, we obtained good analgesia and sufficient motor blockade accompanied by low plasma levels. In our opinion, there is no need to use 0.75% bupivacaine, especially since peak plasma concentrations of more than 2 micrograms/ml occur shortly after its epidural administration.</p>","PeriodicalId":77604,"journal":{"name":"Regional-Anaesthesie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1990-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13370794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Axillary blockade of the brachial plexus using 60 ml prilocaine 0.5% vs. 40 ml prilocaine 1%. A clinical study of 144 patients carried out by the determination of the prilocaine concentration in the central venous blood and by the measurement of the subfascial pressure in the plexus following the injection]. 臂丛腋窝阻断使用60ml 0.5%普拉卡因vs. 40ml 1%普拉卡因。对144例患者进行了注射后中心静脉血浓度测定和神经丛筋膜下压测定的临床研究。
Pub Date : 1990-07-01
J Jage, W Kossatz, J Biscoping, K U Zink, W Wagner

We estimated in this study the efficacy of axillary plexus blockade with 60 ml prilocaine 0.5% (300 mg). Following electrostimulation of the median, radial or ulnar nerve (depending on the area of the hand to be operated on), we injected prilocaine in two groups of patients (large volume group, 60 ml prilocaine 0.5% in 20 s; n = 114 patients; normal volume group, 40 ml prilocaine 1% in 20 s; n = 30 patients). Anesthesia of the median and ulnar nerves was virtually complete in all patients, but anesthesia of the radial and musculocutaneous nerves was complete in only 67% (radial) and 75% (musculocutaneous) in the group with normal injection volume. The injection of a larger volume but a lower concentration of prilocaine (300 mg) achieved better anesthesia of the radial (81%) and musculocutaneous (92%) nerves by 30-60 min after the injection. This difference was significant (p less than 0.05). The measurement of higher subfascial pressure in the axillary plexus following the larger volume of 60 ml than after 40 ml could explain the improved efficacy in overcoming anatomical hindrances in the plexus space. Estimation of the prilocaine concentration in the central venous blood 120 min after injection did not reveal different plasma concentrations in the two groups. The plasma concentrations were far below toxic levels. Only the time of plasma peak was earlier in the group with the larger volume, which was attributed to the larger area of diffusion of the vascular system in the plexus space.(ABSTRACT TRUNCATED AT 250 WORDS)

在这项研究中,我们估计用0.5% (300mg)的60毫升丙罗卡因阻断腋窝神经丛的疗效。在电刺激正中神经、桡神经或尺神经(取决于待手术手的面积)后,两组患者注射丙拉卡因(大容量组,丙拉卡因60ml 0.5%, 20 s;N = 114例;正常容积组,1%丙胺卡因40 ml, 20 s;N = 30例)。在所有患者中,正中神经和尺神经的麻醉几乎完全,而在注射量正常的组中,桡神经和肌皮神经的麻醉完全率仅为67%(桡神经)和75%(肌皮神经)。大体积低浓度的丙罗卡因(300 mg)在注射后30-60 min对桡骨神经(81%)和肌皮神经(92%)的麻醉效果较好。差异有统计学意义(p < 0.05)。60ml容积大于40ml容积后腋窝神经丛的筋膜下压力升高,可以解释克服臂丛间隙解剖障碍的效果提高。注射后120 min中心静脉血浓度测定未见两组血药浓度差异。血浆浓度远低于中毒水平。只是体积越大的组血浆峰时间越早,这是由于血管系统在神经丛空间的扩散面积越大。(摘要删节250字)
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引用次数: 0
[Comments on the paper by R. Bredtmann and A. Scholz. Subdural catheter placement. A complication of peridural anesthesia]. [R. Bredtmann和A. Scholz对论文的评论]硬膜下置管。硬膜外麻醉的并发症]。
Pub Date : 1990-07-01
W Seeling
{"title":"[Comments on the paper by R. Bredtmann and A. Scholz. Subdural catheter placement. A complication of peridural anesthesia].","authors":"W Seeling","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":77604,"journal":{"name":"Regional-Anaesthesie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1990-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13537414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Intravenous regional anesthesia of the foot using prilocaine. Clinical aspects, pharmacokinetic and pharmacodynamic studies]. 用丙罗卡因静脉局部麻醉足部。临床方面,药代动力学和药效学研究]。
Pub Date : 1990-07-01
R Schürg, J Biscoping, B Bachmann-M, G Hempelmann

Intravenous regional anesthesia (IVRA) of the foot is a rarely used but alternative method to other regional techniques and general anesthesia, especially when operating on the distal portion of the lower limb. The present report describes our method and experience with this type of anesthesia in approximately 500 patients, including pharmacokinetic and -dynamic aspects. MATERIALS AND METHODS. Pharmacological studies were performed in 17 orthopedic outpatients undergoing operations on the foot following an IVRA technique with prilocaine. A plastic cannula was inserted into a peripheral vein of the forefoot and a pneumatic tourniquet (350 mm Hg) applied proximally and close to the malleoli after achieving exsanguination with an Esmarch bandage. If there was no sufficient analgesia (pinprick testing) 5 min after injection of 200 mg prilocaine, IVRA was supplemented with another 100 mg of local anesthetic. Peripheral venous blood samples were collected at short intervals for up to 2 h before and after cuff release to determine total plasma concentrations of prilocaine (HPLC) and the degree of methemoglobinemia (CO-Oximeter). RESULTS. Administration of 200-300 mg prilocaine resulted in complete analgesia in 15 of 17 cases that was sufficient for operations lasting up to 85 min. The tourniquet was tolerated for up to 105 min without any complaints. Plasma concentrations after 200 (n = 12) and 300 mg prilocaine (n = 3) peaked between 10 and 20 min after cuff release, respectively, with maximum levels of 0.96 micrograms/ml (means = 0.56 micrograms/ml) and 1.45 micrograms/ml. The extent of methemoglobin formation was low (maximum 3.8% of total hemoglobin). DISCUSSION. In addition to conventional anesthetic techniques, IVRA deserves a firm place in modern anesthesiological practice and should be used more widely. In order to avoid systemic toxic reactions, the use of prilocaine is recommended. Prolocaine plasma concentrations and methemoglobin formation were both far below toxic levels. Failure of IVRA was probably caused by premature outflow of the local anesthetic solution, as shown by the course of prilocaine plasma concentrations and methemoglobinemia.

足部静脉区域麻醉(IVRA)是一种很少使用但可替代其他区域技术和全身麻醉的方法,特别是在下肢远端手术时。本报告描述了我们在大约500例患者中使用这种麻醉的方法和经验,包括药代动力学和动力学方面。材料和方法。对17名骨科门诊患者进行了药理学研究,这些患者在使用丙胺卡因进行IVRA技术后进行了足部手术。在Esmarch绷带止血后,将塑料套管插入前足外周静脉,并在近端和靠近踝部处使用气动止血带(350 mm Hg)。如果在注射200 mg丙洛卡因5 min后仍无足够的镇痛(针刺试验),则在IVRA的基础上再加100 mg局麻。在释放袖带前后2小时内采集短间隔外周静脉血,测定血浆总浓度(HPLC)和高铁血红蛋白血症程度(CO-Oximeter)。结果。17例患者中有15例给予200- 300mg丙罗卡因完全镇痛,足以维持长达85分钟的手术。止血带耐受长达105分钟,无任何不适。200 mg (n = 12)和300 mg (n = 3)的血浆浓度分别在袖带释放后10 - 20分钟达到峰值,最高水平分别为0.96微克/毫升(平均值= 0.56微克/毫升)和1.45微克/毫升。高铁血红蛋白的形成程度较低(最多占总血红蛋白的3.8%)。讨论。除了传统的麻醉技术外,IVRA在现代麻醉实践中应该占有稳固的地位,并应得到更广泛的应用。为了避免全身毒性反应,建议使用丙胺卡因。血浆Prolocaine浓度和高铁血红蛋白的形成都远低于中毒水平。从丙胺卡因血浆浓度和高铁血红蛋白血症的变化过程可以看出,IVRA的失败可能是由于局麻溶液过早流出引起的。
{"title":"[Intravenous regional anesthesia of the foot using prilocaine. Clinical aspects, pharmacokinetic and pharmacodynamic studies].","authors":"R Schürg,&nbsp;J Biscoping,&nbsp;B Bachmann-M,&nbsp;G Hempelmann","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Intravenous regional anesthesia (IVRA) of the foot is a rarely used but alternative method to other regional techniques and general anesthesia, especially when operating on the distal portion of the lower limb. The present report describes our method and experience with this type of anesthesia in approximately 500 patients, including pharmacokinetic and -dynamic aspects. MATERIALS AND METHODS. Pharmacological studies were performed in 17 orthopedic outpatients undergoing operations on the foot following an IVRA technique with prilocaine. A plastic cannula was inserted into a peripheral vein of the forefoot and a pneumatic tourniquet (350 mm Hg) applied proximally and close to the malleoli after achieving exsanguination with an Esmarch bandage. If there was no sufficient analgesia (pinprick testing) 5 min after injection of 200 mg prilocaine, IVRA was supplemented with another 100 mg of local anesthetic. Peripheral venous blood samples were collected at short intervals for up to 2 h before and after cuff release to determine total plasma concentrations of prilocaine (HPLC) and the degree of methemoglobinemia (CO-Oximeter). RESULTS. Administration of 200-300 mg prilocaine resulted in complete analgesia in 15 of 17 cases that was sufficient for operations lasting up to 85 min. The tourniquet was tolerated for up to 105 min without any complaints. Plasma concentrations after 200 (n = 12) and 300 mg prilocaine (n = 3) peaked between 10 and 20 min after cuff release, respectively, with maximum levels of 0.96 micrograms/ml (means = 0.56 micrograms/ml) and 1.45 micrograms/ml. The extent of methemoglobin formation was low (maximum 3.8% of total hemoglobin). DISCUSSION. In addition to conventional anesthetic techniques, IVRA deserves a firm place in modern anesthesiological practice and should be used more widely. In order to avoid systemic toxic reactions, the use of prilocaine is recommended. Prolocaine plasma concentrations and methemoglobin formation were both far below toxic levels. Failure of IVRA was probably caused by premature outflow of the local anesthetic solution, as shown by the course of prilocaine plasma concentrations and methemoglobinemia.</p>","PeriodicalId":77604,"journal":{"name":"Regional-Anaesthesie","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1990-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13537412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Regional-Anaesthesie
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