Abstract
Purpose
Minimum effective anaesthetic concentration (MEAC) of lidocaine for spinal anaesthesia, defined as the concentration at which a spinal anaesthetic agent produces surgical anaesthesia within 20 min of administration in 50% of patients, was determined in a randomised, double-blind study in young patients undergoing knee and ankle surgery.
Methods
Using the combined spinal-epidural technique, 48 or 72 mg hyperbaric lidocaine containing dextrose 7.5% was administered intrathecally to 43 patients at concentrations ranging from 0.2–0.9%. The choice of lidocaine concentration was determined by Dixon’s up-and-down method, Complete anaesthesia was defined as: ( I ) pinprick anaesthesia at or higher than T12, (2) anaesthesia to transcutaneous tetanic electric stimulation (50 Hz at 60 mA for five seconds) in the knees and (3) complete leg paralysis; all occurring in both lower extremities within 20 min. Epidural anaesthesia was initiated if anaesthesia was incomplete.
Results
In the 48 mg group, MEAC was 0.54% (95% Cl-0.21–0.87). Anaesthetic effect was variable with mean duration of anaesthesia of 29 min (range: 20–50 min) and maximum pinprick sensory level ranging from T2-T10. In the 72 mg group, successful anaesthesia was achieved consistently at a concentration of 0,3%, i.e., MEAC was < 0.3%. Mean duration of complete anaesthesia was 46 min (range: 30–60 min) with maximum sensory level from T3–T8.
Discussion
Spinal anaesthesia can be accomplished with very dilute lidocaine solutions (< 0.9%). The value of MEAC is dose-dependent, i.e., complete anaesthesia can be accomplished with lower concentrations by increasing the dose of spinal anaesthetic administered.
Résumé
Objectif
Déterminer la concentration anesthésique minimale efficace (CAME) de lidocaïne pour anesthésie rachidienne. Cette CAME est définie comme la concentration à laquelle l’agent anesthésique produit une anesthésie chirurgicale chez 50% des patients dans un délai de 20 minutes après l’injection. L’étude a été réalisée à double insu et selon une distribution aléatoire chez de jeunes patients soumis à une chirurgie de la cheville ou du genou.
Méthodes
Utilisant une technique combinée de rachi-épidurale, de la lidocaïne rendue hyperbare avec du dextrose 7.5% a été administrée en sous arachnoïdien à raison de 48 ou 72 mg chez 43 patients en concentrations variant de 0,2 à 0,9%. Le choix des concentrations de lidocaïne était déterminé par la méthode des hauts et bas de Dixon, Une anesthésie complète était définie par : I-une anesthésie à la piqûre à Tl2 ou plus haut; 2-une anesthésie à une stimulation électrique tétanique percutanée au niveau des genoux (50 Hz, 60 mA et 5 sec); 3-une paralysie complète des jambes; toutes ces manifestations devaient être présentes aux deux jambes en moins de 20 minutes. Si l’anesthésie étart: incomplète, la relève était assurée par l’épidurale.
Résultats
Dans le groupe 48 mg, la CAME était de 0,54% (intervalle de confiance 95%–0,2l à 0,87%). L’effet anesthésique était variable avec une durée moyenne de 29 min. (écart 20–50 min.) et un niveau senstif à l’aiguille variant de T2 à Tl0. Dans le groupe 72 mg, une anesthésie adéquate était atteinte de façon fiable à une concentration de 0,3%, c’est-à-dire que la CAME était < 0,3%. La durée moyenne de l’anesthésie complète était de 46 minutes (écart 30–60 min.) avec un niveau sensitif maximal variant de T3 à T8.
Discussion
L’anesthésie rachidienne peut être réussie avec des solutions de lidocaïne très diluées (< 0,9%), La valeur de la CAME dépend de la dose, i.e., une anesthésie complète peut être réalisée avec des concentrations plus faibles à condition d’augmenter la dose d’anesthésique local administré.
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Peng, P.W.H., Chan, V.W.S. & Perlas, A. Minimum effective anaesthetic concentration of hyperbaric lidocaine for spinal anaesthesia. Can J Anaesth 45, 122–129 (1998). https://doi.org/10.1007/BF03013249
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DOI: https://doi.org/10.1007/BF03013249