Abstract
Dans ce travail, les effets de la position assise sur la qualité du bloc sensitivomoteur des racines L5 et S1 lors d’une anesthésie péridurale et ses répercussions hémodynamiques ont été étudiés chez 39 patients subissant une chirurgie orthopédique de la cheville ou du pied. Après la mise en place d’un cathéter péridural en position latérale, 19 patients furent placés en position assise pendant 15 min après administration de l’anesthésique local et 20 en décubitus dorsal (groupe contrôle). Tous ont reçu une dose de 20 ml de lidocaïne 1,73% carbonatée adrénalinée. Le temps d’installation et la qualité du bloc sensitif des racines L1-S2 ainsi que les niveaux céphaliques sensitifs ont été comparables dans les deux groupes. Dans le groupe assis, 14 patients sur 19 ont présenté un degré de bloc moteur ≥3/5 contre 5 sur 20 dans le groupe couché (P < 0,001). La diminution de la tension artérielle moyenne a été plus importante dans le groupe assis (−24 ± 10%) comparativement au groupe couché (−16 ± 10%; P < 0,05) et a été observée plus précocément (14 ± 9 min et 21 ± 10 min respectivement; P < 0,01). En conclusion, les résultats de cette etude indiquent que la position assise pendant 15 min lors d’une anesthésie péridurale ne modifie en rien la qualité du bloc sensitif, mais permet d’améliorer significativement la qualité du bloc moteur.
Abstract
The effects of the sitting position on the quality of both sensory and motor blockade of segments L5 and S1 and the haemodynamic consequences during epidural anaesthesia were studied on 39 patients undergoing ankle or foot surgery. After insertion of an epidural catheter with the patient in the lateral position, 19 patients were kept sitting for 15 min following the injection of the local anaesthetic and 20 remained supine for the duration of anaesthesia (control group). All patients received a dose of 20 ml of 1.73% carbonated lidocaine with epinephrine 1:200,000. The quality and time of onset of the sensory blockade for segments L1-S2 as well as its cephalad spread were comparable in both groups. Fourteen patients of the sitting group achieved motor blockade of more than three of five myotomes compared with five patients in the supine group (P < 0.001). The maximum decrease in mean arterial pressure occurred sooner in the sitting group (14 ± 9 min) than in the control group (21 ± 10 min; P < 0.01) and was more severe (−24 ± 10% vs −16 ± 10% respectively; P < 0.05). Our results indicate that placing the patient in the sitting position for 15 min after inducing epidural anaesthesia does not influence caudal sensory blockade but does increase the depth of motor blockade.
Article PDF
Similar content being viewed by others
References
Bromage PR. Epidural Analgesia. Philadelphia: WB Saunders, 1978; 484–512, 513–600.
Cousins MJ, Bromage PR. Epidural neural blockade.In: Cousins MJ, Bridenbaugh PO, (Eds.). Neural Blockade in Anesthesia and Management of Pain, 2nd ed. Philadelphia: JB Lippincott, 1988; 253–360.
Galindo A, Hernandez J, Benavides O, Ortegon de Munoz S, Bonica JJ. Quality of spinal extradural anaesthesia: the influence of spinal nerve root diameter. Br J Anaesth 1975; 47: 41–7.
Bromage PR. Physiology and pharmacology of epidural analgesia. Anesthesiology 1967; 28: 592–622.
Park WY, Hagins FM. Comparison of lidocaine hydrochloride and lidocaine carbonated for epidural anesthesia. Regional Anesthesia 1986; 11: 128–31.
Nickel MP, Bromage PR, Sherrill DL. Comparison of hydrochloride and carbonated salts of lidocaine for epidural analgesia. Regional Anaesthesia 1986; 11: 62–7.
Martin R, Lamarche Y, Tetreault L. Comparison of the clinical effectiveness of lidocaine hydrocarbonated and lidocaine hydrochloride with or without epinephrine in epidural anesthesia. Can Anaesth Soc J 1981; 28: 217–23.
Morison DH. A double-blind comparison of carbonated lidocaine and lidocaine hydrochloride in epidural anaesthesia. Can Anaesth Soc J 1981; 28: 387–9.
Cole CP, McMorland GH, Alexson JE. Epidural blockade for caesarean section: lidocaine-HCl versus lidocaine-CO2. Anesthesiology 1985; 62: 348–50.
Nishimura N, Kitahara T, Kusakafe T. The spread of lidocaine and I131 solution in the epidural space. Anesthesiology 1959; 20: 785–8.
Bromage PR. Spread of analgesic solutions in the epidural space and their site of action: statistical study. Br J Anaesth 1962; 34: 161–78.
Thorburn J, Moir JJ. Epidural analgesia for elective caesarean section. Anaesthesia 1980; 35: 3–6.
Merry AF, Cross JA, Mayadeo SV, Wild CJ. Posture and the spread of extradural analgesia in labour. Br J Anaesth 1983; 55: 303–6.
Park WY, Hagins FM, Massengale MD, MacNamara TE. The sitting position and anesthesic spread in the epidural space. Anesth Analg 1984; 63: 863–4.
Norris MC, Dewan D. Effect of gravity on the spread of extradural anaesthesia for caesarean section. Br J Anaesth 1987; 59: 338–41.
Seow LT, Lips FJ, Cousins MJ. Lidocaine and bupivacaine mixtures for epidural blockade. Anesthesiology 1982; 56: 177–83.
Park WY. Factors influencing distribution of local anesthetics in the epidural space. Regional Anaest 1988; 13: 49–57.
Baron JF, Decaux-Jacolot A, Edouard A, Berdeaux A, Kamran S. Influence of venous return on baroreflex control of heart rate during lumbar epidural anesthesia in humans. Anesthesiology 1986; 64: 188–93.
Wugmeister M, Hehre FW. The absence of differential blockade in peridural anaesthesia. Br J Anaesth 1967; 39: 953–6.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Gosteli, P., Gamulin, Z., Van Gessel, E. et al. Anesthésie péridurale pour la chirurgie de la cheville et du pied: influence de la position assise. Can J Anaesth 39, 337–341 (1992). https://doi.org/10.1007/BF03009043
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03009043