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Rapid injection of epidural mepivacaine speeds the onset of nerve blockade

L’injection péridurale rapide de mépivacaïne accélère l’installation du bloc nerveux

Canadian Journal of Anesthesia volume 52, pages 281–284 (2005)Cite this article

Abstract

Purpose

When used intraoperatively, mepivacaine can produce a satisfactory sensory block. However, insufficient information is available concerning the factors that affect the speed of nerve blockade with epidural analgesia. The optimal rate of injection of mepivacaine has not been determined. We examined whether the speed of epidural infusion of mepivacaine affects the speed of nerve blockade.

Methods

Forty patients, physical status ASA I-II, scheduled for gynecological abdominal surgery, were enrolled in this double blind randomized trial. A catheter was inserted 4 cm in the epidural space in the midline at L1-L2. Three minutes after a test dose of 2 mL plain 1 % mepivacaine over four seconds, 8 mL were injected epidurally at a rate of 1 mL·sec-1 (fast group) or 0.05 mL·sec-1 (slow group). Sensory and motor blockade, blood pressure, and heart rate were assessed at five, ten, and 15 min after the epidural injection.

Results

There was a significant difference in the spread of sensory blockade at five minutes after the epidural injection between the two groups, but not at ten and 15 min. Blood pressure decreased at five and ten minutes, recovered at 15 min in the fast group, and remained stable in the slow group.

Conclusion

Rapid injection of mepivacaine in the epidural space produced a more rapid onset of epidural block than slow injection, but there was no difference in the final extent of the block.

Résumé

Objectif

Utilisée pendant l’opération, la mépivacaïne peut produire un bloc sensitif satisfaisant. Cependant, il y a peu d’information sur les facteurs qui modifient la vitesse d’installation du blocage nerveux avec l’analgésie péridurale. La vitesse optimale de l’injection de mépiva-caïne n’est pas connue. Nous avons vérifié si la vitesse de perfusion péridurale de la mépivacaïne modifiait la vitesse du d’installation-blocage nerveux.

Méthode

Quarante patientes, d’état physique ASA I-II, devant subir une intervention gynécologique abdominale ont participé à l’étude ran-domisée et à double insu. Un cathéter a été inséré à 4 cm dans l’e-space péridural interépineux de L1-L2. Trois minutes après l’injection d’une dose test de 2 mL de mépivacaïne simple à 1 % pendant qua tre secondes, 8 mL ont été injectés dans l’espace péridural à 1 mL·sec-1 (groupe rapide) ou 0,05 mL·sec-1 (groupe lent). Le blocage sensitifet moteur, la tension artérielle et la fréquence cardiaque ont été évalués à cinq, dix et 15 min après l’injection péridurale.

Résultats

La diffusion du blocage sensitif était significativement dif-férente entre les groupes cinq minutes après l’injection, mais non 10 et 15 min après. La tension artérielle a baissé à cinq et dix minutes, s’est rétablie à 15 min dans le groupe rapide et est demeurée stable dans le groupe lent.

Conclusion

L’injection rapide de mépivacaïne dans l’espace péridural a produit une installation plus rapide du bloc péridural que l’injection lente, mais il n’y a pas eu de différence dans l’étendue finale du bloc.

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Affiliations

  1. Department of Anesthesiology, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara 228-8555, Sagamihara, Japan

    Akifumi Kanai, Asaha Suzuki & Sumio Hoka

Authors
  1. Akifumi Kanai
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  2. Asaha Suzuki
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  3. Sumio Hoka
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Correspondence to Akifumi Kanai.

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Kanai, A., Suzuki, A. & Hoka, S. Rapid injection of epidural mepivacaine speeds the onset of nerve blockade. Can J Anesth 52, 281–284 (2005). https://doi.org/10.1007/BF03016064

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