経皮的腎尿管切石術に対する等比重Bupivacaineによる腰推麻酔

Abstract

1)麻酔高の安定に20～30分を要し, Dibucaincより若干長かった.この間は血圧低下や徐脈に対する注意が必要であるが, その後の循環動態は安定しており, 体位変換による血圧の変動は少なかった.2)側臥位でL3/4もしくはL2/3から0.5%Bupivacaine 3.5 mlを用いることにより, T4までの冷感の消失, T6までの麻酔高が期待できた.後者の達成により約90分のPNLが可能であった.90分を越えるPNLが予想される場合, 穿刺する椎間はL2/3が適していた.3) T7以下の麻酔高しか得られなければ, クモ膜下腔の再穿刺を行ない0.5%Bupivacaine 2.0 mlを追加したほうが良い

The duration of analgesia and the cardiovascular changes during anesthesia of spinal blockade with isobaric bupivacaine were examined in 36 patients between 21 and 75 years old undergoing percutaneous nephro-ureterolithotomy. Injection of 0.25% or 0.5% bupivacaine 3.0-4.0 ml through the L3-4 or L2-3 intervertebral space in the horizontal posture resulted in spread of hypalgesia to T6 in 30 patients and of analgesia to T6 in about a half of the patients. In six patients, another intrathecal injection of 2 ml of bupivacaine was performed because their analgesia level had been under T8. Although the operation took 32-141 min. (mean 77.7 +/- 27.5 min.), there was no case requiring exigent exchanging anesthesia for general anesthesia. The frequencies of the hypotension, bradycardia and nausea in spinal blockade with isobaric bupivacaine were not so different from those of the previous epidural anesthesia in 29 patients undergoing the same operation. Most of the cardiovascular changes in the spinal blockade with isobaric bupivacaine happened within 20-30 min. after intrathecal injection of bupivacaine. Spinal anesthesia with isobaric bupivacaine proved satisfactory for percutaneous nephro-ureterolithotomy.