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تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Spinal local anesthetics

Spinal local anesthetics
Local anesthetic Baricity Concentration (%) Dose* (mg) Duration (minutes)
2-chloroprocaine[1] Isobaric 1 40 to 50 30 to 50
2-chloroprocaineΔ[2] Hyperbaric◊ 2, 3 20 to 60 30 to 50
Lidocaine[2-5] Hyperbaric§ 5 50 to 100 45 to 75
LidocaineΔ[6,7] Isobaric◊ 2 40 to 80 45 to 75
MepivacaineΔ[8,9] Isobaric◊ 1, 1.5, 2 50 to 70 45 to 75
Bupivacaine[3,10,11] Hyperbaric§ 0.75 6 to 15 90 to 150
BupivacaineΔ[12] Isobaric◊ 0.5 6 to 15 90 to 150
RopivacaineΔ[13-15] Isobaric◊ 0.5, 0.75, 1 15 to 20 75 to 120
Tetracaine[3] Isobaric◊ 1 5 to 20 90 to 150
Prilocaine¥[16] Hyperbaric 2 30 to 60 60
LA: local anesthetic.
* Spinal anesthetics are injected into the low- to mid-lumbar subarachnoid space. The primary determinants of the extent of dermatomal spread are dose and baricity (relative to the patient's body position). If baricity is held constant, the dose is directly related to extent of dermatomal spread: higher doses result in greater spread. Doses at the low end of the range will result in low-thoracic neuroblockade, and doses at the high end of the range will result in mid-thoracic neuroblockade. High doses of hyperbaric solution generally do not result in neuroblockade higher than T4 because the LA solution tends to layer in the thoracic kyphosis in a patient in the supine position. In practice, we use hyperbaric solutions if the desired sensory level is higher than T10 (eg, pelvic procedures), and we use isobaric (plain) solutions if the desired sensory level is lower than T10 (eg, lower extremity procedures). The addition of opioids to intrathecal LAs decreases the required dose and prolongs the duration of anesthesia.
¶ Two-dermatome regression.
Δ Not approved by the US Food and Drug Administration (FDA) for spinal injection.
◊ Plain LA solutions (dissolved in normal saline solution) may be slightly hypobaric (eg, bupivacaine, 2% lidocaine, isobaric (eg, 1% 2-chloroprocaine), or slightly hyperbaric (eg, 2% or 3% 2-chlroprocaine), but are usually considered clinically to be isobaric solutions. In general, plain solutions have less dermatomal spread than hyperbaric solutions, and longer duration of anesthesia. Plain solutions of LA can be made hypobaric by the addition of sterile water (lidocaine 0.5%, bupivacaine 0.3%, and tetracaine 0.2% are reliably hypobaric).
§ LA solutions are made hyperbaric by the addition of dextrose (5 to 8.25%).
¥ Not approved by the US FDA for spinal injection. Approved for spinal injection in Europe.
References:
  1. Teunkens A, Vermeulen K, Van Gerven E, et al. Comparison of 2-Chloroprocaine, Bupivacaine, and Lidocaine for Spinal Anesthesia in Patients Undergoing Knee Arthroscopy in an Outpatient Setting: A Double-Blind Randomized Controlled Trial. Reg Anesth Pain Med 2016; 41:576.
  2. Smith KN, Kopacz DJ, McDonald SB. Spinal 2-chloroprocaine: A dose-ranging study and the effect of added epinephrine. Anesth Analg 2004; 98:81.
  3. Frey K, Holman S, Mikat-Stevens M, et al. The recovery profile of hyperbaric spinal anesthesia with lidocaine, tetracaine, and bupivacaine. Reg Anesth Pain Med 1998; 23:159.
  4. Kito K, Kato H, Shibata M, et al. The effect of varied doses of epinephrine on duration od lidocaine spinal anesthesia in the thoracic and lumbosacral dermatomes. Anesth Analg 1998; 86:1018.
  5. Liu SS, Chiu AA, Carpenter RL, et al. Fentanyl prolongs lidocaine spinal anesthesia without prolonging recovery. Anesth Analg 1995; 80:730.
  6. Liam BL, Yim CF, Chong JL. Dose response study of 1% lidocaine for spinal anesthesia for lower limb and perineal surgery. Can J Anaesth 1998; 45:645.
  7. Liu SS, Pollock JE, Mulroy MF, et al. Comparison of 5% with dextrose, 1.5% with dextrose, and 1.5% dextrose-free lidocaine solutions for spinal anesthesia in human volunteers. Anesth Analg 1995; 81:697.
  8. Zayas VM, Liguori GA, Chisolm MF, et al. Dose response relationships for isobaric spinal mepivacaine using the combined spinal epidural technique. Anesth Analg 1999; 89:1167.
  9. Pawlowski J, Sukhani R, Pappas A, et al. The anesthetic and recovery profile of two doses (60 and 80 mg) of plain mepivacaine for ambulatory anesthesia. Anesth Analg 2000; 91:580.
  10. Kooger Infante NE, Van Gessel E, Forster A, et al. Extent of hyperbaric spinal anesthesia influences the duration of block. Anesthesiology 2000; 92:1319.
  11. Alley EA, Kopacz DJ, McDonald SB, et al. Hyperbaric spinal levobupivacaine: A comparison to racemic bupivacaine in volunteers. Anesth Analg 2002; 94:188.
  12. Malinovsky JM, Charles F, Kick O, et al. Intrathecal anesthesia: Ropivacaine vs. bupivacaine. Anesth Analg 2001; 91:1457.
  13. Kallio H, Snäll EV, Tuomas CA, Rosenberg PH. Comparison of hyperbaric and plain ropivacaine 15 mg in spinal anaesthesia for lower limb surgery. Br J Anaesth. 2004; 93:664.
  14. Gautier PE, De Kock M, Van Steenberge A, et al. Intrathecal ropivacaine for ambulatory surgery. Anesthesiology 1999; 91:1239.
  15. Boztu? N, Bigat Z, Karsli B, et al. Comparison of ropivacaine and bupivacaine for intrathecal anesthesia during outpatient arthroscopic surgery. J Clin Anesth 2006; 18:521.
  16. Manassero A, Fanelli A. Prilocaine hydrochloride 2% hyperbaric solution for intrathecal injection: a clinical review. Local Reg Anesth 2017; 10:15.
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