Segmental Spread with Three Different Dosages of 1.5% Lidocaine in Thoracic Epidural Analgesia.

Kim,  Sang Ho; Park,  Sun Young; Kim,  Sang Hyun; Lee,  Jeong Seok; Park,  Wook

doi:2007.53.3.S29

Original Article

Korean Journal of Anesthesiology 2007;53(3):S29-S35.
DOI: https://doi.org/10.4097/kjae.2007.53.3.S29

Segmental Spread with Three Different Dosages of 1.5% Lidocaine in Thoracic Epidural Analgesia.

Sang Ho Kim, Sun Young Park, Sang Hyun Kim, Jeong Seok Lee, Wook Park

¹Department of Anesthesiology and Pain Medicine, Soonchunhyang Bucheon Hospital, College of Medicine, Soonchunhyang University, Bucheon, Korea. aurellius@ naver.com
²Department of Anesthesiology and Pain Medicine, National Medical Center, Soonchunhyang University, Seoul, Korea.
³Department of Anesthesiology and Pain Medicine, Neuro-pain Center, Soonchunhyang University, Seoul, Korea.

Abstract

BACKGROUND
To provide adequate preoperative thoracic epidural analgesia, it is important to determine the appropriate initial dosage of local anesthetics. To determine the proper initial dose, current study evaluated the effects of three different dosages of 1.5% lidocaine, injected in a low thoracic epidural space, on the spread of analgesic segments and on hemodynamic variables.
METHODS
The subjects were 117 patients between 18 and 80 years of age with ASA physical status I-II. Using an epidural catheter placed a site among T6-11 intervertebral space, 1.5% lidocaine was injected as follows: Group 1 (n = 39), 0.1 ml/kg Group 2 (n = 39), 0.2 ml/kg and Group 3 (n = 39), 0.3 ml/kg. Sensory analgesia, motor blockade, and hemodynamic variables were evaluated every 5 min for 15 min after the injection.
RESULTS
The number of analgesic segment were 8.1, 10.8, and 12.3 in Group 1, Group 2 and Group 3, respectively. Tripling the volume of 1.5% lidocaine increased the number of analgesic segments by 4.2; on doubling from 0.1 to 0.2 ml/kg, the increase was 2.7. No motor block was observed in any patient. The incidence of hypotension was higher in Groups 2 (25.6%) and 3 (35.9%) than in Group 1 (0%) (P = 0.001).
CONCLUSIONS
To establish the proper preoperative low thoracic epidural analgesia with less hemodynamic changes, it is recommended to use 0.1 ml/kg of 1.5% lidocaine.

Key Words: epidural analgesia; local anaesthetics; thoracic