Abstract
Purpose: The efficacy of low dose intrathecal lidocaine-sufentanil was compared with intrathecal sufentanil for short duration outpatient gynecological laparoscopy.
Methods: Thirteen ASA I and II patients undergoing gynecological laparoscopy were studied in a randomized double-blind trial. Patients received either intrathecal 10 mg lidocaine plus 10 µg sufentanil (Group LS) or intrathecal 20 µg sufentanil (Group S), each diluted to 3 mL with sterile water through a 27 g Whitacre needle in the sitting position. Sensory and motor recovery were assessed with pinprick and a modified Bromage scale.
Results: One of seven Group LS patients and two of five Group S patients required conversion to general anesthesia for failed skin test with forceps. Two of the remaining three Group S patients felt sharpness with skin incision. The study was terminated early because of inadequate anesthesia in Group S. The small sample size (n=9) made statistical analysis uninformative.
Conclusion: Intrathecal 20 µg sufentanil is unsuitable as a sole agent for gynecological laparoscopy.
Résumé
Objectif: Comparer l’efficacité de l’injection intrathécale d’une faible dose de lidocaïne-sufentanil au sufentanil seul dans le contexte d’une laparoscopie gynécologique ambulatoire de courte durée.
Méthode: L’essai randomisé et à double insu a porté sur 13 patientes, ASA I et II, qui devaient subir une laparoscopie gynécologique. On a procédé à l’injection intrathécale, soit 10 mg de lidocaïne plus 10 µg de sufentanil (groupe LS), soit 20 µg de sufentanil (groupe S), complétés dans chaque cas au volume de 3 mL avec de l’eau stérile et administrés, en position assise, à l’aide d’une aiguille Whitacre de calibre 27. La récupération sensitive et motrice a été évaluée par la réaction à la piqûre et par une échelle de Bromage modifiée.
Résultats: Une des sept patientes du groupe LS et deux des cinq patientes du groupe S ont eu besoin d’anesthésie générale à la suite de l’échec du test cutané avec l’utilisation des forceps. Deux des troits patientes restantes du groupe S ont ressenti un inconfort à l’incision cutanée. L’anesthésie étant insuffisant dans le groupe S, on a dû arrêter l’étude plus tôt. Le petit nombre de sujets (n=9) a rendu l’analyse statistique inutile.
Conclusion: L’administration intrathécale de 20 µg de sufentanil seul est inadéquate pour la laparoscopie gynécologique.
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Henderson, C.L., Schmid, J., Vaghadia, H. et al. Selective spinal anesthesia for outpatient laparoscopy. III: Sufentanilvs lidocaine-sufentanil. Can J Anesth 48, 267–272 (2001). https://doi.org/10.1007/BF03019757
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DOI: https://doi.org/10.1007/BF03019757