苯海拉明霜联合甲硝唑霜综合治疗激素依赖性皮炎的疗效

目的探讨用1％苯海拉明霜联合3％甲硝唑霜综合治疗激素依赖性皮炎的疗效和安全性。方法采用随机单盲方法,将90例激素依赖性皮炎患者分为3组：A组用1％苯海拉明霜＋3％甲硝唑霜综合疗法,B组用氯雷他定＋喜疗妥进行治疗,C组用激素递减法治疗,疗程均8周,在治疗的2、4、8周进行随访,并在治疗的第4、8周判断疗效。结果治疗8周后,A、B、C组的有效率分别为86．20％,73．33％,66．67％,3组疗效差异有统计学意义（P〈0．05）,A组疗效明显高于B、C两组。3组治疗方法均无明显不良反应。结论1%苯海拉明霜十3％甲硝唑霜综合疗法是对激素依赖性皮炎有较显著疗效的方法。     

加减地龙活血汤联合激素治疗原发性肾病综合征

目的探讨加减地龙活血汤治疗原发性肾病综合征的临床疗效。方法将病理表现为系膜增生性肾小球肾炎（MsPNS）的原发性肾病综合征患者96例随机分为A、B、C组,各32例。A组用泼尼松和（或）环磷酰胺（CTX）联合地龙活血汤和相应时间的辨证中药;B组除不用地龙活血汤,其余治疗方法同A组;C组仅用泼尼松和（或）CTX治疗。比较3组治疗前以及治疗后第6、12个月24h尿蛋白定量、总胆固醇（TC）、三酰甘油（TG）、血浆白蛋白（Alb）、血红蛋白（Hb）、D二聚体及尿纤维蛋白降解产物（UFDP）等,并比较各组转归与疗效、复发情况和不良反应。结果A组总有效率高于B、C组（P〈0．05或P〈0．01）。3组治疗6个月后复发率无差异（P〉0．05）;治疗12个月后,A、B、C组复发率依次升高（P〈0．05）。A、B组阴虚火旺症、Cushing综合征与感染发生率较C组低;B、C组血栓形成发生率较A组高（Pd0．05）。结论泼尼松和（或）CTX联合地龙活血汤可增强肾病综合征患者疗效,而且可减低复发和不良反应的发生。     

冲击波联合局部注射治疗腰背肌筋膜疼痛综合征

目的 观察冲击波联合局部注射治疗腰背肌筋膜疼痛综合征的疗效.方法 将66例腰背肌筋膜疼痛综合征患者分为三组:冲击波治疗组(A组),局部注射治疗组(B组),冲击波联合局部注射组(C组).记录三组治疗前后的VAS评分.结果 A、B组间的疗效差异没有统计学意义,A、C组间疗效差异具有统计学意义(P=0.015);B、C组间疗效比较差异具有统计学意义(P=0.003).结论 冲击波联合局部注射治疗腰背肌筋膜疼痛综合征较单纯应用冲击波和单纯注射治疗的疗效更好.     

三种方法治疗瘢痕疙瘩的临床疗效观察

目的：比较分析手术联合90Sr-90Y敷贴、手术联合糖皮质激素注射和局部糖皮质激素注射三种方法治疗瘢痕疙瘩的临床疗效。方法：患者分为A、B、C三组,A组行手术联合90Sr-90Y敷贴治疗：手术切除病灶,术后予90Sr-90Y敷贴治疗,每疗程剂量900cGy,小剂量分次,100～200cGy／次,隔日一次,每5次为一疗程,共2～3个疗程。B组行手术联合糖皮质激素注射治疗：手术切除病灶,术中注射醋酸曲安奈德注射液,术后每两周1次,连续2～4月。c组：皮损内注射醋酸曲安奈德注射液,每两周1次,连续3～6月。结果：A、B、C三组总有效率分别为97％,80％和53％。A与B组比较无显著差异（P〉0．05）。A、B组分别与C组间比较均有显著性差异（P〈0．05）。结论：A、B组两种综合治疗方法均较C组单一治疗疗效更为满意。     

冲击波复合激痛点注射对颈肩肌筋膜疼痛综合征的治疗效果

目的比较压痛点注射、体外冲击波疗法(extracorporeal shock wave therapy,ESWT)以及ESWT复合激痛点注射治疗颈肩肌筋膜疼痛综合征的安全性和有效性。方法 2013年5月至2015年2月在门诊诊治的颈肩肌筋膜疼痛综合征患者90例,男48例,女42例,年龄18~65岁,随机分为三组,每组30例。A组:每个压痛点注射复合镇痛液5ml;B组:以压痛点定位冲击点,每次治疗一个或多个冲击点(疼痛区域),每个冲击点次数2 000次;C组:冲击波治疗后,在冲击波诱发的激痛点注射复合镇痛液5 ml。三组的治疗周期均为每周1次,连续治疗3次,治疗时间为5~10min,并随访记录首次治疗前(T0)、首次治疗后即刻(T1)、首次治疗后1周(T2)、2周(T3)、3周(T4)的VAS评分、颈椎的活动度(ROM)评分、症状改善优良率、总有效率。结果 90例患者中81例获得完全随访,B组有3例、C组有2例出现了皮下淤血,3d后消散,无其他不良事件发生。与T0时比较,T1~T4时三组VAS评分均明显降低(P0.05);T2~T4时,三组的VAS评分随着时间的延长、治疗次数的增加逐渐降低;T1时B组和C组的VAS评分明显低于A组(P0.05),T2、T3时C组VAS评分明显低于A组和B组(P0.05),T4时C组VAS评分明显低于A组(P0.05)。与T0时比较,T3时三组ROM评分均明显降低(P0.05),T3时B组和C组ROM评分明显低于A组(P0.05)。末次随访总有效率C组明显高于A组和B组(P0.05),A、B两组差异无统计学意义。结论 ESWT复合激痛点注射治疗颈肩肌筋膜疼痛综合征无明显损伤、安全、简便、疗效显著、患者满意度高,可作为颈肩肌筋膜疼痛综合征综合治疗的选择。     

聚维酮碘帽预防临时血液透析导管相关感染的临床研究

目的：评价自制聚维酮碘帽对血液透析患者临时导管相关感染的预防作用。方法：入选我院符合条件的血液透析患者143例，随机分为3组，A 组以0．5%肝素盐水封管＋封管帽封盖导管出口，B 组以0．4%庆大及0．5%肝素盐水封管＋封管帽封盖导管出口，C 组以0．5%肝素盐水封管＋自制聚维酮碘帽封盖导管出口。随访8周，观察导管相关感染事件，比较三组实验前相关指标及导管感染患病率，进行统计学分析。结果：A 组患者平均血浆总蛋白较低，组间差异有统计学意义（P ﹤0．05），三组年龄、血红蛋白、血浆白蛋白、血浆球蛋白、血肌酐、血尿素氮等差异均无统计学意义。实验终止时，三组 CRI 患病率10．5%（15/143）。A 组培养阳性10例、有临床症状3例，B 组4例、有临床症状1例，C 组1例，三组差异有统计学意义（χ2=10.976，P ﹤0．01）。两两比较显示，C 组与 A 组之间差异有统计学意义（χ2=9.687，P ﹤0．01），B 组与 A 组差异无统计学意义（χ2=3.214，P ﹥0．05）。结论：聚维酮碘局部应用可有效降低血液透析临时导管管内感染率。     

胸廓出口综合征28例分析

1994年 11月～ 1999年 12月 ,我院共收治胸廓出口综合征 2 8例 ,均行手术治疗 ,术中发现前、中、小斜角肌对颈部臂丛神经根的压迫是造成胸廓出口综合征的解剖学基础。一、资料与方法1.一般资料 :本组共 2 8例 ,男 7例 ,女 2 1例 ;年龄 2 4～ 5 7岁 ,平均年龄 42岁。左侧 8例 ,右侧 2 0例。病程最长 10年 ,最短 3个月。职业 :文职人员 2 0例 ,其中包括教师、会计、护士和公司职员。手工劳动者 4例 ,体力劳动者 4例。2 .症状及体征 :均有颈肩痛或不适感 ,上肢乏力、手部麻木 ,以环小指为主。临床检查 :前臂内侧及环小指刺痛觉减退2 3例 ,其中 …     

三苯氧胺与乳癖消联合治疗乳腺增生症

目的 观察三苯氧胺与乳癖消联合治疗乳腺增生症的疗效。方法 将168例乳腺增生症患者随机分A,B,C3组。A组52例,单独以三苯氧胺治疗;B组58例,以三苯氧胺加乳癖消联合治疗;C组58例,单以乳癖消治疗。三苯氧胺与乳癖消均按月经周期给药法。结果 A组总有效率80．8％,B组总有效率94．8％,C组总有效率72．4％,B组与A组相比差异显著（P＜0．05）,B组与C组相比差异显著（P＜0．01）。B组与A组副作用表现也有显著差异（P＜0．01）。结论 三苯氧胺与乳癖消联合治疗乳腺增生症疗效明显,乳癖消能显著减轻三苯氧胺副作用。     

丹参酮联合多西环素治疗炎症性痤疮的临床观察

目的：观察丹参酮短程联合多西环素治疗炎症性痤疮的疗效和复发情况。方法：将150例痤疮患者随机分为A、B、C三组,每组各50例。A组：口服多西环素100mg,2次/天,4周后改为1次/天;B组：口服丹参酮胶囊1g,3次/天;C组：口服多西环素100mg,2次/天,2周后停用,丹参酮胶囊1g,3次/天,8周为一个疗程。结果：B、C两组有效率均明显高于A组,第1、2周C组有效率明显高于A、B组,B、C两组复发率均明显低于A组。结论：丹参酮胶囊早期、短程联合多西环素治疗炎症性痤疮疗效优于单用多西环素,且起效比单用丹参酮快,复发率低,不良反应轻微。     

不同吻合方式修复双侧指固有神经缺损疗效比较

目的比较不同神经吻合方式修复双侧指固有神经缺损的临床疗效。方法选择70例双侧指固有神经缺损患者按照不同神经吻合方式分成A、B、C 3组:A组24例采用移植神经弓端侧吻合,B组26例采用移植神经弓双端侧吻合,C组20例采用移植神经直接桥接端端吻合。观察3组指关节自主活动度总和(TAM)、感觉恢复情况、两点辨别觉和不良反应发生情况。结果患者均获得随访,时间1~10个月。3组指关节TAM优良率比较差异无统计学意义(P0.05)。A组和B组远节指腹感觉明显高于C组(P0.05),A、B两组比较差异无统计学意义(P0.05)。A组和B组两点辨别觉明显低于C组(P0.05),A、B两组比较差异无统计学意义(P0.05)。3组患者伤口均甲级愈合,未出现伤口感染和皮肤软组织坏死。术后72 h出现血管危象A组1例、B组2例、C组1例,均在肌肉注射盐酸哌替啶+静脉滴注肝素钠后缓解。B组2例术后4~6周用力握物时出现麻木和放射性疼痛等,术后6~12周疼痛自行消失。结论移植神经弓端侧吻合能够有效修复双侧指固有神经缺损,促进指腹感觉的恢复,效果优于移植神经直接桥接端端吻合。     

Ultrasonographic guidance reduces the amount of local anesthetic for 3-in-1 blocks

Background and Objectives. Recently it has been demonstrated that the use of ultrasound (US) improves the onset time and the quality of sensory block for 3-in-1 blocks compared with conventional nerve stimulator (NS) techniques. The present study was designed to evaluate if US guidance for 3-in-1 blocks reduces the amount of local anesthetic compared to NS guidance. Methods. After institutional approval and informed consent, 60 patients undergoing hip surgery following trauma were randomly assigned to three groups of 20 patients each. In group A, the 3-in-1 block was performed using US guidance with 20 mL 0.5% bupivacaine. Group B received 20 mL 0.5% bupivacaine, and group C received 30 mL 0.5% bupivacaine during NS guidance. The quality and the onset time was assessed by pinprick test in the central sensory region of each of the three targeted nerves and compared with the contralateral leg every 10 minutes for 1 hour by a blinded observer. The rating was undertaken using a scale from 100% (uncompromised sensibility) to 0% (no sensation). Results. Overall success for the 3-in-1 block in group A was 95% and in groups B and C 80%. Onset time was significantly shorter in the US-guided group compared with both NS-guided groups (group A 13 ± 6 minutes; group B 27 ± 12 minutes; and group C 26 ± 13 minutes; P < .01 to groups B and C). Quality of sensory block was significantly better in group A (4% ± 5% of initial value) compared with groups B and C (group B 21% ± 11% of initial value, P < .01 to group A; group C 22% ± 19%, P < .01 to group A). Conclusion. The amount of local anesthetic for 3-in-1 blocks can be reduced by using US guidance compared with the conventional NS-guided technique.     

Selective spinal anesthesia for outpatient laparoscopy. I: Characteristics of three hypobaric solutions

PURPOSE: To determine the characteristics and recovery profiles of three hypobaric spinal anesthetic solutions. METHODS: Thirty outpatients undergoing outpatient laparoscopy were randomly assigned to receive spinal anesthesia with one of three small-dose solutions. Group I--20 mg lidocaine plus 25 microg fentanyl; Group II--20 mg lidocaine plus 10 microg sufentanil; Group III--10 mg lidocaine plus 10 microg sufentanil. Solutions were diluted to three ml with sterile water for injection. A 27-gauge Whitacre needle was inserted at L2-3 or L3-4 in the sitting position. Sensory and motor recovery were assessed with pinprick, proprioception, light touch and a modified Bromage scale. RESULTS: Operating conditions were good to excellent in all three groups. The incidence of shoulder tip discomfort, pruritus and nausea was not significantly different between groups. Light touch was present in all three groups and proprioception was present in most patients during and after surgery. Group III patients had a more rapid recovery of pinprick analgesia and Group II patients had the slowest recovery of pinprick analgesia. Motor block recovery was comparable in the three groups. Eighty percent of patients in Groups III and I were able to perform 'deep knee bends' and 'straight leg raises' at the end of surgery. CONCLUSION: For short duration laparoscopy, spinal 10 mg lidocaine with 1O microg sufentanil provided selective pin prick analgesia, with preserved touch, proprioception and limited motor block. Operating conditions were satisfactory and most patients were able to fulfill 'walk out' criteria at the end of surgery.     

The addition of fentanyl does not alter the extent of spread of intrathecal isobaric bupivacaine in clinical practice

PURPOSE: Fentanyl is commonly added to intrathecal local anesthetic solutions. In vitro data has shown fentanyl to render isobaric local anesthetics hypobaric, and alter the spread in artificial cerebrospinal fluid. This study examined whether the addition of fentanyl to isobaric bupivacaine with morphine leads to a clinically important alteration in the extent of spread of anesthesia. METHODS: Forty-four ASA I-III patients undergoing lower limb orthopedic procedures completed this double-blind, placebo-controlled trial. Patients were randomized into one of two groups, receiving intrathecal bupivacaine 15 mg and preservative-free morphine 200 microg without (Control group), or with the addition of fentanyl 0.02 mg (Fentanyl group). Patients were maintained at a slight head-up tilt. Variables studied over three hours included sensory level to cold and pinprick, motor blockade (Bromage scale), and circulatory data. RESULTS: No differences existed between the Fentanyl and Control groups with respect to highest level of block for cold: T4 (T2-T5) vs T3.5 (T3-T8) respectively (median, 95% confidence interval) or pinprick: T4 (T3-T6) vs T4.5 (T3-T8). Similarly, there was no difference in the time taken to reach maximum block height to cold (20 +/- 9 vs 23 +/- 13 min, mean +/- SD) or pinprick (20 +/- 9 vs 24 +/- 13 min). CONCLUSION: The addition of fentanyl 0.02 mg to 0.5% bupivacaine with morphine does not affect the maximal block height or time to maximal block in clinical practice.     

Saline volume and local anesthetic concentration modify the spread of epidural anesthesia

PURPOSE: To examine the effects of the volume of saline and the concentration of local anesthetic on the quality of anesthetic level. METHODS: One hundred and fifty two patients received thoracic epidural anesthesia were allocated into two groups; mepivacaine 1% (75 patients) and 1.5% (77 patients). Each group was randomly divided into three subgroups depending on epidural saline volumes of 1 ml, 5 ml, or 10 ml. Fifteen minutes after the injection of 10 ml mepivacaine, the dermatome levels of hypesthesia to cold and pinprick were determined by an individual blinded to the saline volume. RESULTS: The number of spinal segments with hypesthesia to cold in the three subgroups in the mepivacaine 1% group were 12.5 [6-20], 13 [8.5-20.5] and 12.5 [6.5-22], respectively (median [range]). The segments in the mepivacaine 1.5% group were 12 [7-18.5], 14 [8.5-19]* and 15 [6-23]*, respectively (*P < 0.05 vs 1-ml group). The number of spinal segments with hypesthesia for pinprick in the three subgroups in the 1% mepivacaine group were 10.5 [2-22], 10.5 [4-17] and 11 [4-19], respectively. The segments in the mepivacaine 1.5% group were 12 [7.5-16], 12 [7.5-17] and 11.5 [5-22.5], respectively. Saline volume did not alter the anesthetic level of the mepivacaine 1%, although it did affect the anesthetic spread of the mepivacaine 1.5%. In both groups, a differential nerve block was elicited in the 5 ml and 10 ml saline subgroups. CONCLUSION: When a large volume of saline is administered prior to local anesthetic, more differential blockade and a greater extent of anesthesia may be elicited.     

Epidural saline solution prior to local anaesthetic produces differential nerve block

PURPOSE: The loss-of-resistance technique is generally used to identify the epidural space usually with normal saline. However, the effect of epidural saline on anaesthetic spread has not been demonstrated. The purpose of this study was to determine whether epidural saline affected the anaesthetic level and the quality of analgesia. METHODS: Seventy patients undergoing upper abdominal surgery received thoracic epidural anaesthesia combined with general anaesthesia. The patients were randomly allocated into three groups using epidural saline volumes of 1, 5, or 10 ml. Ten minutes after epidural injection of 12 ml mepivacaine 1%, the dermatome levels of hypaesthesia for cold and pinprick were determined by an individual blinded to the amount of saline administered. RESULTS: The levels of hypaesthesia for cold sensation were not different among the three groups (23 [14-44] total bilateral dermatomes blocked with 1 ml saline, 22 [16-41] dermatomes with 5 ml, and 24 [10-36] dermatomes with 10 ml (median [range])). However, the larger volume of saline produced decreased spread of hypaesthesia for pinprick (22 [4-41] dermatomes blocked bilaterally for 1 ml vs 16 [8-24] dermatomes for 10 ml group, P < 0.004). CONCLUSION: Our results suggest that a large volume of saline solution injected in the epidural space to elicit loss-of-resistance dilutes the local anaesthetic solution, resulting in reduced spread of the block to pinprick.     

Thoracic outlet syndrome in whiplash injury.

Thirty-five cases of thoracic outlet syndrome complicating whiplash or cervical strain injury were studied. Thirty cases had confirmation by the demonstration of slowed ulnar nerve conduction velocity (UNCV) through the thoracic outlet. Two distinct groups of patients were found. An acute group, seen an average of 3 1/2 months post injury, had severe neck pain with often mild or incidental thoracic outlet syndrome. A chronic group, with symptoms persisting more than 2 years after cervical injury, often had thoracic outlet symptoms as the predominant complaint. This study suggests that the arm aches and parethesias seen in association with both acute and chronic cervical strain injury are most often secondary to thoracic outlet syndrome.     

Saline — anesthetic interval and the spread of epidural anesthesia

PURPOSE: To examine the effect of modifying the interval between administration of saline used during the loss of resistance (LOR) method and local anesthetic on epidural anesthetic level and its quality. METHODS: Seventy-three patients who received thoracic epidural anesthesia were randomly allocated into three groups; the 2, 5 and 10 min groups, according to the interval between the administration of saline and 8 ml mepivacaine 1.5%. Fifteen minutes after the mepivacaine injection, the dermatome level of hypesthesia was determined by an individual blinded to the interval. RESULTS: When the saline-anesthetic interval was prolonged, the hypesthetic levels for coldness and pinprick were decreased. The number of spinal segments with hypesthesia for coldness were 15 [12-20]#, 12.5 [10.5-22.5]## and 10.5 [6.5-15.5]### in the 2, 5 and 10 min groups, respectively (median [range], # P < 0.05 vs the 5 min group, ## P < 0.05 vs the 10 min group, ### P < 0.05 vs the 2 min group). The number of spinal segments with hypesthesia for pinprick were 13.5 [11-18]#, 11 [7.5-20.5]## and 10 [5.5-13]### in the 2, 5 and 10 min groups, respectively. There were differences in all groups between the number of segments with hypesthesia for coldness and pinprick elicited. CONCLUSION: The interval between the administration of saline and local anesthetic alters the anesthetic level and quality of epidural analgesia.     

Comparison of Ropivacaine and Lidocaine for Intravenous Regional Anesthesia in Volunteers: A Preliminary Study on Anesthetic Efficacy and Blood Level

Background: Ropivacaine may be useful for intravenous regional anesthesia, but its anesthetic effectiveness and toxicity have not been evaluated.

Methods: Two doses of ropivacaine (1.2 and 1.8 mg/kg) and one dose of lidocaine (3 mg/kg) were compared for intravenous regional anesthesia in 15 volunteers. An arm tourniquet was inflated for 30 min after injection and then deflated in two cycles. Sensory block was measured by response to touch, cold, pinprick, and transcutaneous electric stimulation, and motor function was measured by hand grip strength and muscle power. Median, ulnar, radial, and musculocutaneous nerve functions were tested before local anesthetic injection and then at 5-min intervals until blocks resolved. The plasma ropivacaine and lidocaine concentrations were determined from arterial and venous blood samples drawn from the unanesthetized arm.

Results: Sensory and motor blocks were complete within 25 min and 30 min, respectively, in all three treatment groups. However, recovery of sensory and motor block after tourniquet release was slowest in the high-dose ropivacaine group. Anesthesia to pinprick and transcutaneous electric stimulation was sustained in all the volunteers in the high-dose ropivacaine group for 55 min and 85 min, respectively, whereas complete recovery was observed in the lidocaine group (P = 0.008) and partial recovery in the low-dose ropivacaine group (P < 0.05) during the same period. Motor block also was sustained in the high-dose ropivacaine group for 70 min, which was significantly longer than in the lidocaine group (P < 0.05). All volunteers (five of five) given lidocaine and one volunteer given high-dose ropivacaine reported light-headedness and hearing disturbance during tourniquet release when the arterial plasma lidocaine and ropivacaine concentrations were 4.7 +/- 2.1 [micro sign]g/ml (mean) and 2.7 [micro sign]/ml, respectively.     

Comparison of ropivacaine and lidocaine for intravenous regional anesthesia in volunteers: a preliminary study on anesthetic efficacy and blood level.

BACKGROUND: Ropivacaine may be useful for intravenous regional anesthesia, but its anesthetic effectiveness and toxicity have not been evaluated. METHODS: Two doses of ropivacaine (1.2 and 1.8 mg/kg) and one dose of lidocaine (3 mg/kg) were compared for intravenous regional anesthesia in 15 volunteers. An arm tourniquet was inflated for 30 min after injection and then deflated in two cycles. Sensory block was measured by response to touch, cold, pinprick, and transcutaneous electric stimulation, and motor function was measured by hand grip strength and muscle power. Median, ulnar, radial, and musculocutaneous nerve functions were tested before local anesthetic injection and then at 5-min intervals until blocks resolved. The plasma ropivacaine and lidocaine concentrations were determined from arterial and venous blood samples drawn from the unanesthetized arm. RESULTS: Sensory and motor blocks were complete within 25 min and 30 min, respectively, in all three treatment groups. However, recovery of sensory and motor block after tourniquet release was slowest in the high-dose ropivacaine group. Anesthesia to pinprick and transcutaneous electric stimulation was sustained in all the volunteers in the high-dose ropivacaine group for 55 min and 85 min, respectively, whereas complete recovery was observed in the lidocaine group (P = 0.008) and partial recovery in the low-dose ropivacaine group (P < 0.05) during the same period. Motor block also was sustained in the high-dose ropivacaine group for 70 min, which was significantly longer than in the lidocaine group (P < 0.05). All volunteers (five of five) given lidocaine and one volunteer given high-dose ropivacaine reported light-headedness and hearing disturbance during tourniquet release when the arterial plasma lidocaine and ropivacaine concentrations were 4.7+/-2.1 microg/ml (mean) and 2.7 micro/ml, respectively. CONCLUSION: Compared with lidocaine, intravenous regional anesthesia with ropivacaine appears to be comparable but has longer-lasting residual anesthesia.     

The effects of single and fractionated doses of mepivacaine on the extent of thoracic epidural block

BACKGROUND AND OBJECTIVES: The effects of single and fractionated doses of local anesthetic on the extent of thoracic epidural blockade has not yet been determined. This single blinded and randomized study was designed to examine the effects of the initial dose and timing of the additional dose of local anesthetic on the sensory block level of the thoracic epidural anesthesia. METHODS: Eighty-nine patients, who received thoracic epidural anesthesia followed by general anesthesia, were randomly divided into 4 groups: Group I received 5 mL of mepivacaine; Group II, 10 mL; Group III, 5 mL twice, with an interval of 5 minutes; and Group IV, 5 mL twice, with an interval of 10 minutes. After 15 minutes of either a single bolus or after the second bolus drug administration, the level of sensory block to coldness and pinprick were determined by an individual who was uninformed of the groups. RESULTS: The median (range) number of spinal segments with sensory block to coldness in Groups I, II, III, and IV were 8 (5 to 12), 12 (7 to 17)*, 11 (7 to 16)*, and 9 (6 to 17)# (*P < .05 v Group I, #P < .05 v Group II), respectively. The number of segments with sensory block to pinprick in the 4 groups were 7 (4 to 11), 11 (6 to 14)*, 10 (6 to 14)*, and 9 (4 to 16)*#, respectively. These differences were mainly due to the differences of the lower sensory block level. CONCLUSIONS: We concluded that the timing of the second administration of mepivacaine was one of the factors for the spread of the drug into thoracic epidural space. The more extensive sensory block level occurred by shorter time interval of the second drug administration.