In Reply

摘要

We thank Dr. Lambert for his comments, which add interesting aspects to the discussion. The difficulties of controlling local anesthetic (LA) spread during "isobaric" subarachnoid block in daily practice are well-known. As Dr. Lambert states, there is a manifold of influencing factors whereof several are unknown to the practitioner before LA injection (e.g., lumbosacral cerebrospinal fluid volume). Former studies have confirmed that pharmacokinetic action of cold and warm LA is quite different in the subarachnoid space in terms of faster onset and higher maximum level of sensory block when using the warmed solution. Moreover, prolonged analgesia was reported by Dr. Lambert.