Influences of Spinal Anesthesia on Exercise Tolerance in Patients with Chronic Obstructive Pulmonary Disease

Rationale Lower limb muscle dysfunction contributes to exercise intolerance in chronic obstructive pulmonary disease (COPD). We hypothesized that signaling from lower limb muscle group III/IV sensory afferents to the central motor command could be involved in premature cycling exercise termination in COPD. Objectives: To evaluate the effects of spinal anesthesia, which presumably inhibited central feedback from the lower limb muscle group III/IV sensory afferents on exercise tolerance and cardiorespiratory response during constant work-rate cycling exercise in patients with COPD. Methods: In a crossover and double-blind randomized design, eight patients with COPD (FEV1, 67 +/- 8% predicted) completed a constant work-rate cycling exercise after sham (NaCl, interspinous L-3-L-4) or active (fentanyl 25 g, intrathecal L-3-L-4) spinal anesthesia. Measurements and Main Results: When compared with placebo, endurance time was significantly prolonged after spinal anesthesia with fentanyl (639 +/- 87 s vs. 423 +/- 38 s [mean +/- SEM]; P = 0.01). Ventilation and respiratory rate were reduced at isotime points under the fentanyl condition, whereas ventilatory efficiency and dead space ventilation were improved. Patients exhibited less dynamic hyperinflation at isotime points with spinal anesthesia. consequently, the rise in dyspnea was significantly flatter during the fentanyl condition than with placebo. Conclusions: Spinal anesthesia enhanced cycling exercise tolerance in patients with COPD, mostly by reducing ventilatory response and dyspnea during exercise; these effects were possibly mediated through the inhibition of group III/IV lower limb sensory muscle afferents. Clinical trial registered with www.clinicaltrials.gov (NCT01522729).