Cappelleri G, Casati A, Fanelli G, Borghi B, Anelati D, Berti M, Albertin A
Department of Anesthesiology, University of Study, IRCCS H. San Raffaele, Milano.
Minerva Anestesiol. 2000 Mar;66(3):131-6; discussion 137.
To evaluate the time required to achieve surgical block and fulfill standardized discharge criteria in outpatients receiving knee arthroscopy with either unilateral spinal anesthesia or combined sciatic-femoral nerve block.
After a standard midazolam/ketoprofen premedication and baseline measurement of cardiovascular parameters, 50 ASA physical status I-II patients scheduled for elective outpatient knee arthroscopy were randomized to receive unilateral spinal anesthesia with 8 mg of 0.5% hyperbaric bupivacaine injected without barbotage through a 25-gauge Whitacre spinal needle (group USA, n = 25), or combined sciatic-femoral nerve block with 25 ml of 2% mepivacaine (15 ml for femoral nerve block and 10 ml for sciatic nerve block) (group SFNB, n = 25). Times from local anesthetic injection to achievement of surgical block defined as the presence of adequate motor (complete motor blockade of the operated limb in the USA group and inability to move the ankle and the knee of the operated limb in the SFNB group) and sensory (loss of pinprick sensation at T12 on the operated side in the USA group, or in the femoral and sciatic nerves distribution in the SFNB group) blocks was recorded. Times to block resolution, urination, unassisted ambulation, and readiness to home discharge were also recorded by a blind observer, as well as occurrence of untoward events during surgery.
Surgical block was achieved in 15 +/- 6 min in group USA and 16 +/- 6 min in group SFNB (p = NS). No differences in hemodynamic undesired effects and success rate were observed. Even though USA patients showed a faster time to ambulation (166 +/- 44 min versus 217 +/- 49 min, p = 0.002) and later urination (240 +/- 90 min versus 145 +/- 36 min, p = 0.0001) than SFNB group, no differences in home discharging were reported (246 +/- 98 min versus 211 +/- 77 min, respectively). Bladder catheterization was required in 2 patients of USA group only; however, no patient was admitted to the hospital because of urinary retention.
In outpatient knee arthroscopy, a combined sciatic-femoral nerve block with 2% mepivacaine provides similarly successful anesthesia with onset times and home discharge similar to those provided by unilateral spinal anesthesia.
评估接受单侧脊髓麻醉或坐骨-股神经联合阻滞的膝关节镜检查门诊患者达到手术麻醉阻滞及满足标准化出院标准所需的时间。
在给予标准的咪达唑仑/酮洛芬术前用药并测量心血管参数基线后，将50例拟行择期门诊膝关节镜检查的ASA身体状况I-II级患者随机分为两组，一组接受通过25G Whitacre脊髓穿刺针注入8mg 0.5%重比重布比卡因且不回抽的单侧脊髓麻醉（美国组，n = 25），另一组接受25ml 2%甲哌卡因的坐骨-股神经联合阻滞（股神经阻滞用15ml，坐骨神经阻滞用10ml）（坐骨-股神经联合阻滞组，n = 25）。记录从局部麻醉药注射到达到手术麻醉阻滞的时间，手术麻醉阻滞定义为存在足够的运动阻滞（美国组为手术肢体完全运动阻滞，坐骨-股神经联合阻滞组为手术肢体踝关节和膝关节无法活动）和感觉阻滞（美国组为手术侧T12水平针刺感觉丧失，坐骨-股神经联合阻滞组为股神经和坐骨神经分布区域感觉丧失）。由一名盲法观察者记录阻滞消退时间、排尿时间、独立行走时间和准备出院时间，以及手术期间不良事件的发生情况。
美国组手术麻醉阻滞在15±6分钟达到，坐骨-股神经联合阻滞组在16±6分钟达到（p =无统计学意义）。未观察到血流动力学不良影响和成功率的差异。尽管美国组患者比坐骨-股神经联合阻滞组患者行走时间更快（166±44分钟对217±49分钟，p = 0.002）且排尿时间更晚（240±90分钟对145±36分钟，p = 0.0001），但出院时间无差异（分别为246±98分钟对211±77分钟）。仅美国组有2例患者需要导尿；然而，没有患者因尿潴留入院。
在门诊膝关节镜检查中，2%甲哌卡因的坐骨-股神经联合阻滞提供的麻醉效果同样成功，起效时间和出院时间与单侧脊髓麻醉相似。
