Li S, Coloma M, White P F, Watcha M F, Chiu J W, Li H, Huber P J
Departments of Anesthesiology and Pain Management and Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75235-9068, USA.
Anesthesiology. 2000 Nov;93(5):1225-30. doi: 10.1097/00000542-200011000-00015.
Given the current practice environment, it is important to determine the anesthetic technique with the highest patient acceptance and lowest associated costs. The authors compared three commonly used anesthetic techniques for anorectal procedures in the ambulatory setting.
Ninety-three consenting adult outpatients undergoing anorectal surgery were randomly assigned to one of three anesthetic treatment groups: group 1 received local infiltration with a 30-ml mixture containing 15 ml lidocaine, 2%, and 15 ml bupivacaine, 0.5%, with epinephrine (1:200,000) in combination with intravenous sedation using a propofol infusion, 25-100 microg. kg-1. min-1; group 2 received a spinal subarachnoid block with a combination of 30 mg lidocaine and 20 microg fentanyl with midazolam, 1-2-mg intravenous bolus doses; and group 3 received general anesthesia with 2.5 mg/kg propofol administered intravenously and 0.5-2% sevoflurane in combination with 65% nitrous oxide. In groups 2 and 3, the surgeon also administered 10 ml of the previously described local anesthetic mixture at the surgical site before the skin incision.
The mean costs were significantly decreased in group 1 ($69 +/- 20 compared with $104 +/- 18 and $145 +/- 25 in groups 2 and 3, respectively) because both intraoperative and recovery costs were lowest (P < 0.05). Although the surgical time did not differ among the three groups, the anesthesia time and times to oral intake and home-readiness were significantly shorter in group 1 (vs. groups 2 and 3). There was no significant difference among the three groups with respect to the postoperative side effects or unanticipated hospitalizations. However, the need for pain medication was less in groups 1 and 2 (19% and 19% vs. 45% for group 3; P < 0.05). Patients in group 1 had no complaints of nausea (vs. 3% and 26% in groups 2 and 3, respectively). More patients in group 1 (68%) were highly satisfied with the care they received than in groups 2 (58%) and 3 (39%).
The use of local anesthesia with sedation is the most cost-effective technique for anorectal surgery in the ambulatory setting.
鉴于当前的医疗实践环境，确定患者接受度最高且相关成本最低的麻醉技术很重要。作者比较了门诊环境下用于肛肠手术的三种常用麻醉技术。
93名同意接受肛肠手术的成年门诊患者被随机分配到三个麻醉治疗组之一：第1组接受局部浸润麻醉，使用含15ml 2%利多卡因、15ml 0.5%布比卡因及肾上腺素（1:200,000）的30ml混合液，并联合使用丙泊酚静脉输注进行静脉镇静，剂量为25 - 100μg·kg⁻¹·min⁻¹；第2组接受脊髓蛛网膜下腔阻滞，使用30mg利多卡因和20μg芬太尼联合咪达唑仑，静脉推注剂量为1 - 2mg；第3组接受全身麻醉，静脉注射2.5mg/kg丙泊酚，并联合使用0.5 - 2%七氟醚及65%氧化亚氮。在第2组和第3组中，外科医生在皮肤切口前也在手术部位注射10ml上述局部麻醉混合液。
第1组的平均成本显著降低（分别为69±20美元，而第2组和第3组分别为104±18美元和145±25美元）因为术中及恢复成本均最低（P<0.05）。尽管三组的手术时间无差异，但第1组的麻醉时间、恢复经口进食时间及准备出院时间均显著短于第2组和第3组。三组在术后副作用或意外住院方面无显著差异。然而，第1组和第2组对止痛药物的需求较少（分别为19%和19%，而第3组为45%；P<0.05）。第1组患者无恶心主诉（而第2组和第3组分别为3%和26%）。第1组中对所接受护理高度满意的患者比例（68%）高于第2组（58%）和第3组（39%）。
在门诊环境下，局部麻醉联合镇静是肛肠手术最具成本效益的技术。
