Collins L M, Vaghadia H
Department of Anaesthesia, Vancouver Hospital and Health Science Center, Vancouver, British Columbia, Canada.
Anesthesiol Clin North Am. 2001 Mar;19(1):43-55. doi: 10.1016/s0889-8537(05)70210-8.
A variety of laparoscopic procedures can be performed on patients under regional anesthesia. Diagnostic laparoscopy in elective and emergency patients, pain mapping, laparoscopy for infertility, and tubal sterilization are some examples. The key benefits of regional anesthesia include less emesis, less postoperative pain, shorter postoperative stay, improved patient satisfaction, and overall safety. Regional techniques, such as rectus sheath blocks, inguinal blocks, and caudal blocks, are useful adjuncts to general anesthesia and facilitate postoperative analgesia. Other techniques, such as spinal and epidural anesthesia, and combination of the two, are suitable as a sole anesthetic technique for laparoscopy. The physiologic changes during laparoscopy in the awake patient appear to be tolerated well under regional anesthesia. It is reasonable to assume that with advances in instrumentation and surgical techniques, the role of laparoscopy will increase in the future. The benefits conferred by regional anesthesia make it an attractive option to general anesthesia for many patients and procedures. Successful implementation of regional anesthesia is an important determinant of how anesthesiologists, surgeons, and surgical facilities cope with new challenges. In the future, it could be possible to provide "walk-in/walk-out" regional anesthesia with a real possibility of fast tracking patients through the recovery process after ambulatory surgery. For maximal patient safety, however, facilities offering regional anesthesia must have appropriately trained anesthesia personnel and the equipment necessary for monitoring and providing full resuscitation in the event of complications or a need to convert to general anesthesia.
多种腹腔镜手术可在区域麻醉下对患者进行。例如，对择期和急诊患者进行诊断性腹腔镜检查、疼痛定位、不孕症腹腔镜检查以及输卵管绝育术。区域麻醉的主要益处包括呕吐更少、术后疼痛减轻、术后住院时间缩短、患者满意度提高以及整体安全性更高。腹直肌鞘阻滞、腹股沟阻滞和骶管阻滞等区域技术是全身麻醉的有用辅助手段，并有助于术后镇痛。其他技术，如脊髓麻醉和硬膜外麻醉以及两者联合，适合作为腹腔镜手术的单一麻醉技术。在区域麻醉下，清醒患者在腹腔镜手术期间的生理变化似乎能得到很好的耐受。可以合理推测，随着器械和手术技术的进步，腹腔镜手术的作用在未来将会增加。区域麻醉带来的益处使其成为许多患者和手术中全身麻醉的一个有吸引力的选择。区域麻醉的成功实施是麻醉医生、外科医生和手术机构应对新挑战的一个重要决定因素。未来，有可能提供“即来即走”的区域麻醉，真正有可能使门诊手术后的患者在恢复过程中快速康复。然而，为了确保患者的最大安全，提供区域麻醉的机构必须有经过适当培训的麻醉人员以及在出现并发症或需要转为全身麻醉时进行监测和全面复苏所需的设备。
