Casati A, Cappelleri G, Berti M, Fanelli G, Di Benedetto P, Torri G
Vita Salute University, Department of Anaesthesiology, IRCCS H. San Raffaele, Milano, Italy.
Eur J Anaesthesiol. 2002 Feb;19(2):109-14. doi: 10.1017/s0265021502000194.
To evaluate preparation and discharge times as well as the anaesthesia-related costs of out-patient knee arthroscopy performed with a combined sciatic-femoral nerve block, or a propofol-remifentanil general anaesthetic.
With Ethics Committee approval and written informed consent, 40 healthy patients were pre-medicated with intravenous midazolam (0.05 mg kg(-1)) and ketoprofen (50 mg). They were then randomly allocated to receive either a combined sciatic-femoral nerve block with 25 mL mepivacaine 2% (15 mL for the femoral nerve, 10 mL for the sciatic nerve) (PNB group, n = 20), or a general anaesthetic with a continuous intravenous infusion of remifentanil (0.1-0.3 microgkg(-1) min(-1)) and propofol (target plasma concentration 2-4 microg mL(-1)) with a laryngeal mask airway (GA group, n = 20).
The median (range) preparation time was 16 (10-28)min in the PNB group and 13 (8-22)min in the GA group (P = 0.015). Ten PNB patients were directly discharged to the day-surgery unit after the procedure as compared with one GA patient (P = 0.003). Discharge from the postanaesthesia care unit (PACU) required 5 (5-20) min in the PNB group and 23 (7-95) min in the GA group (P = 0.001). Home discharge criteria were fulfilled after 277 (150-485) min in the PNB group and 170 (100-400) min in the GA group (P = 0.005). Costs related to the time spent in the PACU were lower for the PNB group (1.10 euro, range Euro 0-22 euro) compared with the GA group (30 euro, range 0-176 euro) (P = 0.0005). There were no differences in total costs: PNB group 158 euro (range 105-194 euro) versus GA group 160 euro (range 101-238 euro) (P = 0.61).
In patients undergoing out-patient knee arthroscopy, the length of stay in the PACU can be shorter after a sciatic-femoral nerve block with a small volume of mepivacaine 2% compared with a propofol-remifentanil anaesthetic, and there is an increased likelihood that they will bypass the first phase of the postoperative recovery.
评估采用坐骨-股神经联合阻滞或丙泊酚-瑞芬太尼全身麻醉进行门诊膝关节镜检查的准备时间、出院时间以及与麻醉相关的费用。
经伦理委员会批准并获得书面知情同意后，40例健康患者静脉注射咪达唑仑（0.05 mg/kg）和酮洛芬（50 mg）进行术前用药。然后将他们随机分为两组，一组接受25 mL 2%甲哌卡因的坐骨-股神经联合阻滞（股神经15 mL，坐骨神经10 mL）（PNB组，n = 20），另一组采用喉罩气道，持续静脉输注瑞芬太尼（0.1 - 0.3 μg·kg⁻¹·min⁻¹）和丙泊酚（目标血浆浓度2 - 4 μg/mL）进行全身麻醉（GA组，n = 20）。
PNB组的中位（范围）准备时间为16（10 - 28）分钟，GA组为13（8 - 22）分钟（P = 0.015）。术后，10例PNB患者直接出院至日间手术病房，而GA组仅有1例（P = 0.003）。PNB组从麻醉后恢复室（PACU）出院需要5（5 - 20）分钟，GA组需要23（7 - 95）分钟（P = 0.001）。PNB组在277（150 - 485）分钟后达到出院标准，GA组在170（100 - 400）分钟后达到出院标准（P = 0.005）。与GA组（30欧元，范围0 - 176欧元）相比，PNB组在PACU停留时间相关的费用较低（1.10欧元，范围0 - 22欧元）（P = 0.0005）。总费用无差异：PNB组158欧元（范围105 - 194欧元），GA组160欧元（范围101 - 238欧元）（P = 0.61）。
在接受门诊膝关节镜检查的患者中，与丙泊酚-瑞芬太尼麻醉相比，采用小剂量2%甲哌卡因进行坐骨-股神经阻滞术后在PACU的停留时间更短，且更有可能绕过术后恢复的第一阶段。
