Sungurtekin Hulya, Sungurtekin Ugur, Erdem Ergun
Department of Anesthesiology, Pamukkale University School of Medicine, Denizli, Turkey.
J Clin Anesth. 2003 May;15(3):201-5. doi: 10.1016/s0952-8180(03)00032-1.
To evaluate two anesthetic techniques, namely, local anesthesia with sedation, and spinal anesthesia, with respect to recovery times, postoperative side effects, pain scores, patient satisfaction, and hospital costs for ambulatory pilonidal disease surgery.
Prospective, randomized study.
University Hospital of Pamukkale.
60 consenting patients scheduled for pilonidal disease operation with Limberg flap technique.
Patients were randomly allocated into two groups: Group 1 (n = 30) received spinal anesthesia with hyperbaric bupivacaine 1.5 mL 0.5%, and Group 2 (n = 30) received local infiltration with a 50-mL mixture containing 10 mL bupivacaine 0.5%, 10 mL prilocaine HCl 2%, and 30 mL isotonic solution with 1:200,000 epinephrine in combination with intravenous (i.v.) midazolam sedation.
Perioperative and postoperative side effects, patient satisfaction, preoperative visual analog scale (VAS) pain scores, and VAS scores from the fourth hour postoperatively until the seventh day were assessed. Anesthesia, operation, surgery, and total hospital time, and costs (drug, resources, and labor) were recorded.
No difference was found between groups in the frequency of side effects. Urinary retention was diagnosed in two patients in the spinal anesthesia group. There was no statistical significant difference seen in satisfaction scores between groups. No statistical significance in VAS pain scores between groups was noted except for the fourth postoperative hour values. The average time spent in the operating room (OR) was greater in the spinal anesthesia group. All Group 2 patients achieved fast-tracking criteria in the OR and were able to bypass the postanesthesia care unit (PACU). Total hospital time and total cost were significantly higher in the spinal anesthesia group than local anesthesia-sedation group (p < 0.05).
The use of local anesthesia-sedation for ambulatory anorectal surgery resulted in a shorter hospital time, lower hospital costs, and no side effects compared with spinal anesthesia.
评估局部麻醉联合镇静与脊髓麻醉这两种麻醉技术在门诊藏毛窦疾病手术中的恢复时间、术后副作用、疼痛评分、患者满意度及住院费用。
前瞻性随机研究。
棉花堡大学医院。
60例同意采用Limberg皮瓣技术进行藏毛窦疾病手术的患者。
患者被随机分为两组：第1组（n = 30）接受0.5% 1.5 mL重比重布比卡因脊髓麻醉，第2组（n = 30）接受含10 mL 0.5%布比卡因、10 mL 2%盐酸丙胺卡因和30 mL含1:200,000肾上腺素的等渗溶液的50 mL混合液局部浸润，并联合静脉注射咪达唑仑镇静。
评估围手术期和术后副作用、患者满意度、术前视觉模拟量表（VAS）疼痛评分以及术后第4小时至第7天的VAS评分。记录麻醉、手术、住院及总住院时间和费用（药物、资源和人工）。
两组副作用发生率无差异。脊髓麻醉组有2例患者被诊断为尿潴留。两组满意度评分无统计学显著差异。除术后第4小时值外，两组VAS疼痛评分无统计学显著差异。脊髓麻醉组在手术室的平均停留时间更长。第2组所有患者在手术室均达到快速康复标准，可绕过麻醉后护理单元（PACU）。脊髓麻醉组的总住院时间和总费用显著高于局部麻醉联合镇静组（p < 0.05）。
与脊髓麻醉相比，门诊肛肠手术采用局部麻醉联合镇静可缩短住院时间、降低住院费用且无副作用。
