Türker G, UCkunkaya N, Yilmazlar A, Demirag B, Tokat O
Departments of Anesthesiology and Orthopedic Surgery, Uludag University School of Medicine, Bursa, Turkey.
Acta Anaesthesiol Scand. 2003 Sep;47(8):986-92. doi: 10.1034/j.1399-6576.2003.00194.x.
This study investigated whether addition of 15 microg epinephrine plus 25 microg fentanyl to lidocaine spinal anesthesia for outpatient knee arthroscopy makes it possible to use a subanesthetic lidocaine dose. The aim was to assess the quality of anesthesia and the suitability of this protocol for outpatient knee arthroscopy.
Seventy-five outpatients scheduled for knee arthroscopy were randomly assigned to one of three spinal anesthetic protocols: Group L10F25 received 10 mg of lidocaine plus 25 micro g fentanyl; Group L10F25E15 received 10 mg of lidocaine plus 25 microg fentanyl plus 15 microg epinephrine; and Group L20F25 received 20 microg lidocaine plus 25 microg fentanyl. Tourniquet pain and surgical pain were assessed using a visual analog scale. If spinal anesthesia was inadequate despite supplementary intravenous analgesia and sedation, the patient was converted to general anesthesia. Recovery times and side-effects in the early postoperative period were recorded.
The highest level of sensory block was above the T12 dermatome in all patients. Compared with the other groups, significantly more patients in Group L10F25 converted to general anesthesia. Group L10F25 had a significantly higher mean surgical pain score than the other groups. The mean tourniquet pain score was significantly higher in Group L20F25 than Group L10F25E15. Group L10F25E15 had a significantly shorter time to discharge than the other groups. Post-operative nausea and vomiting and drowsiness were more frequent in Group L10F25 than in the other groups.
The combination of 10 mg lidocaine and 25 microg fentanyl plus 15 microg epinephrine provides adequate spinal anesthesia and has favorable recovery characteristics for outpatient knee arthroscopy.
本研究调查了在门诊膝关节镜检查的利多卡因脊髓麻醉中添加15微克肾上腺素加25微克芬太尼是否可以使用亚麻醉剂量的利多卡因。目的是评估麻醉质量以及该方案用于门诊膝关节镜检查的适用性。
75例计划进行膝关节镜检查的门诊患者被随机分配到三种脊髓麻醉方案之一：L10F25组接受10毫克利多卡因加25微克芬太尼；L10F25E15组接受10毫克利多卡因加25微克芬太尼加15微克肾上腺素；L20F25组接受20微克利多卡因加25微克芬太尼。使用视觉模拟量表评估止血带疼痛和手术疼痛。如果尽管补充了静脉镇痛和镇静，脊髓麻醉仍不足，则将患者转为全身麻醉。记录术后早期的恢复时间和副作用。
所有患者的感觉阻滞最高水平均高于T12皮节。与其他组相比，L10F25组中转为全身麻醉的患者明显更多。L10F25组的平均手术疼痛评分明显高于其他组。L20F25组的平均止血带疼痛评分明显高于L10F25E15组。L10F25E15组的出院时间明显短于其他组。L10F25组术后恶心、呕吐和嗜睡比其他组更频繁。
10毫克利多卡因、25微克芬太尼加15微克肾上腺素的组合可提供足够的脊髓麻醉，并且对于门诊膝关节镜检查具有良好的恢复特征。
