Krobbuaban Banjong, Kumkeaw Sujarit, Pakdeesirivong Natha, Diregpoke Siriwan
Department of Anaesthesiology, Chaiyaphum Hospital, Bannakan Rd, Maung, Chaiyaphum 36000, Thailand.
J Med Assoc Thai. 2005 Jul;88(7):909-13.
The choice of anesthesia is one of the most important decisions made by anesthesiologists after preoperative visits with orthopedic patients. No published study has yet quantified the incidence of postanesthetic complaints for either technique. The present study was designed to compare the incidences of postanesthetic complaints after the application of the standardized techniques of spinal anesthesia, using a 27 - gauge needle, and two forms of general anesthesia in patients undergoing lower limb surgery.
In a prospective, randomized, observer blind trial, 260 orthopedic patients who underwent lower limb surgery were randomized into 3 groups; 1) spinal anesthesia (SA), 2) general anesthesia via facemask (GA-M), 3) general anesthesia via endotracheal intubation (GA-T). On postoperative days 1 and 3, patients were interviewed specifically about postanesthetic complaints.
The present study indicated that the incidence of backache was significantly higher in SA (p = 0.01), while nausea/vomiting (p = 0.00) and headache (p = 0.02) were more frequent in GA-M and GA-T on the first postoperative day. In the 3-day period of observation in the ward, the incidence of postoperative complaints did not significantly differ among the three groups.
Spinal anesthesia using a 27-gauge Quincke needle is associated with a lower incidence of postanesthetic complaints compared with general anesthesia. This technique may be recommended for patients undergoing lower limb surgery.
麻醉方式的选择是麻醉医生在对骨科患者进行术前访视后做出的最重要决策之一。目前尚无已发表的研究对这两种技术的麻醉后不适发生率进行量化。本研究旨在比较在接受下肢手术的患者中,使用27号针的标准脊麻技术与两种全身麻醉方式后的麻醉后不适发生率。
在一项前瞻性、随机、观察者盲法试验中,将260例行下肢手术的骨科患者随机分为3组;1)脊麻(SA),2)面罩全身麻醉(GA-M),3)气管插管全身麻醉(GA-T)。在术后第1天和第3天,专门就麻醉后不适对患者进行访谈。
本研究表明,SA组背痛发生率显著更高(p = 0.01),而术后第1天GA-M组和GA-T组恶心/呕吐(p = 0.00)和头痛(p = 0.02)更为常见。在病房观察的3天期间,三组术后不适发生率无显著差异。
与全身麻醉相比,使用27号Quincke针的脊麻与较低的麻醉后不适发生率相关。该技术可能推荐用于接受下肢手术的患者。