Casati A, Fanelli G, Danelli G, Baciarello M, Ghisi D, Nobili F, Chelly J E
Department of Anesthesiology and Pain Therapy, University of Parma, Parma, Italy.
Acta Anaesthesiol Scand. 2006 Nov;50(10):1284-9. doi: 10.1111/j.1399-6576.2006.01101.x.
We prospectively evaluated direct analgesia-related costs of continuous sciatic nerve block using either a stimulating or conventional catheter after hallux valgus repair.
The perineural catheter was inserted through a stimulating introducer either blindly (group Conventional, n= 38) or while stimulating via the catheter (group Stimulating, n= 38). Nerve block was induced with 25 ml of mepivacaine 15 mg/ml, and was followed 3 h later by a patient-controlled infusion of ropivacaine 2 mg/ml (basal infusion: 3 ml/h; incremental dose: 5 ml; lock-out time: 30 min). Rescue tramadol [100 mg intravenous (i.v.)] was given if required. Local anesthetic consumption, need for rescue tramadol and post-operative nausea and vomiting (PONV) treatment, and patient's satisfaction were recorded during first 24-h infusion. Cost calculations were based on the acquisition cost of drugs and devices.
Both techniques were similarly effective, but local anesthetic consumption and need for rescue analgesics were lower in the Stimulating group [respectively, 120 vs. 153 ml (P= 0.004) and 21% vs. 60% (P= 0.001)]. The analgesia-related costs for 24 h were similar when 100-ml bags of ropivacaine 2 mg/ml were used (66 euro vs. 67 euro; P= 0.26). When 200-ml bags of ropivacaine were used, the analgesia-related costs were higher in the Stimulating group than the Conventional group (75 euro vs. 55 euro; P= 0.0005).
Direct costs of continuous sciatic nerve block ranged from 55 to 75 euro. Stimulating catheters reduced local anesthetic consumption and need for rescue analgesics. This was only cost effective when 100-ml bags of 2 mg/ml ropivacaine were used, while the cheapest combination was the use of conventional catheters and 200-ml bags of ropivacaine.
我们前瞻性评估了拇外翻修复术后使用刺激型或传统型导管进行连续坐骨神经阻滞与镇痛相关的直接成本。
通过刺激型穿刺针盲插（传统组，n = 38）或通过导管刺激引导插入神经周围导管（刺激组，n = 38）。用25 ml 15 mg/ml的甲哌卡因诱导神经阻滞，3小时后给予患者自控输注2 mg/ml的罗哌卡因（基础输注：3 ml/h；追加剂量：5 ml；锁定时间：30分钟）。必要时给予补救性曲马多[100 mg静脉注射（i.v.）]。记录首次24小时输注期间的局部麻醉药消耗量、补救性曲马多的需求以及术后恶心呕吐（PONV）治疗情况和患者满意度。成本计算基于药物和器械的购置成本。
两种技术效果相似，但刺激组的局部麻醉药消耗量和补救性镇痛药需求较低[分别为120 ml对153 ml（P = 0.004）和21%对60%（P = 0.001）]。当使用100 ml装2 mg/ml的罗哌卡因时，24小时的镇痛相关成本相似（66欧元对67欧元；P = 0.26）。当使用200 ml装的罗哌卡因时，刺激组的镇痛相关成本高于传统组（75欧元对55欧元；P = 0.0005）。
连续坐骨神经阻滞的直接成本在55至75欧元之间。刺激型导管减少了局部麻醉药消耗量和补救性镇痛药需求。仅当使用100 ml装2 mg/ml的罗哌卡因时具有成本效益，而最便宜的组合是使用传统导管和200 ml装的罗哌卡因。
