Spasiano A, Flore I, Pesamosca A, Della Rocca G
Department of Anesthesiology, and Intensive Care, University of Udine, Udine, Italy.
Minerva Anestesiol. 2007 Jan-Feb;73(1-2):13-21.
We compared spinal anesthesia and sciatic-femoral block for arthroscopic knee surgery in terms of hemodynamic changes, intraoperative anesthesia, postoperative analgesia, postoperative motor block and bladder function, side effects, and patient satisfaction.
Thirty-two patients were randomised into 2 groups: Group B (sciatic-femoral block with mepivacaine 1% 15 + 25 mL, 120 mm/35 mm 22-gauge needles and ElectroNerve Stimulator) and Group S (unilateral spinal anesthesia with 7 mg of hyperbaric bupivacaine 0.5% and 25-gauge Sprotte needle in L2-L3 space). We recorded pain, together with hemodynamic parameters (baseline, 5, 10, 15, 30 min), utilising Numerical Rating Scale (NRS) during the tourniquet application and during the surgical procedures, anesthesia quality, orthopedic evaluation for intraoperative liberty of knee movement. During the postoperative period we recorded at 2, 4 and 6 h: postoperative analgesia, motor block, first urine output, side effects, first requirement for analgesic drug, patient satisfaction and costs.
The only significant differences between the 2 groups (P<0.05) were the heart rate changes at 10, 15, 30 min with an increase in Group B and a decrease in Group S, and the first urine output at 200+/-69 min in Group B versus 269+/-66 min in Group S.
In conclusion the sciatic-femoral nerve block is a valid alternative to spinal anesthesia for arthroscopic knee surgery, leading to a faster discharging from the hospital.
我们比较了脊髓麻醉和坐骨 - 股神经阻滞用于膝关节镜手术时在血流动力学变化、术中麻醉、术后镇痛、术后运动阻滞和膀胱功能、副作用以及患者满意度方面的差异。
32例患者被随机分为2组:B组(用1%甲哌卡因15 + 25 mL、120 mm/35 mm 22号针和神经电刺激仪进行坐骨 - 股神经阻滞)和S组(在L2 - L3间隙用7 mg 0.5%的重比重布比卡因和25号Sprotte针进行单侧脊髓麻醉)。我们记录疼痛情况以及血流动力学参数(基线、5、10、15、30分钟时),在使用止血带期间和手术过程中使用数字评分量表(NRS)评估麻醉质量、对膝关节运动术中自由度的骨科评估。在术后2、4和6小时记录:术后镇痛、运动阻滞、首次尿量、副作用、首次使用镇痛药物的需求、患者满意度和费用。
两组之间唯一显著差异(P<0.05)是在10、15、30分钟时心率变化,B组升高而S组降低,以及B组首次尿量为200±69分钟,而S组为269±66分钟。
总之,坐骨 - 股神经阻滞是膝关节镜手术脊髓麻醉的一种有效替代方法,可使患者更快出院。