van Zundert A A J, Stultiens G, Jakimowicz J J, Peek D, van der Ham W G J M, Korsten H H M, Wildsmith J A W
Department of Anesthesiology, ICU and Pain Therapy, Catharina Hospital-Brabant Medical School, Eindhoven, The Netherlands.
Br J Anaesth. 2007 May;98(5):682-6. doi: 10.1093/bja/aem058. Epub 2007 Mar 19.
Laparoscopic surgery is normally performed under general anaesthesia, but regional techniques have been found beneficial, usually in the management of patients with major medical problems. Encouraged by such experience, we performed a feasibility study of segmental spinal anaesthesia in healthy patients.
Twenty ASA I or II patients undergoing elective laparoscopic cholecystectomy received a segmental (T10 injection) spinal anaesthetic using 1 ml of bupivacaine 5 mg ml-1 mixed with 0.5 ml of sufentanil 5 microg ml-1. Other drugs were only given (systemically) to manage patient anxiety, pain, nausea, hypotension, or pruritus during or after surgery. The patients were reviewed 3 days postoperatively by telephone.
The spinal anaesthetic was performed easily in all patients, although one complained of paraesthesiae which responded to slight needle withdrawal. The block was effective for surgery in all 20 patients, six experiencing some discomfort which was readily treated with small doses of fentanyl, but none requiring conversion to general anaesthesia. Two patients required midazolam for anxiety and two ephedrine for hypotension. Recovery was uneventful and without sequelae, only three patients (all for surgical reasons) not being discharged home on the day of operation.
This preliminary study has shown that segmental spinal anaesthesia can be used successfully and effectively for laparoscopic surgery in healthy patients. However, the use of an anaesthetic technique involving needle insertion into the vertebral canal above the level of termination of the spinal cord requires great caution and should be restricted in application until much larger numbers of patients have been studied.
腹腔镜手术通常在全身麻醉下进行,但已发现区域麻醉技术有益,通常用于有严重内科问题的患者管理。受此经验鼓舞,我们对健康患者进行了节段性脊髓麻醉的可行性研究。
20例接受择期腹腔镜胆囊切除术的美国麻醉医师协会(ASA)I或II级患者,使用1毫升浓度为5毫克/毫升的布比卡因与0.5毫升浓度为5微克/毫升的舒芬太尼混合液进行节段性(T10注射)脊髓麻醉。仅在手术期间或术后给予其他药物(全身用药)以处理患者的焦虑、疼痛、恶心、低血压或瘙痒。术后3天通过电话对患者进行随访。
所有患者的脊髓麻醉操作均顺利,尽管有1例患者抱怨感觉异常,经稍微退针后缓解。所有20例患者的麻醉均有效,6例患者有一些不适,小剂量芬太尼即可轻松处理,但无人需要转为全身麻醉。2例患者因焦虑需要咪达唑仑,2例患者因低血压需要麻黄碱。恢复过程顺利且无后遗症,仅3例患者(均因手术原因)未在手术当天出院回家。
这项初步研究表明,节段性脊髓麻醉可成功且有效地用于健康患者的腹腔镜手术。然而,使用涉及将针插入脊髓终止水平以上椎管的麻醉技术需要极其谨慎,在对大量患者进行研究之前,其应用应受到限制。