Karacalar Serap, Bilen Cenk Yucel, Sarihasan Binnur, Sarikaya Saban
Department of Anesthesiology, Ondokuz Mayis University , Samsun, Turkey.
J Endourol. 2009 Oct;23(10):1591-7. doi: 10.1089/end.2009.0224.
To compare the efficacy between combined spinal-epidural block and general anesthesia in patients undergoing percutaneous nephrolithotripsy (PNL).
A total of 180 patients undergoing PNL were randomly allocated to receive spinal-epidural anesthesia plus intravenous patient-controlled anesthesia with tramadol or general anesthesia (propofol induction, maintenance with sevoflurane) plus intravenous patient-controlled anesthesia with tramadol (G group). Hemodynamic changes, postanesthesia care unit (PACU) discharge times, times to home readiness, side effects, patient and endoscopist satisfaction, postoperative pain (scored from 0 to 10 on a visual analog scale), and analgesic medication were recorded.
Rates of hypotension (p = 0.06) and bradycardia (p = 0.14) did not differ between the groups. Compared with the G group, duration of PACU and the time to home readiness (p = 0.001 for each) were shorter in the spinal-epidural group. The incidence of nausea was higher in the G group (p = 0.001); vomiting and pruritus rates were similar between groups. No patient had respiratory depression. The spinal-epidural group had better patient satisfaction (p = 0.001) and lower pain scores (p = 0.001). The G group required more diclofenac during the first 48 h (p = 0.001).
In patients undergoing PNL, spinal-epidural anesthesia and analgesia gave greater patient satisfaction, shorter times for PACU and home readiness, and less postoperative pain. Spinal-epidural anesthesia is an attractive alternative to general anesthesia in these patients.
比较蛛网膜下腔-硬膜外联合阻滞与全身麻醉用于经皮肾镜取石术（PNL）患者的疗效。
180例行PNL的患者被随机分配接受蛛网膜下腔-硬膜外麻醉加曲马多静脉自控镇痛或全身麻醉（丙泊酚诱导，七氟醚维持）加曲马多静脉自控镇痛（G组）。记录血流动力学变化、麻醉后恢复室（PACU）出院时间、准备回家时间、副作用、患者及内镜医师满意度、术后疼痛（采用视觉模拟评分法，0至10分）及镇痛药物使用情况。
两组间低血压发生率（p = 0.06）和心动过缓发生率（p = 0.14）无差异。与G组相比，蛛网膜下腔-硬膜外组的PACU停留时间和准备回家时间均较短（每项p = 0.001）。G组恶心发生率较高（p = 0.001）；两组间呕吐和瘙痒发生率相似。无患者发生呼吸抑制。蛛网膜下腔-硬膜外组患者满意度更高（p = 0.001），疼痛评分更低（p = 0.001）。G组在术后48小时内需要更多双氯芬酸（p = 0.001）。
在接受PNL的患者中，蛛网膜下腔-硬膜外麻醉与镇痛可提高患者满意度，缩短PACU停留时间和准备回家时间，减轻术后疼痛。蛛网膜下腔-硬膜外麻醉是这些患者全身麻醉的一个有吸引力的替代方案。
