Calvo-Soto Patricia, Trujillo-Hernández Benjamín, Martínez-Contreras Alicia, Vásquez Clemente
Departamento de Anestesiología, Instituto Mexicano del Seguro Social, Hospital General de Zona y Medicina Familiar No. 1 de Colima.
Rev Invest Clin. 2009 Nov-Dec;61(6):482-8.
Combined spinal and general anesthesia block (CSGAB) and combined epidural and general anesthesia block (CEGAB) in laparoscopic cholecystectomy were compared.
Forty patients were randomly selected (ASA physical status I-II) to receive sevoflurane plus 10 to 15 mg of bupivacaine weighed at 0.5% and 20 microg of fentanyl (CSGAB) or sevoflurane plus 150 mg of ropivacaine and 1 microg/kg of fentanyl (CEGAB). Blood pressure, heart rate, oxygen and carbon dioxide saturation, drug doses and sevoflurane MAC (minimum alveolar concentration) were evaluated during surgery. Anesthesia recovery time and pain intensity and duration were evaluated during the first two postoperative hours. Frequency of incisional or referred pain, dyspnea, headache, cramping, nausea and vomiting were evaluated 24 hours after surgery. Statistical analysis was carried out using the Chi-square test and Student t test. Relative risk, absolute risk reduction and number needed to treat (NNT) for adverse reactions were determined.
Systolic and diastolic arterial pressures posterior to semi-Fowler's position were lower in the CSGAB group than in the CEGAB group. (94 +/- 16 vs. 110 +/- 18 mmHg; p < 0.01 and 59 +/- 8 vs. 69 +/- 12, mmHg; p < 0.01, respectively). Anesthesia recovery time (32 +/- 17 vs. 61 +/- 29 minutes; p < 0.01) and pain duration (26 +/- 42 vs. 83 +/- 46 minutes; p < 0.01) were shorter in the CSGAB group. NNT was 8 for postoperative pain, 8 for nausea, and 95 for vomiting.
CSGAB was more efficacious for rapid anesthesia recovery and had a shorter post-operative pain duration than CEGAB.
比较腰麻联合全身麻醉（CSGAB）和硬膜外麻醉联合全身麻醉（CEGAB）在腹腔镜胆囊切除术中的效果。
随机选取40例患者（ASA身体状况分级为I-II级），分别接受七氟醚加0.5%浓度的10至15毫克重比重布比卡因和20微克芬太尼（CSGAB），或七氟醚加150毫克罗哌卡因和1微克/千克芬太尼（CEGAB）。术中评估血压、心率、血氧和二氧化碳饱和度、药物剂量及七氟醚最低肺泡浓度（MAC）。术后前两小时评估麻醉恢复时间、疼痛强度及持续时间。术后24小时评估切口或牵涉痛、呼吸困难、头痛、痉挛、恶心和呕吐的发生率。采用卡方检验和学生t检验进行统计学分析。确定不良反应的相对风险、绝对风险降低率及需治疗人数（NNT）。
半卧位后CSGAB组的收缩压和舒张压低于CEGAB组。（分别为94±16 vs. 110±18 mmHg；p<0.01和59±8 vs. 69±12 mmHg；p<0.01）。CSGAB组的麻醉恢复时间（32±17 vs. 61±29分钟；p<0.01）和疼痛持续时间（得26±42 vs. 83±46分钟；p<0.01）更短。术后疼痛的NNT为8，恶心为8，呕吐为95。
与CEGAB相比，CSGAB在麻醉快速恢复方面更有效，术后疼痛持续时间更短。
