Ankara Numune Training and Research Hospital, Turkey.
Clinics (Sao Paulo). 2010;65(9):831-5. doi: 10.1590/s1807-59322010000900003.
The goal of the study was to investigate the regional intravenous anesthesia procedure in knee arthroscopy and to evaluate the effects of adding ketamine over the anesthesia block charactery and tourniquet pain.
MATERIAL/METHOD: Forty American Society of Anesthesiologists (ASA) II patients who received knee arthroscopy were enrolled. After monitoring, a peripheral IV line was inserted.The venous blood in the lower extremity was evacuated with a bandage, and the proximal cuff of the double-cuff tourniquet was inflated. The patients were randomly split into two groups. While Group P received 80 ml 0.5% prilocaine, Group PK received 0.15 mg/kg ketamine (80 ml in total) via the dorsum of the foot. We recorded onset time of the sensory block, end time of the sensory block, presence of the motor block, the time when the patient verbally reported tourniquet pain and surgical pain, duration of tourniquet tolerance, fentanyl consumption during the operation, time to first analgesic requirement, methemoglobin values at 60 minutes, operative conditions, 24-hour analgesic consumption, discharge time, and hemodynamic parameters.
The body mass index (BMI) of the patients who required general anesthesia was significantly higher than the BMI of other patients. The onset time of the sensory block was shorter for those in Group PK, but the time to first analgesic requirement was longer.
Regional intravenous anesthesia using the doses and volumes commonly used in knee arthroscopy may be an inadequate block among patients with high BMI values. Moreover, the addition of ketamine to the local anesthetic solution may produce a partial solution by shortening the onset of sensory block and prolonging the time until the first analgesic is required.
本研究旨在探讨膝关节镜检查中区域静脉麻醉的方法，并评估在麻醉阻滞特征和止血带疼痛中加入氯胺酮的效果。
材料/方法：本研究纳入了 40 名接受膝关节镜检查的美国麻醉医师协会（ASA）Ⅱ级患者。监测后，插入外周静脉通路。用绷带抽出下肢静脉血，使双袖带止血带的近端袖带充气。患者随机分为两组。在 P 组中，给予 80ml0.5%普鲁卡因，而 PK 组则给予 0.15mg/kg 氯胺酮（共 80ml）于足部背侧。我们记录感觉阻滞的起始时间、感觉阻滞的结束时间、运动阻滞的存在、患者报告止血带疼痛和手术疼痛的时间、止血带耐受时间、手术期间芬太尼的消耗、首次需要镇痛的时间、60 分钟时高铁血红蛋白值、手术条件、24 小时镇痛消耗、出院时间和血流动力学参数。
需要全身麻醉的患者的体重指数（BMI）明显高于其他患者。PK 组的感觉阻滞起始时间较短，但首次需要镇痛的时间较长。
在膝关节镜检查中使用常用剂量和体积的区域静脉麻醉可能对 BMI 值较高的患者造成阻滞不足。此外，在局部麻醉溶液中加入氯胺酮可能通过缩短感觉阻滞的起始时间和延长首次需要镇痛的时间来部分解决问题。
