Lee Jae-Jun, Hwang Sung Mi, Jang Ji Su, Lim So Young, Heo Dong-Hwa, Cho Yong Jun
Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, School of Medicine, Hallym University, Chuncheon, Korea.
J Korean Neurosurg Soc. 2010 Nov;48(5):429-33. doi: 10.3340/jkns.2010.48.5.429. Epub 2010 Nov 30.
This prospective study evaluated the use of continuous sedation using propofol and remifentanil when carpal tunnel release (CTR) was performed under local anesthesia.
We sedated 60 patients undergoing CTR using local anesthesia with remifentanil at loading and continuous doses of 0.5 µg kg(-1) and 0.05 µg kg(-1)min(-1), respectively, and propofol, using a target controlled infusion (TCI) pump set to a target of 2 µg mL(-1) (group A), or with the same drug doses except that the continuous remifentanil dose was 0.07 µg kg(-1)min(-1) (group B) or 0.1 µg kg(-1)min(-1) (group C).
In group B, the levels of pain when local anesthetics were administered (p = 0.001), intraoperative pain (p < 0.001) and anxiety (p = 0.001) were significantly lower than those of group A. Furthermore, the incidence of adverse events, including desaturation (p < 0.001) and vomiting (p = 0.043), was significantly lower in group B than in group C.
Continuous sedation using an appropriate dose of remifentanil and propofol can be used as safe, efficacious ambulatory anesthesia in cases of CTR under local anesthesia, performed using only 2 mL of local anesthetic, with a high degree of patient satisfaction.
本前瞻性研究评估了在局部麻醉下行腕管松解术（CTR）时使用丙泊酚和瑞芬太尼进行持续镇静的效果。
我们对60例行CTR的患者进行局部麻醉，分别给予负荷剂量及持续剂量为0.5μg kg⁻¹和0.05μg kg⁻¹min⁻¹的瑞芬太尼，并使用靶控输注（TCI）泵将丙泊酚靶浓度设定为2μg mL⁻¹（A组）；或给予相同的药物剂量，但瑞芬太尼持续剂量为0.07μg kg⁻¹min⁻¹（B组）或0.1μg kg⁻¹min⁻¹（C组）。
B组在给予局部麻醉药时的疼痛程度（p = 0.001）、术中疼痛（p < 0.001）及焦虑程度（p = 0.001）均显著低于A组。此外，B组不良事件发生率，包括血氧饱和度下降（p < 0.001）和呕吐（p = 0.043），显著低于C组。
在仅使用2 mL局部麻醉药的局部麻醉下CTR病例中，使用适当剂量的瑞芬太尼和丙泊酚进行持续镇静可作为安全、有效的门诊麻醉，患者满意度高。
