Sperber A, Wredmark T
From the Department of Orthopaedic Surgery, Huddinge Hospital, Karolinska Institutet, Eskilstuna and Huddinge, Sweden.
J Shoulder Elbow Surg. 1993 Mar;2(2):106-9. doi: 10.1016/1058-2746(93)90008-5. Epub 2009 Feb 25.
In recent years shoulder arthroscopy has become increasingly used. To simplify the procedure and to minimize cost and operative risks, a study has been conducted to evaluate the use of local anesthesia for diagnostic shoulder arthroscopy. Two groups of patients were studied. The first group of 17 patients was examined while the patients were under general anesthesia, but a continuous infusion of lidocaine-chloride 0.2% was also performed. Serial blood samples were obtained. In all patients the peak serum level of local anesthetic was below the toxic levels. Seventeen other patients were operated on while they were under local anesthesia; 20 ml 1% prilocaine-epinephrine was injected into the soft tissues on the posterior aspect of the shoulder, and a continuous infusion of 0.2% lidocaine-chloride was infused intraarticularly during the procedure. In addition, adjunctive diazepam was used in eight patients. Three patients could not complete the procedure because of pain. We conclude that the absorption pattern of local anesthetic from the shoulder joint during arthroscopy is within the acceptable dose range. However, performing diagnostic shoulder arthroscopy with the patient under local anesthesia is a demanding procedure for the patient and may not always be possible.
近年来，肩关节镜检查的应用越来越广泛。为了简化手术过程并将成本和手术风险降至最低，开展了一项研究以评估局部麻醉在诊断性肩关节镜检查中的应用。对两组患者进行了研究。第一组17例患者在全身麻醉下接受检查，但同时也进行了0.2%利多卡因 - 氯化物的持续输注。采集了系列血样。所有患者局部麻醉药的血清峰值水平均低于中毒水平。另外17例患者在局部麻醉下接受手术；将20 ml 1%丙胺卡因 - 肾上腺素注入肩部后侧的软组织，并在手术过程中向关节腔内持续输注0.2%利多卡因 - 氯化物。此外，8例患者使用了辅助性地西泮。3例患者因疼痛无法完成手术。我们得出结论，关节镜检查期间局部麻醉药从肩关节的吸收模式在可接受的剂量范围内。然而，让患者在局部麻醉下进行诊断性肩关节镜检查对患者来说是一项要求较高的操作，而且并非总是可行的。
