低剂量脊髓布比卡因用于全膝关节置换术有助于患者术后快速康复：一项随机对照试验。

Low-dose spinal bupivacaine for total knee arthroplasty facilitates recovery room discharge: a randomized controlled trial.

机构信息

Department of Anesthesia, M3-200, Sunnybrook Health Sciences Centre and the Holland Orthopedic and Arthritic Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, Canada.

出版信息

Can J Anaesth. 2013 Mar;60(3):259-65. doi: 10.1007/s12630-012-9867-5. Epub 2012 Dec 11.

DOI:10.1007/s12630-012-9867-5

PMID:23229869

Abstract

PURPOSE

Regional anesthesia is the preferred technique for total knee arthroplasty to provide a bridge for early postoperative analgesia, reduce opioid consumption, and improve mobility and rehabilitation. Multiple patient and process factors must be weighed when choosing the appropriate technique to reduce morbidity and facilitate discharge. We hypothesized that a low-dose of intrathecal bupivicaine combined with regional block would facilitate discharge from the postanesthesia care unit (PACU) and reduce postoperative morbidity.

METHODS

Patients undergoing total knee arthroplasty under spinal anesthesia received either 5 mg (low-dose group) or 10 mg (standard-dose group) isobaric bupivacaine in a double-blind randomized controlled trial. The primary outcome measure was time to achieve eligibility for PACU discharge. Secondary outcome measures included time to recovery of S2 dermatome sensation, time to voiding, rate of bladder catheterization, and time required for nursing intervention in the PACU and after discharge to the surgical ward.

RESULTS

Forty-five of the 49 recruited patients completed the study. Patients receiving low-dose spinal anesthesia were eligible for PACU discharge earlier than those receiving the standard dose (P = 0.0036). Patients receiving the standard dose had significantly delayed recovery of S2 dermatome sensation (P = 0.0035). There was no difference between groups in the amount of time required for nursing intervention in the PACU, but patients receiving low-dose spinal anesthesia required more time for nursing intervention within the first four hours of their arrival on the ward (P = 0.009). None of the patients required intraoperative analgesic supplementation.

CONCLUSIONS

In patients undergoing total knee arthroplasty, low-dose intrathecal bupivacaine (5 mg) combined with regional block is associated with a reduced time to achieve eligibility for discharge from the PACU.

摘要

目的

区域麻醉是全膝关节置换术的首选技术，可为术后早期镇痛、减少阿片类药物消耗、改善活动度和康复提供桥梁。在选择合适的技术时，必须权衡多个患者和过程因素，以降低发病率并促进出院。我们假设鞘内给予低剂量布比卡因联合区域阻滞将有助于从麻醉后恢复室（PACU）出院，并降低术后发病率。

方法

接受椎管内麻醉下全膝关节置换术的患者在一项双盲随机对照试验中接受 5 毫克（低剂量组）或 10 毫克（标准剂量组）等比重布比卡因。主要结局指标是达到 PACU 出院标准的时间。次要结局指标包括 S2 皮节感觉恢复时间、排尿时间、导尿率以及 PACU 内和手术后到外科病房护理干预所需的时间。

结果

49 名招募患者中有 45 名完成了研究。接受低剂量脊髓麻醉的患者比接受标准剂量的患者更早符合 PACU 出院标准（P = 0.0036）。接受标准剂量的患者 S2 皮节感觉恢复明显延迟（P = 0.0035）。两组 PACU 内护理干预所需时间无差异，但接受低剂量脊髓麻醉的患者在到达病房的前四个小时内需要更多的护理干预时间（P = 0.009）。术中无需镇痛补充。