Davison Peter G, Cobb Tyson, Lalonde Donald H
Division of Plastic Surgery, Dalhousie University, Hilyard Place, Suite A280, 560 Main Street, Saint John, NB Canada E2K 1J5.
P.C., 3385 Dexter Court Suite 300, Davenport, IA 52807 USA.
Hand (N Y). 2013 Mar;8(1):47-53. doi: 10.1007/s11552-012-9474-5.
The purpose of this study was to provide prospective independently analyzed evidence on how patients feel about a carpal tunnel release (CTR) performed under local anesthesia only (no sedation or tourniquet) versus with local anesthesia, intravenous (IV) sedation, and a tourniquet.
This prospective cohort study compared 100 consecutive CTRs done with only lidocaine and epinephrine in Saint John, New Brunswick to 100 consecutive CTRs done with IV sedation in Davenport, Iowa. Patient perspectives on the anesthesia were captured in a blinded questionnaire 1 week postoperatively.
For subsequent surgery, 93 % of wide awake patients would choose local anesthesia only and 93 % of sedated patients would choose sedation. Wide awake patients spent less time at the hospital (M = 2.6 h) than sedated patients (M = 4.0 h; p < .001). Preoperative blood work, electrocardiograms, and/or chest radiographs were done for 3 % of wide awake patients and 48 % of sedated patients (p < 0.001). Preoperative anxiety levels for wide awake patients were lower than for sedated patients (p = 0.007); postoperative anxiety was similar. There were no anesthesia complications in either group. Narcotics were used by 5 % of unsedated patients and 67 % of sedated patients (p < 0.001). Adequate pain control was reported by 89 % and 90 % of patients, respectively.
The majority of patients from both cohorts liked whichever method of anesthesia they received and would choose it again. However, sedated patients spent more time at the hospital, required more preoperative testing, and reported greater preoperative anxiety.
本研究的目的是提供前瞻性独立分析证据，以了解患者对仅在局部麻醉下（无镇静或止血带）与局部麻醉、静脉（IV）镇静和止血带下行腕管松解术（CTR）的感受。
这项前瞻性队列研究将新不伦瑞克省圣约翰市连续进行的100例仅使用利多卡因和肾上腺素的CTR与爱荷华州达文波特市连续进行的100例IV镇静下的CTR进行比较。术后1周通过盲法问卷收集患者对麻醉的看法。
对于后续手术，93%的清醒患者会选择仅局部麻醉，93%的镇静患者会选择镇静。清醒患者在医院的停留时间（M = 2.6小时）比镇静患者（M = 4.0小时；p <.001）短。3%的清醒患者和48%的镇静患者进行了术前血液检查、心电图和/或胸部X光检查（p < 0.001）。清醒患者的术前焦虑水平低于镇静患者（p = 0.007）；术后焦虑情况相似。两组均无麻醉并发症。5%的未镇静患者和67%的镇静患者使用了麻醉剂（p < 0.001）。分别有89%和90%的患者报告疼痛得到充分控制。
两个队列中的大多数患者都喜欢他们接受的任何一种麻醉方法，并会再次选择。然而，镇静患者在医院停留的时间更长，需要更多的术前检查，并且术前焦虑程度更高。
