连续脊髓麻醉与超声引导下腰大肌间隙-坐骨神经联合阻滞用于老年高危患者髋关节置换手术：一项前瞻性随机研究。
Continuous spinal anaesthesia versus ultrasound-guided combined psoas compartment-sciatic nerve block for hip replacement surgery in elderly high-risk patients: a prospective randomised study.
作者信息
Aksoy Mehmet, Dostbil Aysenur, Ince Ilker, Ahiskalioglu Ali, Alici Hacı Ahmet, Aydin Ali, Kilinc Osman Ozgur
机构信息
Department of Anaesthesiology and Reanimation, Faculty of Medicine, Ataturk University, Erzurum, Turkey.
Department of Orthopedics and Traumatology, Faculty of Medicine, Ataturk University, Erzurum, Turkey.
出版信息
BMC Anesthesiol. 2014 Nov 5;14:99. doi: 10.1186/1471-2253-14-99. eCollection 2014.
BACKGROUND
Our aim is to compare the hemodynamic effects of combined psoas compartment-sciatic nerve block (PCSNB) with continuous spinal anaesthesia (CSA) in elderly high-risk patients undergoing hip replacement surgery.
METHODS
Seventy patients over the age of 60 with ASA III or IV physical status were randomly allocated to two groups: In the PCSNB group, ultrasound-guided psoas compartment block was performed with modified Winnie technique using 30 mL of 0.25% bupivacaine with 1:200.000 epinephrine (5 μgr/mL) and iliac crest block was performed using the same local anaesthetic solution (5 mL). All patients in the PCSNB group needed continuing infusion of propofol (2 mg/kg/h) during operation. In the CSA group, CSA was performed in the L3-L4 interspaced with the patient in lateral decubitus position using 2.5 mg of isobaric bupivacaine 0.5%. When sensory block was not reached to the level of T12 within 10 minutes in the CSA group, additional 2.5 mg of isobaric bupivacaine 0.5% was administered through the catheter at 5-min intervals by limiting the total dose of 15 mg until a T12 level of the sensory block was achieved.
RESULTS
The PCSNB group had significantly higher mean arterial blood pressure values at the beginning of surgery and at 5(th), 10(th) and 20(th) minutes of surgery compared to the CSA group (P = 0.038, P = 0.029, P = 0.012, P = 0.009 respectively). There were no significant differences between groups in terms of heart rate and peripheral oxygen saturation values during surgery and the postoperative period (P >0.05). Arterial hypotension required ephedrine was observed in 13 patients in the CSA and 4 patients in the PCSNB group (P =0.012).
CONCLUSIONS
CSA and PCSNB produce satisfactory quality of anaesthesia in elderly high-risk patients with fewer hemodynamic changes in PCSNB cases compared with CSA cases.
TRIAL REGISTRATION
Australian New Zealand Clinical Trials Registry: ACTRN12614000658617, Registered 24 June 2014.
背景
我们的目的是比较在接受髋关节置换手术的老年高危患者中，联合腰大肌间隙 - 坐骨神经阻滞（PCSNB）与连续脊麻（CSA）的血流动力学效应。
方法
70例年龄超过60岁、美国麻醉医师协会（ASA）身体状况分级为III或IV级的患者被随机分为两组：在PCSNB组，采用改良的Winnie技术行超声引导下腰大肌间隙阻滞，使用30 mL含1:200000肾上腺素（5μg/mL）的0.25%布比卡因，并使用相同的局部麻醉溶液（5 mL）行髂嵴阻滞。PCSNB组所有患者在手术期间均需持续输注丙泊酚（2 mg/kg/h）。在CSA组，患者侧卧位，于L3 - L4间隙行CSA，使用2.5 mg 0.5%的等比重布比卡因。若CSA组在10分钟内感觉阻滞未达到T12水平，则通过导管每隔5分钟追加2.5 mg 0.5%的等比重布比卡因，直至感觉阻滞达到T12水平，总剂量限制在15 mg。
结果
与CSA组相比，PCSNB组在手术开始时以及手术第5、10和20分钟时的平均动脉血压值显著更高（分别为P = 0.038、P = 0.029、P = 0.012、P = 0.009）。手术期间及术后两组在心率和外周血氧饱和度值方面无显著差异（P > 0.05）。CSA组有13例患者、PCSNB组有4例患者出现需要麻黄碱治疗的动脉低血压（P = 0.012）。
结论
CSA和PCSNB在老年高危患者中均能产生满意的麻醉效果，与CSA相比，PCSNB患者的血流动力学变化较少。
试验注册
澳大利亚新西兰临床试验注册中心：ACTRN1261400065861
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