Harsten A, Kehlet H, Ljung P, Toksvig-Larsen S
Department of Anesthesiology, Hässleholm Hospital and Lund University, Hässleholm, Sweden.
Acta Anaesthesiol Scand. 2015 Mar;59(3):298-309. doi: 10.1111/aas.12456. Epub 2014 Dec 18.
The choice of anaesthetic technique for patients undergoing joint arthroplasty is debatable. The hypothesis of this study was that general anaesthesia would generate a more favourable recovery profile than spinal anaesthesia.
We randomly allocated 120 patients to either intrathecal bupivacaine or general anaesthesia with target-controlled infusion of remifentanil and propofol. Length of hospital stay assessed as meeting discharge criteria was the primary outcome parameter. Other outcome parameters were actual time of discharge, pain, use of rescue pain medication, blood loss, length of stay in the post-operative care unit, dizziness, post-operative nausea, need of urinary catheterisation and patient satisfaction.
General anaesthesia resulted in slightly reduced length of hospital stay (26 vs. 30 h, P = 0.004), less nausea (P = 0.043) and dizziness (P < 0.001). General anaesthesia patients had higher pain scores during the first two post-operative hours (P < 0.001) but lower after 6 h compared with the spinal anaesthesia group (P < 0.01 and P < 0.05). General anaesthesia patients had better orthostatic function compared with spinal anaesthesia patients (P = 0.008). Patients in the spinal anaesthesia group fulfilled the discharge criteria from the post-operative care unit earlier compared with the general anaesthesia patients (P = 0.004). General anaesthesia patients requested a change in the method of anaesthesia for a subsequent operation less often than the spinal anaesthesia patients (5 vs. 13, P = 0.022).
General anaesthesia resulted in a more favourable recovery profile compared with spinal anaesthesia.
关节置换术患者麻醉技术的选择存在争议。本研究的假设是全身麻醉比脊髓麻醉能产生更有利的恢复情况。
我们将120例患者随机分为鞘内注射布比卡因组或采用瑞芬太尼和丙泊酚靶控输注的全身麻醉组。以达到出院标准评估的住院时间是主要结局参数。其他结局参数包括实际出院时间、疼痛、急救止痛药物的使用、失血量、术后监护病房的住院时间、头晕、术后恶心、导尿需求和患者满意度。
全身麻醉导致住院时间略有缩短（26小时对30小时，P = 0.004），恶心（P = 0.043）和头晕（P < 0.001）情况较少。与脊髓麻醉组相比，全身麻醉患者术后前两小时疼痛评分较高（P < 0.001），但6小时后较低（P < 0.01和P < 0.05）。与脊髓麻醉患者相比，全身麻醉患者的直立功能更好（P = 0.008）。与全身麻醉患者相比，脊髓麻醉组患者更早达到术后监护病房的出院标准（P = 0.004）。全身麻醉患者在后续手术中要求更改麻醉方法的频率低于脊髓麻醉患者（5例对13例，P = 0.022）。
与脊髓麻醉相比，全身麻醉导致更有利的恢复情况。
