Sansonnens Julien, Taffé Patrick, Burnand Bernard
IUMSP-Institute of Social and Preventive Medicine, Lausanne University Hospital, Route de la Corniche 10, CH-1010, Lausanne, Switzerland.
BMC Anesthesiol. 2016 Jul 26;16(1):44. doi: 10.1186/s12871-016-0207-0.
Under the assumption that postoperative nausea and vomiting (PONV) may occur after total hip arthroplasty (THA) regardless of the anesthetic technique used, it is not clear whether general (GA) or spinal (SA) anesthesia has higher causal effect on this occurrence. Conflicting results have been reported.
In this observational study, we selected all elective THA interventions performed in adults between 1999 and 2008 in a Swiss orthopedic clinic under general or spinal anesthesia. To assess the effect of anesthesia type on the occurrence of PONV, we used the propensity score and matching methods, which allowed us to emulate the design and results of an RCT.
Among 3922 procedures, 1984 (51 %) patients underwent GA, of which 4.1 % experienced PONV, and 1938 underwent SA, of which 3.5 % experienced PONV. We found that the average treatment effect on the treated, i.e. the effect of anesthesia type for a sample of individuals that actually received spinal anesthesia compared to individuals who received GA, was ATET = 2.00 % [95 % CI, 0.78-3.19 %], which translated into an OR = 1.97 [95 % CI 1.35; 2.87].
This suggests that the type of anesthesia is not neutral regarding PONV, general anesthesia being more strongly associated with PONV than spinal anesthesia in orthopedic surgery.
假设全髋关节置换术（THA）后无论采用何种麻醉技术均可能发生术后恶心呕吐（PONV），目前尚不清楚全身麻醉（GA）或脊髓麻醉（SA）对此发生率的因果影响是否更高。已有相互矛盾的报道。
在这项观察性研究中，我们选取了1999年至2008年间在瑞士一家骨科诊所接受全身或脊髓麻醉的所有成年患者的择期THA干预措施。为评估麻醉类型对PONV发生率的影响，我们使用了倾向评分和匹配方法，这使我们能够模拟随机对照试验（RCT）的设计和结果。
在3922例手术中，1984例（51%）患者接受了全身麻醉，其中4.1%发生了PONV，1938例接受了脊髓麻醉，其中3.5%发生了PONV。我们发现，对接受治疗者的平均治疗效果，即与接受全身麻醉的个体相比，实际接受脊髓麻醉的个体样本中麻醉类型的效果为ATET = 2.00% [95% CI，0.78 - 3.19%]，这转化为OR = 1.97 [95% CI 1.35；2.87]。
这表明麻醉类型对PONV并非无影响，在骨科手术中，全身麻醉与PONV的关联比脊髓麻醉更强。
