三种麻醉技术用于日间开放腹股沟疝修补术可行性的随机对照研究

Randomized comparison of the feasibility of three anesthetic techniques for day-case open inguinal hernia repair.

作者信息

Pere Pertti, Harju Jukka, Kairaluoma Pekka, Remes Veikko, Turunen Päivi, Rosenberg Per H

机构信息

Division of Anesthesiology, Department of Anesthesiology, University of Helsinki and Helsinki University Hospital, Intensive Care and Pain Medicine; Day-Surgery Center at Surgical Hospital, Helsinki University Central Hospital, PO Box 263, 00029, HUS, Helsinki, Finland.

Division of Gastrointestinal Surgery, Department of Surgery, University of Helsinki, 00014 University of Helsinki; Day-Surgery Center at Surgical Hospital, Helsinki University Central Hospital, PO Box 263, 00029, HUS, Helsinki, Finland.

出版信息

J Clin Anesth. 2016 Nov;34:166-75. doi: 10.1016/j.jclinane.2016.03.062. Epub 2016 May 8.

DOI:10.1016/j.jclinane.2016.03.062

PMID:27687366

Abstract

STUDY OBJECTIVE

Comparison of local anesthetic infiltration (LAI), spinal anesthesia (SPIN) and total intravenous anesthesia (TIVA) for open inguinal herniorrhaphy. We hypothesized that patients receiving LAI could be discharged faster than SPIN and TIVA patients.

DESIGN

Randomized, prospective trial.

SETTING

University hospital day-surgery center.

PATIENTS

156 adult male patients (ASA 1-3) undergoing day-case open inguinal herniorrhaphy.

INTERVENTIONS

Patients were randomized to either LAI (lidocaine+ropivacaine), SPIN (bupivacaine+fentanyl) or TIVA (propofol+remifentanil). Perioperative Ringer infusion was 1.5mL/h. Urinary bladder was scanned before and after surgery. Interviews were performed on postoperative days 1, 7 and 90.

MEASUREMENTS

Duration of surgery, duration of the patients' stay in the operating room and time until their readiness for discharge home. Patient satisfaction and adverse effects were registered.

MAIN RESULTS

Surgery lasted longer in LAI group (median 40min) than in SPIN group (35min) (P=.003) and TIVA group (33min) (P<.001). Although surgery was shortest in TIVA group, TIVA patients stayed longer in the operating room than LAI patients (P=.001). Time until readiness for discharge was shorter in LAI group (93min) than in TIVA (147min) and SPIN (190min) groups (P<.001). Supplementary lidocaine infiltration was given to 32 LAI patients, and IV fentanyl to 29 LAI and 4 SPIN patients. Ephedrine was required in 34 TIVA, 5 LAI and 5 SPIN patients. One SPIN and three LAI patients had to be given TIVA and another SPIN patient LAI to complete the operations. Urinary retention was absent. Discomfort in the scar (26%) three months postoperatively was not anesthesia-related.

CONCLUSIONS

Logistically, LAI was superior because of the fastest recovery postoperatively. The anesthetic techniques were adequate for surgery in all but a few LAI and SPIN patients. Lack of urinary retention was probably related to the small IV infusion volumes.

摘要

研究目的

比较局部麻醉浸润（LAI）、脊髓麻醉（SPIN）和全静脉麻醉（TIVA）用于开放性腹股沟疝修补术的效果。我们假设接受LAI的患者比接受SPIN和TIVA的患者出院更快。

设计

随机前瞻性试验。

地点

大学医院日间手术中心。

患者

156例接受日间开放性腹股沟疝修补术的成年男性患者（ASA 1-3级）。

干预措施

患者被随机分为LAI组（利多卡因+罗哌卡因）、SPIN组（布比卡因+芬太尼）或TIVA组（丙泊酚+瑞芬太尼）。围手术期林格氏液输注速度为1.5mL/h。手术前后对膀胱进行扫描。在术后第1天、第7天和第90天进行访谈。

测量指标

手术时间、患者在手术室的停留时间以及直至准备好出院回家的时间。记录患者满意度和不良反应。

主要结果

LAI组手术持续时间（中位数40分钟）长于SPIN组（35分钟）（P=0.003）和TIVA组（33分钟）（P<0.001）。虽然TIVA组手术时间最短，但TIVA组患者在手术室的停留时间比LAI组患者长（P=0.001）。LAI组直至准备好出院的时间（93分钟）短于TIVA组（147分钟）和SPIN组（190分钟）（P<0.001）。32例LAI患者接受了补充利多卡因浸润，29例LAI患者和4例SPIN患者接受了静脉注射芬太尼。34例TIVA患者、5例LAI患者和5例SPIN患者需要使用麻黄碱。1例SPIN患者和3例LAI患者不得不改为TIVA，另1例SPIN患者改为LAI以完成手术。无尿潴留情况。术后三个月瘢痕处不适（26%）与麻醉无关。