Department of Anesthesiology and Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Pain Med. 2018 Feb 1;19(2):368-384. doi: 10.1093/pm/pnx045.
The authors investigated a wide range of perioperative outcome measures in the context of a robust regional anesthesia practice.
Comprehensive review of a prospectively collected six-year database.
Freestanding, academic ambulatory surgery center.
There were 13,897 consecutive regional anesthetics in 10,338 patients.
We investigated patient satisfaction, postoperative nausea and vomiting (PONV), postoperative pain, catheter analgesia, and complications. Clinical risk factors were examined and presented as odds ratios for multiple outcome analyses including block success, patient satisfaction, PONV, and postoperative neurologic symptoms (PONS).
Decreased block success was associated with nerve stimulation alone (P < 0.001), obesity (P = 0.001), higher American Society of Anesthesiologists classification (ASA; P = 0.01), lower extremity blocks (P = 0.04), and male sex (P < 0.001). Decreased patient satisfaction was associated with poor catheter analgesia (P < 0.001), complications (P < 0.001), higher ASA (P = 0.001), and younger age (P = 0.008). PONV was associated with postoperative pain (P < 0.005), female sex (P < 0.001), general anesthesia (P < 0.001), younger age (P = 0.001), lack of catheter (P = 0.03), and lack of dexamethasone/clonidine (D + C) adjuncts (P = 0.01). Serious complications and unexpected hospitalizations were rare (<0.2%). D + C adjuncts, lower extremity blocks, clonidine (but not dexamethasone alone), and female sex were associated with PONS (all P < 0.001).
A regional anesthesia-based practice in ambulatory surgery is an effective means of providing excellent postoperative analgesia and is associated with a low rate of PONV and unexpected admissions. Dexamethasone, clonidine, and their combination when combined with 0.5% ropivacaine may have mixed effects on PONS risk that warrant dose/concentration alterations of these three drugs in the context of off-label perineural adjunct use.
作者在一个健全的区域麻醉实践中研究了广泛的围手术期结果指标。
对一个前瞻性收集的六年数据库进行综合回顾。
独立的学术日间手术中心。
在 10338 名患者中，共有 13897 例连续的区域麻醉。
我们调查了患者满意度、术后恶心和呕吐（PONV）、术后疼痛、导管镇痛和并发症。检查了临床危险因素，并以比值比的形式呈现，用于包括阻滞成功率、患者满意度、PONV 和术后神经症状（PONS）在内的多项结果分析。
单独神经刺激（P<0.001）、肥胖（P=0.001）、美国麻醉医师协会（ASA）分级较高（P=0.01）、下肢阻滞（P=0.04）和男性（P<0.001）与阻滞成功率降低相关。患者满意度降低与导管镇痛不良（P<0.001）、并发症（P<0.001）、ASA 较高（P=0.001）和年龄较小（P=0.008）相关。PONV 与术后疼痛（P<0.005）、女性（P<0.001）、全身麻醉（P<0.001）、年龄较小（P=0.001）、无导管（P=0.03）和无地塞米松/可乐定（D+C）辅助（P=0.01）相关。严重并发症和意外住院很少见（<0.2%）。D+C 辅助、下肢阻滞、可乐定（而非单独地塞米松）和女性与 PONS 相关（均 P<0.001）。
在日间手术中，以区域麻醉为基础的实践是提供良好术后镇痛的有效手段，其 PONV 和意外住院率较低。地塞米松、可乐定及其与 0.5%罗哌卡因联合使用可能对 PONS 风险有混合影响，需要在局麻药周围神经辅助使用的背景下改变这三种药物的剂量/浓度。
