Okitsu Kenta, Iritakenishi Takeshi, Iura Akira, Kuri Michioki, Fujino Yuji
Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan.
J Anesth. 2017 Oct;31(5):672-677. doi: 10.1007/s00540-017-2376-5. Epub 2017 Jun 12.
Regional anesthesia is more favorable than general anesthesia in patients with severe comorbidity; however, data on the superiority of peripheral nerve blocks over general anesthesia in patients with severe cardiac dysfunction are lacking. We aimed to demonstrate that peripheral nerve blocks reduce perioperative analgesic requirements and promote faster recovery compared to general anesthesia.
We retrospectively evaluated intraoperative blood pressure, perioperative medications, and postoperative recovery in patients who underwent skeletal muscle harvesting for autologous myoblast sheet transplantation. We compared patients who received general anesthesia (group G, n = 27) to those who received femoral nerve block with propofol sedation (group B, n = 22).
Left ventricular ejection fraction was 24% on average, with no significant difference between groups. Compared with group G, a lower dose of propofol was used intraoperatively (1.25 versus 2.0 µg/mL, respectively; P < 0.001) and fewer patients required opioids (13.6 versus 100%, P < 0.01) in group B. Additionally, the lowest intraoperative mean blood pressure was higher (54 versus 48 mmHg, respectively; P = 0.02) in group B. More patients received postoperative analgesic drugs (51.9 versus 13.6%, P = 0.01) and they received them more frequently (1 [0-3] versus 0 [0-1], P = 0.02) in group G. The length of heart care unit stay was shorter in group B than group G (0 [0-18.5] versus 17 [0-47] h, respectively; P < 0.0001).
Femoral nerve block with sedation was more beneficial than general anesthesia in patients with severe cardiac dysfunction who underwent skeletal muscle harvesting for autologous myoblast sheet transplantation.
对于患有严重合并症的患者，区域麻醉比全身麻醉更具优势；然而，关于严重心脏功能不全患者外周神经阻滞优于全身麻醉的数据尚缺乏。我们旨在证明，与全身麻醉相比，外周神经阻滞可减少围手术期镇痛需求并促进更快恢复。
我们回顾性评估了接受自体成肌细胞片移植进行骨骼肌采集患者的术中血压、围手术期用药及术后恢复情况。我们将接受全身麻醉的患者（G组，n = 27）与接受股神经阻滞联合丙泊酚镇静的患者（B组，n = 22）进行了比较。
平均左心室射血分数为24%，两组间无显著差异。与G组相比，B组术中丙泊酚使用剂量更低（分别为1.25与2.0μg/mL；P < 0.001），且需要使用阿片类药物的患者更少（分别为13.6%与100%，P < 0.01）。此外，B组术中最低平均血压更高（分别为54与48 mmHg；P = 0.02）。G组更多患者接受了术后镇痛药（分别为51.9%与13.6%，P = 0.01），且用药频率更高（分别为1[0 - 3]次与0[0 - 1]次，P = 图02）。B组心脏监护病房住院时间比G组短（分别为0[0 - 18.5]小时与17[0 - 47]小时；P < 0.0001）。
对于接受自体成肌细胞片移植进行骨骼肌采集的严重心脏功能不全患者，股神经阻滞联合镇静比全身麻醉更有益。
