Department of Surgery, University Hospital, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
Department of Surgery, University Hospital, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
J Clin Anesth. 2017 Sep;41:48-54. doi: 10.1016/j.jclinane.2017.06.005. Epub 2017 Jun 26.
Pneumoperitoneum during laparoscopic cholecystectomy (LC) can cause hypercapnia, hypoxemia, hemodynamic changes and shoulder pain. General anesthesia (GA) enables the control of intraoperative pain and ventilation. The need for GA has been questioned by studies suggesting that neuraxial anesthesia (NA) is adequate for LC.
To quantify the prevalence of intraoperative pain and to verify whether evidence on the maintenance of ventilation, circulation and surgical anesthesia during NA compared with GA is consistent.
Systematic review with meta-analyses.
Anesthesia for laparoscopic cholecystectomy.
We searched Medline, Cochrane and EBSCO databases up to 2016 for randomized controlled trials that compared LC in the two groups under study, neuraxial (subarachnoid or epidural) and general anesthesia.
The primary outcome was the prevalence of intraoperative pain referred to the shoulder in the NA group. Hemodynamic and respiratory outcomes and adverse effects in both groups were also collected.
Eleven comparative studies were considered eligible. The pooled prevalence of shoulder pain was 25%. Intraoperative hypotension and bradycardia occurred more frequently in patients who received NA, with a risk ratio of 4.61 (95% confidence interval [CI] 1.70-12.48, p=0.003) and 6.67 (95% CI 2.02-21.96, p=0.002), respectively. Postoperative nausea and vomiting was more prevalent in patients who submitted to GA. The prevalence of postoperative urinary retention did not differ between the techniques. Postoperative headache was more prevalent in patients who received NA, while the postoperative pain intensity was lower in this group. Performing meta-analyses on hypertension, hypercapnia and hypoxemia was not possible.
NA as sole anesthetic technique, although feasible for LC, was associated with intraoperative pain referred to the shoulder, required anesthetic conversion in 3.4% of the cases and did not demonstrate evidence of respiratory benefits for patients with normal pulmonary function.
腹腔镜胆囊切除术（LC）时的气腹会导致高碳酸血症、低氧血症、血液动力学变化和肩部疼痛。全身麻醉（GA）可控制术中疼痛和通气。一些研究质疑 GA 的必要性，认为神经阻滞麻醉（NA）足以用于 LC。
量化术中疼痛的发生率，并验证与 GA 相比，关于 NA 维持通气、循环和手术麻醉的证据是否一致。
系统评价和荟萃分析。
LC 的麻醉。
我们检索了 Medline、Cochrane 和 EBSCO 数据库，以获取截至 2016 年比较两种研究组（椎管内[蛛网膜下腔或硬膜外]和全身麻醉）下 LC 的随机对照试验。
主要结果是 NA 组肩部疼痛的发生率。还收集了两组的血液动力学和呼吸结果及不良反应。
11 项比较研究被认为符合条件。肩部疼痛的总发生率为 25%。接受 NA 的患者术中发生低血压和心动过缓的频率更高，风险比为 4.61（95%置信区间[CI]1.70-12.48，p=0.003）和 6.67（95%CI2.02-21.96，p=0.002）。GA 组术后恶心和呕吐更为常见。两种技术的术后尿潴留发生率无差异。NA 组术后头痛更为常见，而该组术后疼痛强度较低。由于高血压、高碳酸血症和低氧血症的发生率无法进行荟萃分析。
NA 作为唯一的麻醉技术，尽管适用于 LC，但与肩部疼痛有关，需要在 3.4%的病例中转用麻醉，且对正常肺功能患者的呼吸无益处。
