Niskakangas M, Dahlbacka S, Liisanantti J, Vakkala M, Kaakinen T
Department of Surgery, Oulu University Hospital, Oulu, Finland.
Department of Vascular Surgery, Vaasa Central Hospital, Vaasa, Finland.
Acta Anaesthesiol Scand. 2018 Feb;62(2):226-233. doi: 10.1111/aas.13019. Epub 2017 Oct 24.
The present study aimed to determine which method of anaesthesia (spinal anaesthesia or general anaesthesia) is better in reducing post-operative analgesic requirements in patients undergoing major limb amputation for lower-limb ischaemia. Another aim was to find out if anaesthesiologists use neuraxial anaesthesia in high-risk patients despite abnormal coagulation profile or use of anticoagulation.
The study was a retrospective cohort study. All patients undergone above-the-knee amputation or below-the-knee amputation due to peripheral artery disease between 1996 and 2010 were reviewed to evaluate post-operative opioid consumption and complications.
A total of 434 amputations in 323 patients were included in the study. The number of surgical complications, the need for surgical revision and the number of intensive care unit admissions were significantly higher in the general anaesthesia group. The need for post-operative opioid medication was significantly lower in patients with above-the-knee amputation and spinal anaesthesia. The use of post-operative epidural analgesia did not reduce analgesic requirements. In the present study, there were patients who received neuraxial anaesthesia despite abnormal coagulation profile or uninterrupted warfarin or clopidogrel. There were no reported cases of spinal or epidural haematoma.
Patients with spinal anaesthesia had a lower rate of surgical complications, re-operations and intensive care unit admissions. Patients with above-the-knee amputation and spinal anaesthesia had a lesser need for opioid medication in the post-operative period than patients with general anaesthesia. Anaesthesiologists performed neuraxial anaesthesia and/or analgesia in high-risk patients despite abnormal coagulation profile or ongoing anticoagulation, but no adverse outcomes were reported.
本研究旨在确定哪种麻醉方法（脊髓麻醉或全身麻醉）在降低因下肢缺血接受大肢体截肢手术患者的术后镇痛需求方面效果更佳。另一个目的是了解麻醉医生在高危患者存在凝血异常或使用抗凝药物的情况下是否会使用神经轴索麻醉。
本研究为回顾性队列研究。对1996年至2010年间因外周动脉疾病接受膝上截肢或膝下截肢的所有患者进行回顾，以评估术后阿片类药物的消耗量及并发症情况。
本研究共纳入323例患者的434例截肢手术。全身麻醉组的手术并发症数量、手术翻修需求及重症监护病房收治人数显著更高。膝上截肢且接受脊髓麻醉的患者术后阿片类药物用药需求显著更低。术后使用硬膜外镇痛并未降低镇痛需求。在本研究中，有患者尽管存在凝血异常或持续使用华法林或氯吡格雷仍接受了神经轴索麻醉。未报告脊髓或硬膜外血肿病例。
接受脊髓麻醉的患者手术并发症、再次手术及重症监护病房收治率更低。膝上截肢且接受脊髓麻醉的患者术后阿片类药物用药需求低于接受全身麻醉的患者。尽管存在凝血异常或正在进行抗凝治疗，麻醉医生仍在高危患者中实施了神经轴索麻醉和/或镇痛，但未报告不良后果。
