Frisch Nicholas B, Darrith Brian, Hansen Dane C, Wells Adrienne, Sanders Sheila, Berger Richard A
Ascension Crittenton Hospital, DeClaire LaMacchia Orthopaedic Institute, Rochester Hills, MI, USA.
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
Arthroplast Today. 2018 Mar 28;4(2):236-239. doi: 10.1016/j.artd.2018.02.011. eCollection 2018 Jun.
With the increasing interest in fast recovery and outpatient joint arthroplasty, short-acting local anesthetic agents and minimal narcotic use are preferred. Lidocaine is a fast-onset, short-duration local anesthetic that has been used for many years in spinal anesthesia. However, lidocaine spinal anesthesia has been reported to have a risk of transient neurologic symptoms (TNSs). The purpose of this study is to determine the safety and efficacy of single-dose lidocaine spinal anesthesia in the setting of outpatient joint arthroplasty.
We performed a prospective study on 50 patients who received lidocaine spinal anesthesia in the setting of outpatient hip and knee arthroplasty. All patients received a single-shot spinal injection, with 2% isobaric lidocaine along with titrated propofol sedation. We evaluated demographic data, length of motor blockage, time to ambulation, time to discharge readiness, patient-reported symptoms of TNS.
Of the 50 patients studied, 11 had total hip arthroplasty, 33 total knee arthroplasty, 5 unicompartmental knee arthroplasty, and 1 underwent isolated polyethylene liner exchange in a total knee arthroplasty. The average total duration of motor blockade was 2.89 hours (range 1.73-5.17, standard deviation 0.65). Average time from postanesthesia care unit to return of motor function was 0.58 hours (range 0-1.5, standard deviation 0.48). None of the patients reported TNS.
Isobaric lidocaine spinal anesthesia appears to be a safe and effective regimen for outpatient hip and knee arthroplasty. All patients were discharged on the day of surgery with isobaric lidocaine spinal injection. There were no reports of TNSs.
随着人们对快速康复和门诊关节置换术的兴趣日益增加，短时效局部麻醉剂和最小限度的麻醉药物使用成为首选。利多卡因是一种起效快、作用时间短的局部麻醉剂，多年来一直用于脊髓麻醉。然而，据报道，利多卡因脊髓麻醉存在短暂性神经症状（TNS）的风险。本研究的目的是确定单剂量利多卡因脊髓麻醉在门诊关节置换术中的安全性和有效性。
我们对50例在门诊髋关节和膝关节置换术中接受利多卡因脊髓麻醉的患者进行了一项前瞻性研究。所有患者均接受单次脊髓注射，使用2%等比重利多卡因并联合滴定丙泊酚镇静。我们评估了人口统计学数据、运动阻滞时间、行走时间、出院准备时间以及患者报告的TNS症状。
在研究的50例患者中，11例行全髋关节置换术，33例行全膝关节置换术，5例行单髁膝关节置换术，1例在全膝关节置换术中进行了单纯聚乙烯衬垫置换。运动阻滞的平均总时长为2.89小时（范围1.73 - 5.17，标准差0.65）。从麻醉后护理单元到运动功能恢复的平均时间为0.58小时（范围0 - 1.5，标准差0.48）。没有患者报告出现TNS。
等比重利多卡因脊髓麻醉似乎是门诊髋关节和膝关节置换术的一种安全有效的方案。所有接受等比重利多卡因脊髓注射的患者均在手术当天出院。没有TNS的报告。
