清醒状态下与全身麻醉下进行腕部腱鞘囊肿关节镜切除术的成本效益分析。
A cost and efficacy analysis of performing arthroscopic excision of wrist ganglions under wide-awake anaesthesia versus general anaesthesia.
作者信息
Yen Cheng-Yo, Ma Ching-Hou, Wu Chin-Hsien, Yang Shih-Chieh, Jou I-Ming, Tu Yuan-Kun
机构信息
Department of Orthopedics, E-Da Cancer Hospital, Kaohsiung, Taiwan.
School of Medicine, College of Medicine, I-Shou University, No.1, E-Da Road, Yan-Chau District, 824, Kaohsiung City, Taiwan.
出版信息
BMC Musculoskelet Disord. 2020 Jul 13;21(1):459. doi: 10.1186/s12891-020-03482-0.
BACKGROUND
Arthroscopic excision has currently become popular for the treatment of wrist ganglions. The objective of this study was to evaluate the clinical outcomes and cost effectiveness of arthroscopic wrist ganglion excisions under Wide-Awake Local Anaesthesia No Tourniquet versus general anaesthesia.
METHODS
We retrospectively reviewed patients who underwent arthroscopic ganglionectomy from April 2009 to October 2016 at our institute. They were separated into two groups according to anaesthesia techniques: general anaesthesia and Wide-Awake Local Anaesthesia No Tourniquet. We compared the clinical outcomes and cost-effectiveness of the two groups.
RESULTS
Seventy-four patients were included. Both groups were matched with regard to the demographics and preoperative clinical assessments. We found no significant differences between groups in postoperative visual analog scale, modified Mayo wrist score, Disabilities of Arm, Shoulder and Hand score, recurrence, residual pain, or complications. Recurrence was found in five of 74 patients, one (4.3%) in the Wide-Awake Local Anaesthesia No Tourniquet group and four (7.8%) in the general anaesthesia group. One extensor tendon injury and four extensor tenosynovitis cases occurred in the general anaesthesia group. Regarding cost effectiveness, the mean operating time in the Wide-Awake Local Anaesthesia No Tourniquet and general anaesthesia groups were 88.7 ± 24.51 and 121.5 ± 25.75 min, respectively (p < 0.001). The average total costs of the Wide-Awake Local Anaesthesia No Tourniquet and general anaesthesia groups were €487.4 ± 89.15 and €878.7 ± 182.13, respectively (p < 0.001).
CONCLUSIONS
For arthroscopic wrist ganglion resections, both anaesthesia techniques were effective and safe regarding recurrence rates, complications, and residual pain. The most important finding of this study was that arthroscopic ganglionectomy under Wide-Awake Local Anaesthesia No Tourniquet was superior to that under general anaesthesia for cost-effectiveness.
LEVEL OF EVIDENCE
Level III, Retrospective comparative study.
背景
关节镜下切除术目前已成为治疗腕部腱鞘囊肿的常用方法。本研究的目的是评估清醒局部麻醉无止血带与全身麻醉下行关节镜下腕部腱鞘囊肿切除术的临床疗效和成本效益。
方法
我们回顾性分析了2009年4月至2016年10月在我院接受关节镜下腱鞘囊肿切除术的患者。根据麻醉技术将他们分为两组：全身麻醉组和清醒局部麻醉无止血带组。我们比较了两组的临床疗效和成本效益。
结果
共纳入74例患者。两组在人口统计学和术前临床评估方面相匹配。我们发现两组在术后视觉模拟评分、改良梅奥腕关节评分、手臂、肩部和手部功能障碍评分、复发率、残留疼痛或并发症方面无显著差异。74例患者中有5例复发，清醒局部麻醉无止血带组1例（4.3%），全身麻醉组4例（7.8%）。全身麻醉组发生1例伸肌腱损伤和4例伸肌腱腱鞘炎。在成本效益方面，清醒局部麻醉无止血带组和全身麻醉组的平均手术时间分别为88.7±24.51分钟和121.5±25.75分钟（p<0.001）。清醒局部麻醉无止血带组和全身麻醉组的平均总费用分别为487.4±89.15欧元和878.7±182.13欧元（p<0.001）。
结论
对于关节镜下腕部腱鞘囊肿切除术，两种麻醉技术在复发率、并发症和残留疼痛方面均有效且安全。本研究最重要的发现是，清醒局部麻醉无止血带下行关节镜下腱鞘囊肿切除术在成本效益方面优于全身麻醉。
证据级别
III级，回顾性比较研究。
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