From the Department of Anaesthesia, Manchester Royal Infirmary (KB, RW, WM, CJ), Department of Anaesthesia and Intensive Care, Wythenshawe Hospital (MC) and Department of Transplant Surgery, Manchester Royal Infirmary, Manchester University Hospital NHS Foundation Trust, Manchester, UK (TC, DVD).
Eur J Anaesthesiol. 2021 Apr 1;38(4):374-382. doi: 10.1097/EJA.0000000000001337.
The role of spinal anaesthesia in patients having a transperitoneal hand-assisted laparoscopic donor nephrectomy in an enhanced recovery setting has never been investigated.
We explored whether substituting a rectus sheath block (RSB) with spinal anaesthesia, as an adjunct to a general anaesthetic technique, influenced time-to-readiness for discharge in patients undergoing hand-assisted laparoscopic donor nephrectomy.
Prospective randomised open blinded end-point (PROBE) study with two parallel groups.
Tertiary University Hospital.
Ninety-seven patients undergoing a trans-peritoneal hand-assisted laparoscopic donor nephrectomy.
Patients (n=52) were randomly assigned to receive a general anaesthetic and a surgical RSB with 2 mg kg-1 of levobupivacaine at the time of surgical closure or a spinal anaesthetic with hyperbaric bupivacaine 12.5 mg and diamorphine 0.5 mg (n=45) before general anaesthesia.
The primary outcome was the time-to-readiness for discharge following surgery.
Median [IQR] times-to-readiness for discharge were 75 [56 to 83] and 79 [67 to 101] h for RSB and spinal anaesthesia and there was no significant difference in times-to-readiness for discharge (median difference 4 (95% CI, 0 to 20h; P = 0.07)). There were no significant differences in pain scores at rest (P = 0.91) or on movement (P = 0.66). Median 24-h oxycodone consumptions were similar (P = 0.80). Nausea and vomiting scores were similar (P = 0.57) and urinary retention occurred in one vs. four patients with RSB and spinal anaesthesia, respectively (P = 0.077).
Substitution of RSB with spinal anaesthesia using 12.5 mg hyperbaric bupivacaine and 0.5 mg diamorphine, together with a general anaesthetic failed to confer any benefit on time-to-discharge readiness following transperitoneal hand-assisted laparoscopic donor nephrectomy. RSB provided similar analgesia in the immediate postoperative period with a low frequency of side-effects in this cohort.
ClinicalTrial.gov identifier: NCT02700217.
在强化康复环境下，经腹腹腔镜辅助供体肾切手中，椎管内麻醉在患者中的作用从未被研究过。
我们探讨了在经腹腹腔镜辅助供体肾切手中，使用罗哌卡因行脊麻联合全身麻醉作为全身麻醉技术的辅助手段，是否会影响患者的出院准备时间。
前瞻性随机开放盲终点（PROBE）研究，设有两个平行组。
三级大学医院。
97 例行经腹腹腔镜辅助供体肾切除术的患者。
患者（n=52）随机分配，在手术关闭时接受全身麻醉和 2mg/kg 的左布比卡因外科直肠鞘阻滞，或在全身麻醉前接受 12.5mg 布比卡因和 0.5mg 吗啡的脊麻（n=45）。
主要结局是手术结束后的出院准备时间。
直肠鞘阻滞和脊麻的中位（IQR）出院准备时间分别为 75[56 至 83]和 79[67 至 101]小时，且出院准备时间无显著差异（中位差值 4（95%CI，0 至 20 小时；P=0.07））。两组患者在静息时（P=0.91）或活动时（P=0.66）的疼痛评分均无显著差异。24 小时内羟考酮消耗量相似（P=0.80）。恶心和呕吐评分相似（P=0.57），直肠鞘阻滞组和脊麻组分别有 1 例和 4 例发生尿潴留（P=0.077）。
使用 12.5mg 布比卡因和 0.5mg 吗啡的脊麻替代直肠鞘阻滞，与全身麻醉联合使用，并未使经腹腹腔镜辅助供体肾切除术后的出院准备时间提前。在该队列中，直肠鞘阻滞在术后即刻提供了相似的镇痛效果，且不良反应发生率较低。
ClinicalTrials.gov 标识符：NCT02700217。
