Stasiowski Michał Jan, Pluta Aleksandra, Lyssek-Boroń Anita, Kawka Magdalena, Krawczyk Lech, Niewiadomska Ewa, Dobrowolski Dariusz, Rejdak Robert, Król Seweryn, Żak Jakub, Szumera Izabela, Missir Anna, Jałowiecki Przemysław, Grabarek Beniamin Oskar
Department of Emergency Medicine, Faculty of Medical Sciences, Medical University of Silesia, 41-200 Sosnowiec, Poland.
Department of Anaesthesiology and Intensive Therapy, 5th Regional Hospital, Medykow Square 1, 41-200 Sosnowiec, Poland.
Medicina (Kaunas). 2021 Mar 12;57(3):262. doi: 10.3390/medicina57030262.
Although vitreoretinal surgery (VRS) is most commonly performed under regional anaesthesia (RA), in patients who might be unable to cooperate during prolonged procedures, general anaesthesia (GA) with intraprocedural use of opioid analgesics (OA) might be worth considering. It seems that the surgical pleth index (SPI) can be used to optimise the intraprocedural titration of OA, which improves haemodynamic stability. Preventive analgesia (PA) is combined with GA to minimise intraprocedural OA administration. We evaluated the benefit of PA combined with GA using SPI-guided fentanyl (FNT) administration on the incidences of PIPP (postprocedural intolerable pain perception) and haemodynamic instability in patients undergoing VRS ( < 0.05). We randomly assigned 176 patients undergoing VRS to receive GA with SPI-guided FNT administration alone (GA group) or with preventive topical 2% proparacaine (topical anaesthesia (TA) group), a preprocedural peribulbar block (PBB) using 0.5% bupivacaine with 2% lidocaine (PBB group), or a preprocedural intravenous infusion of 1.0 g of metamizole (M group) or 1.0 g of paracetamol (P group). Preventive PBB reduced the intraprocedural FNT requirement without influencing periprocedural outcomes ( < 0.05). Intraprocedural SPI-guided FNT administration during GA resulted in PIPP in 13.5% of patients undergoing VRS and blunted the periprocedural effects of preventive intravenous and regional analgesia with respect to PIPP and haemodynamic instability. SPI-guided FNT administration during GA eliminated the benefits of preventive analgesia in the PBB, TA, M, and P groups following VRS.
尽管玻璃体视网膜手术（VRS）最常在局部麻醉（RA）下进行，但对于那些在长时间手术过程中可能无法配合的患者，术中使用阿片类镇痛药（OA）的全身麻醉（GA）可能值得考虑。手术体积描记指数（SPI）似乎可用于优化术中OA的滴定，从而改善血流动力学稳定性。预防性镇痛（PA）与GA联合使用，以尽量减少术中OA的使用。我们评估了在VRS患者中，PA联合GA并采用SPI引导芬太尼（FNT）给药对术后难以忍受的疼痛感知（PIPP）发生率和血流动力学不稳定的益处（<0.05）。我们将176例行VRS的患者随机分为四组，分别单独接受SPI引导FNT给药的GA（GA组），或预防性局部使用2%丙美卡因（局部麻醉（TA）组），术前球周阻滞（PBB）使用0.5%布比卡因加2%利多卡因（PBB组），或术前静脉输注1.0 g安乃近（M组）或1.0 g对乙酰氨基酚（P组）。预防性PBB减少了术中FNT的需求量，且不影响围手术期结果（<0.05）。GA期间术中SPI引导FNT给药导致13.5%的VRS患者出现PIPP，并减弱了预防性静脉和区域镇痛对PIPP和血流动力学不稳定的围手术期效果。GA期间SPI引导FNT给药消除了VRS后PBB、TA、M和P组预防性镇痛的益处。
