Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, USA.
Department of Vascular and Endovascular Surgery, Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School.
Ann Vasc Surg. 2021 Oct;76:399-405. doi: 10.1016/j.avsg.2021.03.029. Epub 2021 Apr 23.
Despite progress in perioperative care standards, there has not been a significant risk reduction in morbidity and mortality rates of lower extremity amputations, an intermediate risk surgery performed on high risk patients. The single-shot peripheral nerve block has shown equivocal impact on postoperative course following lower extremity amputation. Hence, we assessed the potential of preemptive use of continuous catheter-based peripheral nerve block in lower extremity amputations for reduction in pulmonary complications, acute post-operative pain scores, and opioid use in post-operative period.
A retrospective review of a quality improvement project initiated in 2018 was conducted to compare outcomes amongst general anesthesia in combination with a catheter-based peripheral nerve block (catheter group) and general anesthesia alone in patients receiving lower extremity amputation. The rate of postoperative pulmonary complications was identified as a primary endpoint. The secondary outcomes assessed were acute post-operative pain scores and opioid consumption up to 48 hours. Our analysis was adjusted for potential confounding variables inclusive of demographics, medical comorbidities, type of surgical procedure and smoking status.
Ninety-six patients were included in the study (61 in the general anesthesia group, 35 in the catheter group). After adjusting for baseline demographics, comorbidities, surgical technique and smoking status, the odds of postoperative pulmonary complications were significantly lower with catheter-based peripheral nerve block in comparison to general anesthesia alone, OR 0.11 [95% CI, 0.01- 0.88] (P = 0.048). The decrease in acute pain scores was also observed in the catheter group when compared to general anesthesia alone, OR 0.72 [95% CI, 0.56 - 0.93] (P = 0.012). Similarly, the opioid consumption was also lower in the catheter group in comparison to general anesthesia alone, OR 0.97 [95% CI, 0.95 - 0.99] (P = 0.025).
Preemptive use of continuous peripheral nerve block in patients undergoing lower extremity amputation reduces the incidence of pulmonary complications, acute postoperative pain scores and narcotic use in post-operative period.
尽管围手术期护理标准有所进步，但下肢截肢术（一种在高危患者中进行的中等风险手术）的发病率和死亡率并未显著降低。单次外周神经阻滞对下肢截肢术后的病程影响仍存在争议。因此，我们评估了在下肢截肢术中超前使用连续导管外周神经阻滞以减少肺部并发症、急性术后疼痛评分和术后阿片类药物使用的潜力。
对 2018 年启动的一项质量改进项目进行回顾性研究，比较全身麻醉联合导管外周神经阻滞（导管组）与单纯全身麻醉在接受下肢截肢术患者中的结局。将术后肺部并发症发生率作为主要终点。评估的次要结局包括术后 48 小时内的急性术后疼痛评分和阿片类药物消耗。我们的分析调整了包括人口统计学、合并症、手术类型和吸烟状况在内的潜在混杂变量。
本研究共纳入 96 例患者（全身麻醉组 61 例，导管组 35 例）。在调整基线人口统计学、合并症、手术技术和吸烟状况后，与单纯全身麻醉相比，导管外周神经阻滞术后肺部并发症的发生几率显著降低，OR 0.11[95%CI，0.01-0.88]（P=0.048）。与单纯全身麻醉相比，导管组的急性疼痛评分也有所下降，OR 0.72[95%CI，0.56-0.93]（P=0.012）。同样，与单纯全身麻醉相比，导管组的阿片类药物消耗也较低，OR 0.97[95%CI，0.95-0.99]（P=0.025）。
在接受下肢截肢术的患者中预防性使用连续外周神经阻滞可降低肺部并发症、急性术后疼痛评分和术后阿片类药物的使用。
