Department of Anaesthesiology and Critical Care Medicine, Centre Hospitalier Universitaire (CHU) Saint-Etienne, Université Jean Monnet Saint-Etienne, Saint-Etienne, F-42055, France.
Pneumology and Thoracic Oncology Department, Centre Hospitalier Universitaire (CHU) Saint-Etienne, Université Jean Monnet Saint-Etienne, Saint-Etienne, F-42055, France.
Anaesth Crit Care Pain Med. 2021 Aug;40(4):100927. doi: 10.1016/j.accpm.2021.100927. Epub 2021 Jul 2.
Mechanisms of postoperative sleep architecture disturbances and sleep-disordered breathing are uncertain. The authors hypothesised that patients undergoing surgery under regional anaesthesia without opioids used for postoperative analgesia would experience lesser changes in these parameters than patients operated under general anaesthesia with per- and postoperative opioids.
After ethical approval and informed consent, patients undergoing total hip replacement were included in a prospective, randomised trial comparing 3 groups of patients: (1) S-LPB group receiving spinal anaesthesia and postoperative analgesia by lumbar plexus block; (2) GA-PCA group receiving general anaesthesia and postoperative analgesia by morphine patient-controlled analgesia; (3) GA-LPB group receiving general anaesthesia and postoperative analgesia by lumbar plexus block. Outcome measurements were polysomnographic parameters of sleep architecture and sleep-disordered breathing.
Eighteen patients completed the 5-night study protocol (preoperative night: N-1, postoperative nights: N1 to N4). The percentage of rapid eye movement (REM) sleep decreased by 49% and 47% during N1 in the GA-PCA and GA-LPB groups respectively. A rebound phenomenon of more than 40% in the GA-PCA group and 25% in the GA-LPB group was observed during N2 and N3. Apnoea hypopnoea index (AHI) and the number of arousals per hour were significantly increased during N2 and N3 when compared with N-1 in the GA-groups. No sleep architecture disturbances and no sleep-disordered breathing were measured in the S-LPB group.
Postoperative sleep architecture and breathing pattern were disturbed in GA groups. Both were preserved under spinal anaesthesia associated with a free opioid postoperative analgesia.
术后睡眠结构紊乱和睡眠呼吸障碍的机制尚不清楚。作者假设，与接受全身麻醉加围手术期阿片类药物治疗的患者相比，接受区域麻醉且术后不使用阿片类药物进行镇痛的患者，这些参数的变化较小。
在获得伦理批准和知情同意后，将接受全髋关节置换术的患者纳入一项前瞻性、随机试验，比较 3 组患者：（1）S-LPB 组，接受脊髓麻醉和腰丛阻滞术后镇痛；（2）GA-PCA 组，接受全身麻醉和术后吗啡患者自控镇痛；（3）GA-LPB 组，接受全身麻醉和术后腰丛阻滞镇痛。主要观察指标为睡眠结构和睡眠呼吸障碍的多导睡眠图参数。
18 例患者完成了 5 个夜间研究方案（术前夜：N-1，术后夜：N1 至 N4）。GA-PCA 和 GA-LPB 组 N1 期间快速眼动（REM）睡眠的百分比分别下降了 49%和 47%。GA-PCA 组在 N2 和 N3 期间出现了超过 40%的反弹现象，而 GA-LPB 组则出现了 25%的反弹现象。与 GA 组的 N-1 相比，N2 和 N3 期间呼吸暂停低通气指数（AHI）和每小时唤醒次数显著增加。S-LPB 组未测量到睡眠结构紊乱和睡眠呼吸障碍。
GA 组术后睡眠结构和呼吸模式受到干扰。脊髓麻醉联合术后无阿片类药物镇痛可保留这些功能。
