硬膜外麻醉与下肢微血管重建患者游离皮瓣动脉最大血流速度：一项随机对照试验
Epidural Anesthesia and Arterial Maximal Flow Velocity of Free Flap in Patients Having Microvascular Lower Extremity Reconstruction: A Randomized Controlled Trial.
作者信息
Park Jun-Young, Suh Hyunsuk Peter, Kwon Jin Geun, Yu Jihion, Lee Joonho, Hwang Jai-Hyun, Hong Joon Pio, Kim Young-Kug
机构信息
From the Departments of Anesthesiology and Pain Medicine and Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine.
出版信息
Plast Reconstr Surg. 2022 Feb 1;149(2):496-505. doi: 10.1097/PRS.0000000000008764.
BACKGROUND
One of the critical factors for free flap survival is to maintain adequate perfusion. The authors evaluated the effect of epidural anesthesia on arterial maximal flow velocity of the free flap in microvascular lower extremity reconstruction.
METHODS
This is a prospective randomized study where patients were allocated to receive either combined general-epidural anesthesia (epidural group, n = 26) or general anesthesia alone (control group, n = 26). After injecting epidural ropivacaine 10 ml in the epidural group, the effect on arterial maximal flow velocity of the free flap was analyzed using ultrasonography. The primary outcome measurement was the arterial maximal flow velocity 30 minutes after establishing the baseline. Intraoperative hemodynamics and postoperative outcomes such as postoperative pain, opioid requirements, surgical complications, intensive care unit admission, and hospital length of stay were also assessed.
RESULTS
The arterial maximal flow velocity 30 minutes after the baseline measurement was significantly higher in the epidural group (35.3 ± 13.9 cm/second versus 23.5 ± 8.4 cm/second; p = 0.001). The pain score at 1 hour postoperatively and opioid requirements at 1 and 6 hours postoperatively were significantly lower in the epidural group [3.0 (interquartile range, 2.0 to 5.0) versus 5.0 (interquartile range, 3.0 to 6.0), p = 0.019; 0.0 μg (interquartile range, 0.0 to 50.0 μg) versus 50.0 μg (interquartile range, 0.0 to 100.0 μg), p = 0.005; and 46.9 μg (interquartile range, 0.0 to 66.5 μg) versus 96.9 μg (interquartile range, 41.7 to 100.0 μg), p = 0.014, respectively]. There were no significant differences in intraoperative hemodynamics or other postoperative outcomes between the two groups.
CONCLUSION
Epidural anesthesia increased the arterial maximal flow velocity of the free flap and decreased postoperative pain and opioid requirements in microvascular lower extremity reconstruction.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.
背景
游离皮瓣存活的关键因素之一是维持充足的灌注。作者评估了硬膜外麻醉对下肢微血管重建中游离皮瓣动脉最大流速的影响。
方法
这是一项前瞻性随机研究，患者被分配接受全身 - 硬膜外联合麻醉（硬膜外组，n = 26）或单纯全身麻醉（对照组，n = 26）。在硬膜外组注射10 ml罗哌卡因后，使用超声分析其对游离皮瓣动脉最大流速的影响。主要观察指标是建立基线后30分钟的动脉最大流速。还评估了术中血流动力学以及术后结局，如术后疼痛、阿片类药物需求量、手术并发症、重症监护病房入住情况和住院时间。
结果
硬膜外组基线测量后30分钟的动脉最大流速显著更高（35.3±13.9厘米/秒对23.5±8.4厘米/秒；p = 0.001）。硬膜外组术后1小时疼痛评分以及术后1小时和6小时阿片类药物需求量显著更低[3.0（四分位间距，2.0至5.0）对5.0（四分位间距，3.0至6.0），p = 0.019；0.0μg（四分位间距，0.0至50.0μg）对50.0μg（四分位间距，0.0至100.0μg），p = 0.005；以及46.9μg（四分位间距，0.0至66.5μg）对96.9μg（四分位间距，41.7至100.0μg），p分别为0.014]。两组术中血流动力学或其他术后结局无显著差异。
结论
在下肢微血管重建中，硬膜外麻醉增加了游离皮瓣的动脉最大流速，并减轻了术后疼痛和阿片类药物需求量。
临床问题/证据水平：治疗性，I级
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