Sarkar Priyasmita, Singh Yudhyavir, Patel Nishant, Kumar Shailendra, Khanna Puneet, Kashyap Lokesh, Subramaniam Rajeshwari
Department of Anesthesiology, Pain medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
Anesth Essays Res. 2021 Jul-Sep;15(3):290-295. doi: 10.4103/aer.aer_121_21. Epub 2022 Feb 7.
Selective spinal anesthesia has been safely applied for short-duration outpatient gynecological laparoscopic procedure. However, this anesthesia technique is often inadequate and not tolerated by awake patients due to pneumoperitoneum and visceral manipulation.
We aimed to conduct a study to compare spinal anesthesia with bupivacaine, fentanyl, and i.v. sedation with i.v. sedation and laparoscopic port-site infiltration with local anaesthetic in outpatient laparoscopic tubal ligation procedures.
100 female patients posted for elective surgeries were recruited for a prospective single blind randomised control trial in a tertiary care center in two groups.
In Group S, patients receive intrathecal 3 mg hyperbaric bupivacaine 0.5% plus 20 microgram fentanyl along with intravenous (i.v.) fentanyl at 1μg.kg.h and in Group C i.v. fentanyl at 1μg.kg.h along with laparoscopic port site infiltration with 0.5% bupivacaine. Postoperatively, overall patient satisfaction, visual analog score (VAS) score, duration of motor blockade, sensory blockade, and time to attain discharge criteria and any adverse.
Continuous variables between the groups were compared by the independent -test and Wilcoxon rank sum. Chi-square and Fisher exact test used for the categorical value.
Overall VAS was significantly lower and patient satisfaction was higher in Group S than Group C. Time to oral intake was significantly prolonged in Group C 126.33 (±29.54) compared to group S 110.81 (±29.54). The requirement of total rescue analgesia (fentanyl) was significantly higher in Group C 2.0 (±0.6) μg.kg compared to group S 0.79 (±0.53) μg.kg. Incidence of postoperative nausea vomiting (PONV) was significantly greater in Group C while incidence of pruritus was significantly greater in Group S.
Low-dose intrathecal anesthesia with 3 mg bupivacaine and 20 μg fentanyl provided better analgesia, patient satisfaction and with less opioids consumption.
选择性脊髓麻醉已安全应用于短期门诊妇科腹腔镜手术。然而，由于气腹和内脏操作，这种麻醉技术往往不足且清醒患者难以耐受。
我们旨在开展一项研究，比较在门诊腹腔镜输卵管结扎手术中，布比卡因、芬太尼脊髓麻醉联合静脉镇静与单纯静脉镇静及腹腔镜穿刺点局部麻醉浸润的效果。
在一家三级护理中心，将100例拟行择期手术的女性患者招募入前瞻性单盲随机对照试验，分为两组。
S组患者接受鞘内注射0.5%重比重布比卡因3mg加20μg芬太尼，同时静脉输注芬太尼1μg·kg·h；C组静脉输注芬太尼1μg·kg·h，同时腹腔镜穿刺点用0.5%布比卡因浸润。术后，评估总体患者满意度、视觉模拟评分（VAS）、运动阻滞持续时间、感觉阻滞持续时间、达到出院标准的时间以及任何不良反应。
组间连续变量采用独立样本t检验和Wilcoxon秩和检验进行比较。分类变量采用卡方检验和Fisher精确检验。
S组的总体VAS显著低于C组，患者满意度高于C组。C组口服摄入时间显著延长，为126.33（±29.54），而S组为110.81（±29.54）。C组总的补救镇痛（芬太尼）需求量显著高于S组，分别为2.0（±0.6）μg·kg和0.79（±0.53）μg·kg。C组术后恶心呕吐（PONV）发生率显著更高，而S组瘙痒发生率显著更高。
3mg布比卡因和20μg芬太尼的低剂量鞘内麻醉提供了更好的镇痛效果、患者满意度，且阿片类药物消耗量更少。
