超声引导下骶管硬膜外阻滞与腰麻用于肛肠手术的比较：一项随机对照试验
Comparison of Ultrasound-Guided Caudal Epidural Blocks and Spinal Anesthesia for Anorectal Surgery: A Randomized Controlled Trial.
作者信息
Chen Shibiao, Wei Aiping, Min Jia, Li Lei, Zhang Yang
机构信息
Department of Anesthesiology, First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, 330006, Jiangxi, China.
出版信息
Pain Ther. 2022 Jun;11(2):713-721. doi: 10.1007/s40122-022-00389-7. Epub 2022 May 2.
INTRODUCTION
The aim of this study is to observe the effect of spinal anesthesia (SA) and ultrasound-guided caudal epidural blocks (CEB) on perioperative satisfaction in patients undergoing anorectal surgery.
METHODS
A group of 106 patients were randomly allocated to receive either SA (the SA group) or CEB (the CEB group), and 11 patients were excluded. Finally, 95 patients were left, with 48 in the SA group and 47 in the CEB group for data analysis. The primary endpoint was patient satisfaction with the quality of their anesthetic technique. The secondary outcome measures included postoperative pain at 2, 4, 8, 16, 24, and 48 h after surgery at rest, time to first analgesic request, analgesia requirements, incidence of phantom limb syndrome (PLS), time until return of bowel function, time to ambulation, incidence of postoperative nausea and vomiting (PONV), intraoperative mean arterial pressure (MAP) reduction > 20% from baseline, and surgeon satisfaction.
RESULTS
A significantly lower proportion of patients in the SA group was highly satisfied with the quality of their anesthetic technique compared with the CEB group (20.8% versus 68.1%). NRS scores at rest were significantly lower at 4, 8, 16, and 24 h after surgery in the CEB group compared with the SA group. The time to first analgesic request was significantly earlier for patients in the SA group compared with patients in the CEB group. Analgesia requirements, the incidence of PLS, the incidence of PONV, and intraoperative MAP reduction > 20% from baseline were significantly decreased in the CEB group. There were no significant differences between the groups in time until return of bowel function, surgeon satisfaction, or time to ambulation.
CONCLUSIONS
Ultrasound-guided caudal epidural blocks have higher patient satisfaction compared with spinal anesthesia.
TRIAL REGISTRATION
This study was registered in the Chinese Clinical Trial Registry (ChiCTR 2000041026) on 06/12/2020.
引言
本研究旨在观察脊髓麻醉（SA）和超声引导下骶管硬膜外阻滞（CEB）对接受肛肠手术患者围手术期满意度的影响。
方法
将106例患者随机分为接受SA组（SA组）或CEB组（CEB组），排除11例患者。最终，留下95例患者，SA组48例，CEB组47例用于数据分析。主要终点是患者对麻醉技术质量的满意度。次要结局指标包括术后2、4、8、16、24和48小时静息时的疼痛、首次镇痛需求时间、镇痛需求、幻肢综合征（PLS）发生率、肠功能恢复时间、下床活动时间、术后恶心呕吐（PONV）发生率、术中平均动脉压（MAP）较基线降低>20%以及外科医生满意度。
结果
与CEB组相比，SA组对麻醉技术质量高度满意的患者比例显著更低（20.8%对68.1%）。与SA组相比，CEB组术后4、8、16和24小时静息时的数字疼痛评分量表（NRS）得分显著更低。SA组患者首次镇痛需求时间比CEB组患者显著更早。CEB组的镇痛需求、PLS发生率、PONV发生率以及术中MAP较基线降低>20%均显著降低。两组在肠功能恢复时间、外科医生满意度或下床活动时间方面无显著差异。
结论
与脊髓麻醉相比，超声引导下骶管硬膜外阻滞患者满意度更高。
试验注册
本研究于2020年12月6日在中国临床试验注册中心注册（ChiCTR 2000041026）。
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