胸腔硬膜外麻醉与全身麻醉用于腹腔镜胆囊切除术的随机对照试验。

Thoracic Epidural Versus General Anaesthesia For Laparoscopic Cholecystectomy: A Randomized Controlled Trial.

机构信息

Department of Anesthesiology, Fauji Foundation Hospital, Rawalpindi, Pakistan.

Department of Gynecology, City Med Hospital Rawalpindi,Pakistan.

出版信息

J Ayub Med Coll Abbottabad. 2022 Apr-Jun;34(2):279-282. doi: 10.55519/JAMC-02-9071.

DOI:10.55519/JAMC-02-9071

PMID:35576286

Abstract

BACKGROUND

Laparoscopic cholecystectomy is one of the most commonly performed surgeries worldwide. Aim of our study was to compare the effectiveness of thoracic epidural anaesthesia with general anaesthesia for Laparoscopic cholecystectomy in terms of changes in blood pressure during surgery, postoperative pain, respiratory complications and average length of hospital stay. It was a randomized controlled trial conducted from 1stOctober 2018 to 31st October 2019.

METHODS

Eightytwo patients planned to undergo elective laparoscopic cholecystectomy were randomly divided into two groups, T and G. In Group T all patients underwent laparoscopic cholecystectomy under thoracic epidural anaesthesia with 12 ml of 0.25% bupivacaine and 1% lignocaine plain whereas in group G all patients underwent surgery under general anaesthesia. Intra-operative mean arterial pressure (MAP) and postoperative opioid consumption in first 24hrs were recorded as primary outcomes whereas presence or absence of respiratory complication and duration of hospital stay as secondary outcome..

RESULTS

Out of 82 patients, 41 patients underwent laparoscopic cholecystectomy under thoracic epidural anaesthesia and 41 patients had surgery under general anaesthesia. Mean arterial pressure was lower in Group T and the difference was statistically significant. The average time of first complaint of postoperative pain in Group T was 5.4±1.26 hours as compared to less than 0.79±0.25 hours in Group G. Patients in group T required lower doses of opioid analgesia in first twenty-four hours as compared to patients in group G. Mean hospital stay in group T was 1 day as compared to 3 days in group G.

CONCLUSIONS

Thoracic epidural anaesthesia provides a better alternative to general anaesthesia for Laparoscopic cholecystectomy with lower intraoperative mean arterial blood pressure, 24 hours postoperative consumption of opioids, respiratory complications and length of hospital stay.

摘要

背景

腹腔镜胆囊切除术是全球最常见的手术之一。我们的研究目的是比较胸椎硬膜外麻醉与全身麻醉在腹腔镜胆囊切除术中的有效性，主要从术中血压变化、术后疼痛、呼吸并发症和平均住院时间来评估。这是一项于 2018 年 10 月 1 日至 2019 年 10 月 31 日进行的随机对照试验。

方法

82 例拟行择期腹腔镜胆囊切除术的患者被随机分为两组，T 组和 G 组。T 组所有患者在胸椎硬膜外麻醉下进行手术，使用 12ml0.25%布比卡因和 1%利多卡因混合液；G 组所有患者在全身麻醉下进行手术。记录术中平均动脉压（MAP）和术后 24 小时内阿片类药物的消耗量作为主要结果，同时记录呼吸并发症的发生情况和住院时间作为次要结果。

结果

82 例患者中，41 例在胸椎硬膜外麻醉下进行了腹腔镜胆囊切除术，41 例在全身麻醉下进行了手术。T 组的平均动脉压较低，差异有统计学意义。T 组患者术后首次出现疼痛的平均时间为 5.4±1.26 小时，G 组为少于 0.79±0.25 小时。T 组患者在术后 24 小时内需要的阿片类药物镇痛剂量也低于 G 组。T 组患者的平均住院时间为 1 天，G 组为 3 天。