From the Department of Anesthesiology, Mwatate Sub-County Hospital, Mwatate, Kenya.
Department of Orthopedics and Traumatology, Kilimanjaro Christian Medical Center, Moshi, Tanzania.
Anesth Analg. 2024 Jan 1;138(1):180-186. doi: 10.1213/ANE.0000000000006374. Epub 2023 Dec 15.
Regional anesthesia techniques are increasingly used in high-income countries (HICs) for both surgical anesthesia and postoperative analgesia. However, regional anesthesia has not been utilized to the same degree in low- to middle-income countries (LMICs) due to a lack of resources and trained personnel. This study evaluates patient satisfaction with, and outcomes of, ultrasound-guided regional anesthesia for extremity surgery at Kilimanjaro Christian Medical Center (KCMC) in the Northeastern zone of Tanzania.
Study patients were ≥18 years of age; American Society of Anesthesiologists (ASA) physical status I, II, or III; and underwent extremity surgery under peripheral nerve block with ultrasound guidance at KCMC. After placement, blocks were assessed for effectiveness intraoperatively, as demonstrated by the need for supplemental analgesic or sedative medication or conversion to a general anesthetic. Postoperatively, patients were assessed for satisfaction with their nerve block and pain at 12 and 24 hours. Adverse events related to regional anesthesia were assessed immediately, 45 minutes after block placement, and at 12 and 24 hours postoperatively. The primary outcome was patient satisfaction at 12 hours. Secondary outcomes were block success rate and analgesia at 12 and 24 hours postoperatively.
A convenience sample of 170 patients was included in the study, of whom 156 (95% confidence interval [CI], 87-95) were either satisfied or very satisfied with their block. Block placement was highly successful with only 8 of 170 participants (95% CI, 2.4-8.3), requiring conversion to a general anesthetic. Analgesia continued in the postoperative period, with 164 of 170 (95% CI, 93-98) patients and 145 of 170 (95% CI, 80-90) patients reporting acceptable analgesia at 12 and 24 hours, respectively. No major adverse events, such as local anesthetic toxicity, infection, bleeding, nerve injury, or pneumothorax, were observed.
Our study found that ultrasound-guided regional anesthesia in a resource-constrained setting was effective for extremity surgery and resulted in high patient satisfaction. No complications occurred. The use of ultrasound-guided regional anesthesia shows promise for the safe and effective care of patients undergoing extremity surgery in LMICs.
区域麻醉技术在高收入国家（HICs）中越来越多地用于手术麻醉和术后镇痛。然而，由于资源和训练有素的人员短缺，区域麻醉在中低收入国家（LMICs）并未得到同等程度的应用。本研究评估了坦桑尼亚东北部基利马尼基督教医学中心（KCMC）接受超声引导的四肢手术的患者对区域麻醉的满意度和结果。
研究患者年龄≥18 岁；美国麻醉医师协会（ASA）身体状况 I、II 或 III 级；并在 KCMC 接受外周神经阻滞下的超声引导下进行四肢手术。放置后，根据需要补充镇痛或镇静药物或转为全身麻醉来评估术中阻滞的效果。术后，评估患者在 12 小时和 24 小时时对神经阻滞和疼痛的满意度。在放置阻滞后立即、45 分钟、12 小时和 24 小时评估与区域麻醉相关的不良事件。主要结局是 12 小时时患者的满意度。次要结局是术后 12 小时和 24 小时的阻滞成功率和镇痛效果。
本研究纳入了 170 名患者的方便样本，其中 156 名（95%置信区间[CI]，87-95）对他们的阻滞感到满意或非常满意。只有 8 名（95%CI，2.4-8.3）的 170 名参与者需要转换为全身麻醉，阻滞放置成功率非常高。术后镇痛仍在继续，170 名患者中有 164 名（95%CI，93-98）和 170 名患者中有 145 名（95%CI，80-90）分别在 12 小时和 24 小时报告可接受的镇痛效果。未观察到局部麻醉毒性、感染、出血、神经损伤或气胸等主要不良事件。
我们的研究发现，在资源有限的环境中，超声引导下的区域麻醉对四肢手术有效，并使患者满意度高。未发生并发症。超声引导下的区域麻醉为中低收入国家接受四肢手术的患者提供安全有效的护理提供了希望。
