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择期膝关节镜手术中单侧脊髓麻醉与超声引导下坐骨神经和股神经联合阻滞的比较。

Comparison of unilateral spinal anaesthesia with ultrasound-guided combined sciatic and femoral nerve block in elective arthroscopic knee surgeries.

作者信息

Bhardwaj Avanish, Ravi Parli R, Mishra Satish Kumar, Damodar P

机构信息

Classified Specialist (Anaesthesia) & Neuroanaesthesiologist, Command Hospital (Air Force), Bangalore, India.

Senior Consultant (Anaesthesiology), Sultan Qaboos Comprehensive Cancer Care & Research Center, Oman.

出版信息

Med J Armed Forces India. 2023 Jul-Aug;79(4):392-398. doi: 10.1016/j.mjafi.2021.09.009. Epub 2021 Nov 24.

Abstract

BACKGROUND

Arthroscopic knee surgeries are commonly performed orthopaedic procedures, which can be done under unilateral spinal anaesthesia (USA) or ultrasound-guided combined sciatic and femoral nerve block (USFB). However, not many studies have compared both these techniques. Hence this study was undertaken to compare USA and USFB in arthroscopic knee surgeries in terms of time to readiness for discharge (TRD).

METHODS

Eighty patients were randomised into the USA ( = 40) and USFB groups ( = 40). They were administered either USA or USFB on the affected side. The TRD values were compared. Patients were considered fit for discharge after voiding urine, ambulation and obtaining a visual analogue scale (VAS) score of <3. The maximum time required for any of the three parameters was taken as the TRD for that particular patient.

RESULTS

The mean TRD was 595.41 ± 195.69 min in the USA group and 351.86 ± 129.51 min in the USFB group ( < 0.001). The median VAS scores for postoperative pain assessment were lower in the USFB group at 2, 4, 12 and 24 h ( < 0.05). The number of patients requiring rescue analgesia was lower in the USFB group at 6 and 12 h after surgery ( < 0.05).

CONCLUSION

Patients undergoing arthroscopic knee surgeries under USFB have an advantage when it comes to TRD as these patients have comparatively better postoperative analgesia, less requirement of rescue analgesia, early voiding of urine and early ambulation.

摘要

背景

膝关节镜手术是常见的骨科手术,可在单侧脊髓麻醉(USA)或超声引导下坐骨神经与股神经联合阻滞(USFB)下进行。然而,比较这两种技术的研究并不多。因此,本研究旨在比较膝关节镜手术中USA和USFB在出院准备时间(TRD)方面的差异。

方法

80例患者被随机分为USA组(n = 40)和USFB组(n = 40)。在患侧给予他们USA或USFB。比较TRD值。患者在排尿、行走且视觉模拟评分(VAS)<3分时被认为适合出院。将这三个参数中任何一个所需的最长时间作为该特定患者的TRD。

结果

USA组的平均TRD为595.41±195.69分钟,USFB组为351.86±129.51分钟(P<0.001)。USFB组术后2、4、12和24小时的术后疼痛评估中值VAS评分较低(P<0.05)。术后6和12小时需要补救镇痛的患者数量在USFB组中较少(P<0.05)。

结论

在TRD方面,接受USFB下膝关节镜手术的患者具有优势,因为这些患者术后镇痛效果相对较好,补救镇痛需求较少,排尿早且行走早。

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[Advantages of unilateral spinal anaesthesia].[单侧脊髓麻醉的优势]
Anasthesiol Intensivmed Notfallmed Schmerzther. 2010 Mar;45(3):182-7. doi: 10.1055/s-0030-1249401. Epub 2010 Mar 15.
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Regional anesthesia techniques for ambulatory orthopedic surgery.门诊骨科手术的区域麻醉技术
Curr Opin Anaesthesiol. 2008 Dec;21(6):723-8. doi: 10.1097/aco.0b013e328314b665.
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Ultrasound-guided peripheral nerve blocks: what are the benefits?超声引导下的外周神经阻滞:有哪些益处?
Acta Anaesthesiol Scand. 2008 Jul;52(6):727-37. doi: 10.1111/j.1399-6576.2008.01666.x. Epub 2008 May 12.

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