Ambrose Nicole, Sadacharam Kesavan, Burke Brian, Figueroa T Ernesto, Lang Robert Scott, Kjelstrom Stephanie, Hagerty Jennifer
Department of Urology, Main Line Health. Bryn Mawr, PA 19010, USA.
Department of Surgery and Anesthesiology, Nemours Children's Health, Delaware. 1600 Rockland Rd., Wilmington, DE 19803, USA.
J Pediatr Urol. 2023 Oct;19(5):621.e1-621.e9. doi: 10.1016/j.jpurol.2023.06.024. Epub 2023 Jul 7.
Available literature comparing spinal anesthesia (SA) to general anesthesia (GA) in the pediatric population describes multiple benefits in appropriately selected patients including cost reduction, lower incidence of complications, and shorter operative times. In patients undergoing urologic procedures, data are sparse.
Our goal was to expand on the paucity of existing urologic literature as SA appears to be uniquely suited for a substantial number of its common pediatric procedures.
Within a single institution, patients who had a urologic procedure performed under SA between May 2019 and July 2021 and were less than 18 months old were compared with a matched cohort of patients who had GA. The SA and GA groups were compared by two-sample t-tests, chi-square test for independence, and Fisher's exact test.
There were a total of 184 SA and 202 GA patients. There was no significant difference in the demographics except that SA patients were younger and weighed less than GA patients. The patients in the SA group needed less opioids both during the surgery (0% vs 26.1% p N/A) and in the immediate postoperative period when compared with GA patients (0% vs 18.2% p N/A). The patients who had SA had fewer complications necessitating PICU admission, or cancellation of surgery (0% vs 6.8% p = 0.03). Total anesthesia and emergence time were lower for SA patients (41 vs 50.2 p = 0.001 & 3.4 vs 6.1 p = 0.001). Both surgery and total OR time were not different between the groups (37.6 vs 35.5 p = 0.35 and 56.3 vs 54.4 p = 0.49). Overall, raw material cost was also found to be lower per procedure in the SA group vs the GA group ($8.90 vs $38.8: 77% reduction). Adjusted total mean costs for the surgery were not different between groups. The reduction in opioid use postoperatively also suggests reduced cost in the management of postoperative pain in the SA group.
Total anesthesia time, opioid use, and serious complications were all significantly lower in the SA group. We did not find significant difference in total surgery cost between two groups. However, patients who had SA had better pain control and needed less rescue analgesics in the immediate postoperative period. No patients in either group were sent home with opioids.
Spinal anesthesia was found to be an equally effective and appropriate alternative to GA with many proposed benefits for common pediatric urologic procedures. With further research, SA may prove to be a safer alternative in patients at risk for complications related to GA general anesthesia while also offering a cost benefit.
现有文献比较了小儿群体中脊髓麻醉（SA）与全身麻醉（GA），结果表明，在适当选择的患者中，SA具有多种益处，包括降低成本、减少并发症发生率以及缩短手术时间。在接受泌尿外科手术的患者中，相关数据较少。
我们的目标是补充现有泌尿外科文献的不足，因为SA似乎特别适用于许多常见的小儿泌尿外科手术。
在单一机构内，将2019年5月至2021年7月期间接受SA且年龄小于18个月的泌尿外科手术患者与匹配的GA患者队列进行比较。SA组和GA组通过双样本t检验、独立性卡方检验和Fisher精确检验进行比较。
共有184例SA患者和202例GA患者。除SA患者比GA患者年龄更小、体重更轻外，两组在人口统计学特征上无显著差异。与GA患者相比，SA组患者在手术期间（0%对26.1%，p值无可用数据）和术后即刻使用的阿片类药物更少（0%对18.2%，p值无可用数据）。接受SA的患者因并发症需要入住儿科重症监护病房（PICU）或取消手术的情况更少（0%对6.8%，p = 0.03）。SA患者的总麻醉和苏醒时间更短（41对50.2，p = 0.001；3.4对6.1，p = 0.001）。两组之间的手术时间和总手术室时间无差异（37.6对35.5，p = 0.35；56.3对54.4，p = 0.49）。总体而言，SA组每个手术的原材料成本也低于GA组（8.90美元对38.8美元：降低77%）。两组手术的调整后总平均成本无差异。术后阿片类药物使用的减少也表明SA组术后疼痛管理成本降低。
SA组的总麻醉时间、阿片类药物使用和严重并发症均显著更低。我们发现两组之间的总手术成本无显著差异。然而，接受SA的患者疼痛控制更好，术后即刻所需的急救镇痛药更少。两组均无患者带阿片类药物出院。
脊髓麻醉被发现是GA的一种同样有效且合适的替代方法，对于常见的小儿泌尿外科手术有许多潜在益处。随着进一步研究，SA可能被证明是GA相关并发症风险患者更安全的替代方法，同时还具有成本效益。
