Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria.
Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria.
J Arthroplasty. 2024 Apr;39(4):904-909. doi: 10.1016/j.arth.2023.10.018. Epub 2023 Oct 16.
Our aim was to analyze anesthetic induction time and postoperative pain using spinal anesthesia versus general anesthesia with or without the use of peripheral nerve blocks (PNBs) in total knee arthroplasty. The hypothesis was that spinal anesthesia would be beneficial with respect to induction time and postoperative pain and that PNBs would complement this effect.
Patients were stratified according to demographics, American Society of Anesthesiologists physical status classification system (ASA), and opioid intake and divided into: (A) general anesthesia without PNB; (B) general anesthesia with PNB; (C) spinal anesthesia without PNB; and (D) spinal anesthesia with PNB. Endpoints were anesthetic induction time, opioid consumption, and pain. Of 559 patients, 348 (62.3%) received general anesthesia (consisting of group A with 46 and group B with 302 patients), and 211 (37.7%) spinal anesthesia (consisting of group C with 117 and group D with 94 patients).
We observed significantly lower total opioid intake 48 hours postoperative when applying spinal anesthesia by 2.08 mg (P < .05) of intravenous morphine-equivalent, and a reduction of 7.0 minutes (P < .05) until skin incision. The application of a PNB achieved a reduction of piritramide intake of 3.59 mg (P < .05) 48 hours postoperative and lengthened induction time by 8.5 minutes (P < .05).
Statistically shorter anesthetic induction times without clinical relevance, but lower postoperative opioid dosages with clinical relevance were observed for patients undergoing total knee arthroplasty with spinal anesthesia. The additional application of PNBs led to a lower need for opioids and lower pain levels in the early postoperative phase.
本研究旨在分析全身麻醉与椎管内麻醉（是否联合使用外周神经阻滞）在全膝关节置换术中对麻醉诱导时间和术后疼痛的影响。我们假设椎管内麻醉在诱导时间和术后疼痛方面具有优势，外周神经阻滞可以增强这种效果。
根据患者的人口统计学、美国麻醉医师协会（ASA）身体状况分类系统和阿片类药物的使用情况进行分层，并分为：（A）未使用外周神经阻滞的全身麻醉；（B）使用外周神经阻滞的全身麻醉；（C）未使用外周神经阻滞的椎管内麻醉；（D）使用外周神经阻滞的椎管内麻醉。主要观察指标为麻醉诱导时间、阿片类药物用量和疼痛程度。559 例患者中，348 例（62.3%）接受全身麻醉（A 组 46 例，B 组 302 例），211 例（37.7%）接受椎管内麻醉（C 组 117 例，D 组 94 例）。
我们观察到，与全身麻醉相比，椎管内麻醉可使术后 48 小时静脉注射吗啡等效物的总用量减少 2.08 mg（P <.05），切皮时间提前 7.0 分钟（P <.05）。应用外周神经阻滞可使术后 48 小时哌替啶用量减少 3.59 mg（P <.05），并使麻醉诱导时间延长 8.5 分钟（P <.05）。
虽然椎管内麻醉的麻醉诱导时间更短，但术后阿片类药物的用量更少，对全膝关节置换术患者具有临床意义。联合使用外周神经阻滞可减少术后早期阿片类药物的需求和疼痛程度。
