Leoni Matteo Luigi Giuseppe, Rossi Tommaso, Mercieri Marco, Cerati Giorgia, Abbott David Michael, Varrassi Giustino, Cattaneo Gaetano, Capelli Patrizio, Mazzoni Manuela, Corso Ruggero Massimo
Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, 29121 Rome, Italy.
Department of Anesthesiology and Intensive Care, Guglielmo da Saliceto Hospital, 29122 Piacenza, Italy.
J Pers Med. 2024 Aug 9;14(8):845. doi: 10.3390/jpm14080845.
Emergency laparotomy is a surgical procedure associated with significantly higher mortality rates compared to elective surgeries. Awake laparotomy under neuraxial anaesthesia has recently emerged as a promising approach in abdominal surgery to improve patient outcomes. This study aims to evaluate the feasibility and potential benefits of using neuraxial anaesthesia as the primary anaesthetic technique in emergency laparotomies. We conducted a case series involving 16 patients who underwent emergency laparotomy for bowel ischemia, perforation, or occlusion. Neuraxial anaesthesia was employed as the main anaesthetic technique. We analysed patient demographics, clinical characteristics, intraoperative details, and postoperative outcomes. The primary outcome measures included the adequacy of postoperative pain control, the incidence of postoperative complications, and mortality rates. Among the 16 patients, adequate postoperative pain control was achieved, with only 2 patients requiring additional analgesia. Postoperative complications, including sepsis, wound dehiscence, and pneumonia, were observed in seven patients (44%). The observed mortality rate was relatively low at 6% (one patient). Notably, conversion to general anaesthesia was not necessary in any of the cases, and no early readmissions were reported. Our findings highlight the feasibility and potential benefits of using neuraxial anaesthesia in emergency laparotomies. The observed low mortality rate and the avoidance of conversion to general anaesthesia suggest that neuraxial anaesthesia may be a useful alternative in emergency settings. However, the occurrence of postoperative complications in 44% of patients indicates the need for cautious patient selection and close monitoring. Further research with larger sample sizes is warranted to fully elucidate the efficacy, safety, and potential impact of this technique on patient outcomes in emergency laparotomies.
与择期手术相比，急诊剖腹手术是一种死亡率显著更高的外科手术。近年来，在腹部手术中，神经轴麻下清醒剖腹手术已成为一种有望改善患者预后的方法。本研究旨在评估在急诊剖腹手术中使用神经轴麻作为主要麻醉技术的可行性和潜在益处。我们进行了一项病例系列研究，纳入了16例因肠缺血、穿孔或梗阻而接受急诊剖腹手术的患者。采用神经轴麻作为主要麻醉技术。我们分析了患者的人口统计学特征、临床特征、术中细节及术后结局。主要结局指标包括术后疼痛控制是否充分、术后并发症发生率及死亡率。在这16例患者中，术后疼痛得到了充分控制，仅有2例患者需要额外镇痛。7例患者（44%）出现了术后并发症，包括脓毒症、伤口裂开和肺炎。观察到的死亡率相对较低，为6%（1例患者）。值得注意的是，所有病例均无需转为全身麻醉，且未报告早期再入院情况。我们的研究结果凸显了在急诊剖腹手术中使用神经轴麻的可行性和潜在益处。观察到的低死亡率以及避免转为全身麻醉表明，神经轴麻在急诊情况下可能是一种有用的替代方法。然而，44%的患者出现术后并发症表明需要谨慎选择患者并密切监测。有必要进行更大样本量的进一步研究，以充分阐明该技术在急诊剖腹手术中对患者结局的疗效、安全性及潜在影响。
