Department of Nephrology, First Affiliated Hospital, Third Military Medical University (Army Medical University), Gaotanyan No.30, Chongqing, 400038, China.
Department of Anesthesiology, First Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China.
BMC Anesthesiol. 2024 Oct 11;24(1):366. doi: 10.1186/s12871-024-02751-y.
Given the lack of global consensus on anesthesia selection for peritoneal dialysis catheter (PDC) placement via open surgery, this study investigates the safety and efficacy of combining local infiltration anesthesia (LIA) with monitored anesthesia care (MAC) in patients with end-stage renal disease (ESRD).
This retrospective analysis of ESRD patients who underwent open surgical placement of PDC in the Department of Nephrology, the First Affiliated Hospital of the Army Medical University from 1 August 2020 to 31 May 2022. Patients were categorized into two groups based on anesthesia method: LIA group and LIA + MA group. MA was defined as preoperative sedation (0.2-0.7 µg/kg/h) with dexmedetomidine injection (Huidrican trade name, DEX), and intraoperative analgesia with dexrazoxane injection (Garonin trade name, DEZ) as appropriate according to the patients' pain scores. We compared the general clinical data of the two groups of patients, the changes in blood pressure and heart rate during the whole operation, the intraoperative and postoperative pain, the total duration of the operation and the immediate postoperative complications.
The study included 123 patients (59 in the LIA + MAC group and 64 in the LIA group). The LIA + MA group exhibited lower pain scores measured by Visual Analogue Scale(VAS) during surgery (skin incision, subcutaneous adipose tissue dissection, anterior fascia, muscle traction, posterior fascia, peritoneum, and catheterization) compared to the LIA group(p<0.05). In terms of surgical incisions, to intraoperative pain scores (VRS), the LIA + MA group showed higher score level I and lower score level II compared to the LIA group (p = 0.002, 0.004, respectively). The LIA + MA group experienced lower postoperative resting pain (NRS) and VAS than the LIA group (p = 0.001,0.003, respectively). The surgical duration for the LIA + MA group was shorter than that of the LIA group (p<0.001). Preoperative systolic and diastolic blood pressures (SBP and DBP) were higher in the LIA + MA group compared to the LIA group (p<0.001,<0.001, respectively). Postoperative heart rate and DBP were lower in the LIA + MA group (p<0.001, 0.004, respectively). The LIA + MA group exhibited greater changes in heart rate, SBP, and DBP during and after surgery compared to the LIA group (p = 0.009, <0.001,<0.001, respectively). In terms of immediate postoperative complications, the proportion of patients requiring analgesics within 24 h post-surgery was significantly lower in the LIA + MA group (p = 0.031).
Open surgery for PDC placement under LIA + MAC is both safe and effective.
鉴于全球在腹膜透析导管（PDC）经开放手术置管时选择麻醉方法缺乏共识，本研究旨在探讨局部浸润麻醉（LIA）联合监测麻醉护理（MAC）在终末期肾病（ESRD）患者中的安全性和有效性。
本回顾性研究纳入了 2020 年 8 月 1 日至 2022 年 5 月 31 日期间在中国人民解放军陆军军医大学第一附属医院肾病科行开放手术置管的 ESRD 患者。根据麻醉方法将患者分为两组：LIA 组和 LIA+MAC 组。MAC 定义为术前给予右美托咪定（Huidrican 商品名，DEX）镇静（0.2-0.7μg/kg/h），根据患者疼痛评分，术中给予右雷佐生（Garonin 商品名，DEZ）镇痛。我们比较了两组患者的一般临床资料、整个手术过程中的血压和心率变化、术中及术后疼痛、手术总时间和术后即刻并发症。
该研究共纳入 123 例患者（LIA+MAC 组 59 例，LIA 组 64 例）。LIA+MAC 组患者术中 VAS 评分（皮肤切口、皮下脂肪组织切开、前筋膜、肌肉牵引、后筋膜、腹膜和导管置入）均低于 LIA 组（p<0.05）。在手术切口方面，与 LIA 组相比，LIA+MAC 组术中疼痛评分（VRS）的 I 级评分更高，II 级评分更低（p=0.002，0.004）。LIA+MAC 组患者术后静息疼痛（NRS）和 VAS 评分均低于 LIA 组（p=0.001，0.003）。LIA+MAC 组的手术时间短于 LIA 组（p<0.001）。LIA+MAC 组患者术前收缩压和舒张压（SBP 和 DBP）高于 LIA 组（p<0.001，<0.001）。LIA+MAC 组患者术后心率和 DBP 均低于 LIA 组（p<0.001，0.004）。与 LIA 组相比，LIA+MAC 组患者术中及术后心率、SBP 和 DBP 的变化更大（p=0.009，<0.001，<0.001）。在术后即刻并发症方面，LIA+MAC 组患者术后 24 小时内需要镇痛药物的比例明显低于 LIA 组（p=0.031）。
LIA+MAC 用于开放手术置 PDC 是安全有效的。
