D'Alessio J G, Rosenblum M, Shea K P, Freitas D G
Department of Anesthesiology, University of Tennessee, Memphis 38163, USA.
Reg Anesth. 1995 Jan-Feb;20(1):62-8.
An increasing percentage of all surgery is performed in an ambulatory surgery setting. Concurrently, arthroscopy of the shoulder joint has allowed definitive repair of shoulder pathology to occur in this environment. This study was designed to ascertain whether interscalene block is reliable and efficient for use in same-day surgery compared with general anesthesia for shoulder arthroscopy.
The authors retrospectively reviewed patients treated at the University of Connecticut over a 42-month period in the same-day surgery unit. Of 263 patients, 160 had a general anesthetic and 103 had an interscalene block. All times recorded for the study were contemporaneously logged into the operating room computer data base from which they were extracted. Data on complications were retrieved from individual patient charts and hospital quality assurance files.
Compared to general anesthesia, regional anesthesia required significantly less total nonsurgical intraoperative time use (53 +/- 12 vs. 62 +/- 13 minutes, P = .0001) and also decreased postanesthesia care unit stay (72 +/- 24 vs. 102 +/- 40, P = .0001). Interscalene block anesthesia resulted in significantly fewer unplanned admissions for therapy of severe pain, sedation, or nausea/vomiting than general anesthesia (0 vs. 13, P = .004) and an acceptable failure rate (8.7%).
Interscalene block should be considered as a viable alternative to general anesthesia for shoulder arthroscopy in ambulatory surgery patients.
在门诊手术环境中进行的外科手术比例日益增加。与此同时，肩关节镜检查已使得肩关节病变能够在这种环境下得到确切修复。本研究旨在确定与肩关节镜检查全麻相比，肌间沟阻滞用于日间手术是否可靠且有效。
作者回顾性分析了康涅狄格大学日间手术单元在42个月期间治疗的患者。263例患者中，160例接受全身麻醉，103例接受肌间沟阻滞。研究记录的所有时间均同步录入手术室计算机数据库，数据从中提取。并发症数据从个体患者病历和医院质量保证档案中获取。
与全身麻醉相比，区域麻醉所需的非手术术中总时间显著更少（53±12分钟对62±13分钟，P = 0.0001），且麻醉后护理单元停留时间也缩短（72±24分钟对102±40分钟，P = 0.0001）。肌间沟阻滞麻醉导致因严重疼痛、镇静或恶心/呕吐治疗而计划外入院的情况显著少于全身麻醉（0例对13例，P = 0.004），且失败率可接受（8.7%）。
对于门诊手术患者的肩关节镜检查，肌间沟阻滞应被视为全身麻醉的可行替代方法。
