Ecoffey C
Département d'Anesthésie-Réanimation chirurgicale, Hôpital de Bicêtre, Université Paris-Sud, Le Kremlin-Bicêtre.
Cah Anesthesiol. 1993;41(4):357-60.
The use of regional anaesthesia in day care practice is discussed. Five criteria of discharge are described: the four "A"s: awake, ambulation, alimentation, analgesia plus micturition. Complementary sedation with the regional block, if needed, should be midazolam and fentanyl. These drugs should be titrated in order to administer the efficient minimal dosage. The main techniques of regional anaesthesia are as follows: for upper limbs, intravenous regional anaesthesia, axillary and interscalenic brachial plexus blocks; for the lower limbs epidural and spinal blocks. However, urinary retention and orthostatic hypotension can occur. Furthermore the risk of headache is not a contraindication to an ambulatory practice if some guidelines are observed. In addition, penile blocks and caudal blocks are widely used in pediatrics.
本文讨论了区域麻醉在日间手术中的应用。文中描述了五项出院标准：四个“A”，即清醒、可走动、能进食、无痛且能排尿。如有需要，区域阻滞辅助镇静应选用咪达唑仑和芬太尼。这些药物应进行滴定，以便给予有效最小剂量。区域麻醉的主要技术如下：上肢采用静脉区域麻醉、腋路和肌间沟臂丛神经阻滞；下肢采用硬膜外阻滞和脊髓阻滞。然而，可能会发生尿潴留和体位性低血压。此外，如果遵循一些指导原则，头痛风险并非日间手术的禁忌证。另外，阴茎阻滞和骶管阻滞在儿科中广泛应用。
