Inberg P, Tarkkila P J, Neuvonen P J, Vilkki S
Department of Anesthesia, Tampere University Hospital, Finland.
Reg Anesth. 1993 Mar-Apr;18(2):98-102.
To evaluate the usefulness, safety, and efficacy of the combined plexus brachial, spinal, and epidural blocks in free toe to hand transplantations.
Prospective, case series.
Tampere University Hospital, Finland.
Fifteen adult patients for toe to hand microvascular transplantation under combined regional anesthesia with bupivacaine.
The efficacy of the blocks, complications, and patient satisfaction were recorded in the study form.
The duration of operations varied between 8 and 18 hours. No major complications occurred. Vasodilatation in the operated hand was maintained during the entire operation as well as in the postoperative period, and the surgical results were satisfactory. The mean skin temperature was 5 degrees C higher in the blocked extremity compared to the opposite hand. In every patient the skin temperature of the transplant was over 32.4 degrees C after the operation. Blood pressure, heart rate, temperature and oxygen saturation were well maintained during the entire procedure. All patients were satisfied with their anesthesia. Back pain occurred in 11 patients and in two it was considered severe. One patient may have had a systemic toxic reaction (shivering) due to high plasma levels of bupivacaine, but the symptom was transient.
Combined regional anesthesia is an alternative to general anesthesia in prolonged microsurgical operations and it appears to improve perfusion of the transplanted extremity.
评估臂丛、脊髓及硬膜外联合阻滞在游离足趾移植至手部手术中的实用性、安全性及有效性。
前瞻性病例系列研究。
芬兰坦佩雷大学医院。
15例成年患者接受布比卡因复合区域麻醉下的足趾移植至手部的微血管手术。
在研究表格中记录阻滞效果、并发症及患者满意度。
手术时长在8至18小时之间。未发生重大并发症。手术全过程及术后患手均保持血管扩张，手术效果满意。阻滞侧肢体皮肤温度比健侧手高5摄氏度。术后每位患者移植部位的皮肤温度均超过32.4摄氏度。整个手术过程中血压、心率、体温及血氧饱和度均维持良好。所有患者对麻醉效果满意。11例患者出现背痛，其中2例被认为疼痛严重。1例患者可能因血浆布比卡因水平过高出现全身毒性反应（寒战），但症状为一过性。
在长时间显微外科手术中，复合区域麻醉可替代全身麻醉，且似乎能改善移植肢体的灌注。
