Luchetti M, Palomba R, Sica G, Massa G, Tufano R
University of Naples, Federico II Institute of Anesthesiology and Intensive Care, Italy.
Reg Anesth. 1996 Sep-Oct;21(5):465-9.
The aim of this study was to compare the efficacy and safety of two anesthesia techniques, combined epidural/general anesthesia (CEGA) versus total intravenous anesthesia (TIVA), for laparoscopic cholecystectomy.
Forty patients were randomly assigned to one of two different groups: group A received TIVA and group B received CEGA. At preset times during the operation, systolic and diastolic arterial pressure, heart rate, oxygen saturation (SaO2) and end-tidal carbon dioxide (Etco2) were monitored. Postoperatively, recovery (Steward's test) and analgesia (visual analog scale [VAS] pain scores) were assessed, as well as the incidence of adverse effects.
The groups were comparable as to demographic data and duration of surgery and of anesthesia. Intraoperative parameters also showed no statistical differences. Both groups had a rapid recovery (Steward score of 6 within 12 minutes), but group B showed better recovery scores at 4 minutes. Postoperative pain was well controlled in both groups, but group B exhibited better scores at postoperative hour 2. The incidence of postoperative side effects was low in both groups.
The use of CEGA for laparoscopic cholecystectomy seems to be effective and safe and to offer some advantages as compared to TIVA alone. CEGA can control pain due to CO2-induced peritoneal irritation, providing excellent intra- and postoperative analgesia. CEGA does not require the use of intraoperative intravenous opioids and shortens recovery time, without increasing the incidence of side effects.
本研究旨在比较两种麻醉技术，即硬膜外/全身联合麻醉（CEGA）与全静脉麻醉（TIVA）用于腹腔镜胆囊切除术的疗效和安全性。
40例患者被随机分为两组：A组接受TIVA，B组接受CEGA。在手术过程中的预设时间，监测动脉收缩压和舒张压、心率、血氧饱和度（SaO2）和呼气末二氧化碳（Etco2）。术后，评估恢复情况（Steward测试）和镇痛效果（视觉模拟量表[VAS]疼痛评分）以及不良反应的发生率。
两组在人口统计学数据、手术时间和麻醉时间方面具有可比性。术中参数也无统计学差异。两组恢复均较快（12分钟内Steward评分为6分），但B组在4分钟时恢复评分更好。两组术后疼痛均得到良好控制，但B组在术后2小时评分更佳。两组术后副作用发生率均较低。
与单独使用TIVA相比，CEGA用于腹腔镜胆囊切除术似乎有效且安全，并具有一些优势。CEGA可控制因二氧化碳引起的腹膜刺激所致的疼痛，提供良好的术中和术后镇痛效果。CEGA无需术中使用静脉阿片类药物，可缩短恢复时间，且不增加副作用的发生率。
