Nakamura S J, Conte-Hernandez A, Galloway M T
Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut, USA.
Arthroscopy. 1997 Dec;13(6):699-703. doi: 10.1016/s0749-8063(97)90003-7.
Arthroscopically assisted anterior cruciate ligament (ACL) reconstruction is a common orthopaedic procedure. Until recently, the majority of these procedures have been performed on an impatient basis. This retrospective study evaluated 67 consecutive patients who underwent an arthroscopically assisted, autogenous bone-patellar ligament-bone ACL reconstruction that was supervised by the same surgeon. General endotracheal anesthesia was used for 36 patients and a femoral sciatic nerve block was used in 31 patients. Only patients who underwent either isolated ACL reconstructions, or those combined with either medial or lateral meniscectomies, were included. No statistically significant differences in either the mean anesthesia time or operative time existed between the general anesthesia and regional anesthesia groups. Patients receiving regional anesthesia did require a significantly longer recovery room stay than those who received general anesthesia. Most of the patients who received general anesthesia had inpatient procedures. In the general anesthesia group, 31 of 36 patients spent at least one night in the hospital. Three of 30 patients who received regional anesthesia required hospital admission. There were no differences between anesthesia-related complication between groups. The cost saving of performing ACL reconstructions under regional anesthesia compared with general anesthesia was calculated to be $2,907 per case and predominantly reflected the outpatient approach used in these cases. This study supports the use of femoral sciatic nerve block anesthesia as a safe and reliable alternative to general anesthesia for patients undergoing outpatient ACL reconstruction. The use of this technique was not found to compromise operating room efficiency. Patients receiving regional anesthesia did require a slightly longer recovery room stay. ACL reconstruction performed under regional anesthesia with same-day discharge was well tolerated by our patients and it provides a cost-efficient alternative to ACL reconstructions performed as inpatient procedures.
关节镜辅助下前交叉韧带（ACL）重建是一种常见的骨科手术。直到最近，大多数此类手术都是在非住院基础上进行的。这项回顾性研究评估了67例连续接受关节镜辅助下自体髌韧带-骨ACL重建手术的患者，这些手术均由同一位外科医生主刀。36例患者采用全身气管内麻醉，31例患者采用股坐骨神经阻滞麻醉。仅纳入了接受单纯ACL重建或合并内侧或外侧半月板切除术的患者。全身麻醉组和区域麻醉组在平均麻醉时间或手术时间上均无统计学显著差异。接受区域麻醉的患者在恢复室停留的时间明显长于接受全身麻醉的患者。大多数接受全身麻醉的患者进行的是住院手术。在全身麻醉组中，36例患者中有31例至少在医院住了一晚。接受区域麻醉的30例患者中有3例需要住院。两组之间与麻醉相关的并发症无差异。与全身麻醉相比计算得出，区域麻醉下进行ACL重建每例节省成本2907美元，这主要反映了这些病例采用的门诊手术方式。这项研究支持将股坐骨神经阻滞麻醉作为门诊ACL重建患者全身麻醉的一种安全可靠的替代方法。未发现使用该技术会影响手术室效率。接受区域麻醉的患者在恢复室停留的时间确实稍长一些。区域麻醉下进行的同日出院的ACL重建手术，患者耐受性良好，它为住院手术方式的ACL重建提供了一种经济高效的替代方案。
