Sala-Blanch X, Lázaro J R, Otero E, Gómez-Bonfills J, el-Mezil A
Servicio de Anestesiología y Reanimación, Hospital de Sant Boi, Sant Boi de Llobregat, Barcelona.
Rev Esp Anestesiol Reanim. 1998 Aug-Sep;45(7):275-9.
Trunk blockades in arthroscopic knee surgery are rarely performed because combined blockade of the sciatic and lumbar plexus nerves are required, particularly if ischemia is required. We aimed to assess the efficacy of the "3-in-1 block" combined with intraarticular infiltration of local anesthetic for arthroscopic meniscectomy. The results were compared with our standard technique, subarachnoid anesthesia.
Forty ASA I-II patients undergoing arthroscopic meniscectomy without ischemia. The patients were randomly assigned to receive "3-in-1 block" with 40 mL of 1.5% mepivacaine (T group, n = 20), or the standard technique of subarachnoid puncture with 3 mL of 2% lidocaine (S group, n = 20). Twenty minutes after puncture patients in both groups received intraarticular injections of 20 ml of bupivacaine 0.25% with 1:200,000 adrenaline in the knee. Surgery began 10 minutes later. We assessed requirements for sedation during surgery, degree of satisfaction during surgery according to the surgeon and the patient, hemodynamic variables at predetermined times, postoperative pain (on a verbal scale and related to consumption of analgesics in the first 48 hours after surgery), and the appearance of side effects attributable to anesthetic technique.
Demographic variables were comparable in the two groups and no surgical events were recorded. Eighteen patients in the T group and one in the S group required sedation during surgery (p < 0.05). Blood pressure was significantly lower in the S group than in the T group (p < 0.05). No patient in the T group required atropine and/or ephedrine during surgery, whereas 5 patients in the S group did (p < 0.05). Postoperative evolution was similar in the two groups. No postoperative complications attributable to the techniques were recorded.
The "3-in-1 block" combined with joint infiltration of local anesthetics may be an effective alternative when subarachnoid anesthesia is contraindicated in patients undergoing arthroscopic meniscectomy.
关节镜下膝关节手术很少进行躯干阻滞，因为需要联合阻滞坐骨神经和腰丛神经，尤其是在需要缺血的情况下。我们旨在评估“三合一阻滞”联合关节内注射局部麻醉药用于关节镜下半月板切除术的疗效。将结果与我们的标准技术蛛网膜下腔麻醉进行比较。
40例美国麻醉医师协会（ASA）分级为I-II级、接受关节镜下半月板切除术且无需缺血处理的患者。患者被随机分配接受40毫升1.5%甲哌卡因的“三合一阻滞”（T组，n = 20），或接受3毫升2%利多卡因蛛网膜下腔穿刺的标准技术（S组，n = 20）。穿刺20分钟后，两组患者均在膝关节内注射20毫升含1:200,000肾上腺素的0.25%布比卡因。10分钟后开始手术。我们评估了手术期间的镇静需求、外科医生和患者对手术期间的满意度、预定时间的血流动力学变量、术后疼痛（采用语言评分并与术后头48小时内的镇痛药使用情况相关）以及麻醉技术所致副作用的出现情况。
两组的人口统计学变量具有可比性，未记录到手术相关事件。T组18例患者和S组1例患者在手术期间需要镇静（p < 0.05）。S组的血压显著低于T组（p < 0.05）。T组无患者在手术期间需要阿托品和/或麻黄碱，而S组有5例患者需要（p < 0.05）。两组的术后情况相似。未记录到因技术导致的术后并发症。
对于接受关节镜下半月板切除术且蛛网膜下腔麻醉禁忌的患者，“三合一阻滞”联合局部麻醉药关节内浸润可能是一种有效的替代方法。
