低阻滞平面腰麻对日间病房肛周手术的临床效果
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摘要
目的分析低阻滞平面腰麻下行肛周手术的临床效果,探讨腰麻下小剂量缓慢给药的最佳剂量及注射速度。方法选择2016年8月至2017年3月在我院行肛周手术患者65例,按麻醉药剂量及注射速度不同分为2组:观察组布比卡因0. 6 m L,注药速度为0. 1 m L/5 s;对照组布比卡因1. 5 m L,注药速度为0. 1 m L/s。观察患者麻醉前,麻醉后10 min、30 min血压、心率,麻醉阻滞平面,抬臀能力,VAS,外科医生满意评分,患者满意评分,术后运动及疼痛恢复时间,腰麻后并发症情况。结果观察组阻滞平面、术后运动恢复时间和疼痛恢复时间明显低于对照组,差异有统计学意义(P <0. 05),且抬臀能力优于对照组,差异有统计学意义(P <0. 05)。本研究外科医生满意度、患者舒适度、VAS及腰麻后并发症差异无统计学意义。结论腰麻时采用小剂量、缓慢注药可获得较常规腰麻更低的阻滞平面,与常规腰麻下行肛周手术相比有更优的临床效果。
Objective To assess the clinical effects of spinal anesthesia with low blocking level for perianal surgery,and to explore the optimal dose and injection speed of low dose and slow administration under spinal anesthesia. Methods A total of 65 patients who planned to undergo perianal surgery in our hospital from August 2016 to March 2017 were selected. The patients were divided into the observation group and the control group randomly. For the observation group,the bupivacaine is 0. 6 m L with slowly injection rate of 0. 1 m L/5 s. For the control group,the bupivacaine is 1. 5 m L with injection rate of 0. 1 m L/s. Observed the blood pressure and heart rates before anesthesia,10 minutes and 30 minutes after anesthesia. Recorded the blocking level,movement capability of hip,visual analogue scale( VAS),surgeon and patient satisfaction,time of pain relief,time of postoperative motion recovery,and complication of the the two groups after spinal anesthesia.Results In the observation group,the blocking level,time of pain relief,time of postoperative motion recovery were obviously lower than those of the control group( P < 0. 05); and the movement capability of hip was obviously better than the control group( P < 0. 05). There was no siginificant difference in satisfaction of surgeon and patient,VAS,and complication after spinal anesthesia between the two groups.Conclusion Low dose and slow drug injection speed in lumbar anesthesia can obtain a lower blocking level than conventional lumbar anesthesia,and it may have a better clinical effect in perianal surgery.
Objective To assess the clinical effects of spinal anesthesia with low blocking level for perianal surgery,and to explore the optimal dose and injection speed of low dose and slow administration under spinal anesthesia. Methods A total of 65 patients who planned to undergo perianal surgery in our hospital from August 2016 to March 2017 were selected. The patients were divided into the observation group and the control group randomly. For the observation group,the bupivacaine is 0. 6 m L with slowly injection rate of 0. 1 m L/5 s. For the control group,the bupivacaine is 1. 5 m L with injection rate of 0. 1 m L/s. Observed the blood pressure and heart rates before anesthesia,10 minutes and 30 minutes after anesthesia. Recorded the blocking level,movement capability of hip,visual analogue scale( VAS),surgeon and patient satisfaction,time of pain relief,time of postoperative motion recovery,and complication of the the two groups after spinal anesthesia.Results In the observation group,the blocking level,time of pain relief,time of postoperative motion recovery were obviously lower than those of the control group( P < 0. 05); and the movement capability of hip was obviously better than the control group( P < 0. 05). There was no siginificant difference in satisfaction of surgeon and patient,VAS,and complication after spinal anesthesia between the two groups.Conclusion Low dose and slow drug injection speed in lumbar anesthesia can obtain a lower blocking level than conventional lumbar anesthesia,and it may have a better clinical effect in perianal surgery.
引文
[1]靳杭红,王明圣,吴晓庆.日间手术病房运行模式的探讨[J].西南国防医药,2017,27(9):1013-1015.doi:10.3969/j.issn.1004-0188.2017.09.042.
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[9]Soltani Mohammadi S,Piri M,Khajehnasiri A.Comparing Three different modified sitting positions for ease of spinal needle insertion in patients undergoing spinal anesthesia[J].Anesth Pain Med,2017,7(5):e55932.doi:10.5812/aapm.55932.
[10]Davoudi M,Tarbiat M,Ebadian MR,et al.Effect of position during spinal anesthesia on postdural puncture headache after cesarean section:a prospective,single-blind randomized clinical trial[J].Anesth Pain Med,2016,6(4):e35486.doi:10.5812/aapm.35486.
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[12]Khraise WN,Allouh MZ,El-Radaideh KM,et al.Assessment of risk factors for postdural puncture headache in women undergoing cesarean delivery in Jordan:a retrospective analytical study[J].Local Reg Anesth,2017,10:9-13.doi:10.2147/LRA.S129811.
[13]Tekgul ZT,Pektas S,Turan M,et al.Acute back pain following surgery under spinal anesthesia[J].Pain Pract,2015,15(8):706-711.doi:10.1111/papr.12260.
[14]汪伟,郁万友,钱燕宁.芬太尼复合小剂量布比卡因腰麻在老年患者下肢手术的应用[J].临床麻醉学杂志,2013,29(11):1088-1090.doi:10.3760/cma.j.issn.1673-4378.2014.01.015.
[15]张景山,李飞.布比卡因与左布比卡因在剖宫产术中的麻醉效果比较[J].河北医学,2016,22(7):1152-1155.doi:10.3969/j.issn.1006-6233.2016.07.038.
[16]石岩.电脑泵控制布比卡因注射速度用于腰麻的临床观察[D].广州:中山大学,2006.
[17]Imbelloni LE.Spinal hemianesthesia:unilateral and posterior[J].Anesth Essays Res,2014,8(3):270-276.doi:10.4103/0259-1162.143108.
[18]Gebhardt V,Mueller-Hansen L,Schwarz A,et al.Chloroprocaine 10mg/ml for low-dose spinal anaesthesia in perianal surgery-a randomised dose finding study[J].Acta Anaesthesiol Scand,2017,61(2):241-249.doi:10.1111/aas.12839.
[19]Prakash S,Mullick P.Spinal anesthesia and direction of spinal needle bevel[J].J Anaesthesiol Clin Pharmacol,2016,32(2):268-269.doi:10.4103/0970-9185.173360.
[20]Moosavi Tekye SM,Alipour M.Comparison of the effects and complications of unilateral spinal anesthesia versus standard spinal anesthesia in lower-limb orthopedic surgery[J].Braz J Anesthesiol,2014,64(3):173-176.doi:10.1016/j.bjane.2013.06.014.
[21]Gebhardt V,Hausen S,Weiss C,et al.Using chloroprocaine for spinal anaesthesia in outpatient knee-arthroscopy results in earlier discharge and improved operating room efficiency compared to mepivacaine and prilocaine[J].Knee Surg Sports Traumatol Arthrosc,2018(26):167.doi:10.1007/s00167-018-5327-2.
[22]Gebhardt V,Herold A,Weiss C,et al.Dosage finding for low-dose spinal anaesthesia using hyperbaric prilocaine in patients undergoing perianal outpatient surgery[J].Acta Anaesthesiol Scand,2013,57(2):249-256.doi:10.1111/aas.12031.
[23]Gebhardt V,Kiefer K,Bussen D,et al.Retrospective analysis of mepivacaine,prilocaine and chloroprocaine for low-dose spinal anaesthesia in outpatient perianal procedures[J].Int J Colorectal Dis,2018,33(10):1469-1477.doi:10.1007/s00384-018-3085-8.
[24]Kucur M,Goktas S,Kaynar M,et al.Selective low-dose spinal anesthesia for transrectal prostate biopsy:a prospective and randomized study[J].J Endourol,2015,29(12):1412-1417.doi:10.1089/end.2015.0450.
[2]金特特.痔疮手术中骶管阻滞和硬膜外腔阻滞的效果比较[J].浙江临床医学,2013(7):1068-1069.doi:10.3969/j.issn.1008-7664.2013.07.065.
[3]郭小平.肛周会阴部手术的麻醉选择和临床观察[J].山西医药杂志,2013(19):1152-1153.doi:10.3969/j.issn.0253-9926.2013.19.042.
[4]Manassero A,Bossolasco M,Ugues S,et al.Comparison of unilateral and bilateral spinal anesthesia with 2%hyperbaric prilocaine in day-case inguinal herniorrhaphy:a randomized controlled trial[J].Minerva Anestesiol,2014,80(6):685-691.
[5]Hanlon John G,Peng Philip WH.Caudal epidural injections in adult patients.Regional nerve blocks in anesthesia and pain therapy:traditional and ultrasound-Guided techniques[M].Cham:Springer International Publishing,2015:585-596.
[6]Fukazawa K,Matsuki Y,Ueno H,et al.Risk factors related to accidental intravascular injection during caudal anesthesia[J].J Anesth,2014,28(6):940-943.doi:10.1007/s00540-014-1840-8.
[7]高申山,刘友坦.腰麻中的心跳骤停[J].国际麻醉学与复苏杂志,2014,35(1):55-59.doi:10.3760/cma.j.issn.1673-4378.2014.01.015.
[8]Borges LA,da Cunha Leal P,Rey Moura EC,et al.Randomized clinical study on the analgesic effect of local infiltration versus spinal block for hemorrhoidectomy[J].Sao Paulo Med J,2017,135(3):247-252.doi:10.1590/1516-3180.2017.0001260117.
[9]Soltani Mohammadi S,Piri M,Khajehnasiri A.Comparing Three different modified sitting positions for ease of spinal needle insertion in patients undergoing spinal anesthesia[J].Anesth Pain Med,2017,7(5):e55932.doi:10.5812/aapm.55932.
[10]Davoudi M,Tarbiat M,Ebadian MR,et al.Effect of position during spinal anesthesia on postdural puncture headache after cesarean section:a prospective,single-blind randomized clinical trial[J].Anesth Pain Med,2016,6(4):e35486.doi:10.5812/aapm.35486.
[11]Arevalo-Rodriguez,Munoz L,Godoy-Casasbuenas N,et al.Needle gauge and tip designs for preventing post-dural puncture headache(PDPH)[J].Cochrane Database Syst Rev,2017,4:CD010807.doi:10.1002/14651858.CD010807.pub2.
[12]Khraise WN,Allouh MZ,El-Radaideh KM,et al.Assessment of risk factors for postdural puncture headache in women undergoing cesarean delivery in Jordan:a retrospective analytical study[J].Local Reg Anesth,2017,10:9-13.doi:10.2147/LRA.S129811.
[13]Tekgul ZT,Pektas S,Turan M,et al.Acute back pain following surgery under spinal anesthesia[J].Pain Pract,2015,15(8):706-711.doi:10.1111/papr.12260.
[14]汪伟,郁万友,钱燕宁.芬太尼复合小剂量布比卡因腰麻在老年患者下肢手术的应用[J].临床麻醉学杂志,2013,29(11):1088-1090.doi:10.3760/cma.j.issn.1673-4378.2014.01.015.
[15]张景山,李飞.布比卡因与左布比卡因在剖宫产术中的麻醉效果比较[J].河北医学,2016,22(7):1152-1155.doi:10.3969/j.issn.1006-6233.2016.07.038.
[16]石岩.电脑泵控制布比卡因注射速度用于腰麻的临床观察[D].广州:中山大学,2006.
[17]Imbelloni LE.Spinal hemianesthesia:unilateral and posterior[J].Anesth Essays Res,2014,8(3):270-276.doi:10.4103/0259-1162.143108.
[18]Gebhardt V,Mueller-Hansen L,Schwarz A,et al.Chloroprocaine 10mg/ml for low-dose spinal anaesthesia in perianal surgery-a randomised dose finding study[J].Acta Anaesthesiol Scand,2017,61(2):241-249.doi:10.1111/aas.12839.
[19]Prakash S,Mullick P.Spinal anesthesia and direction of spinal needle bevel[J].J Anaesthesiol Clin Pharmacol,2016,32(2):268-269.doi:10.4103/0970-9185.173360.
[20]Moosavi Tekye SM,Alipour M.Comparison of the effects and complications of unilateral spinal anesthesia versus standard spinal anesthesia in lower-limb orthopedic surgery[J].Braz J Anesthesiol,2014,64(3):173-176.doi:10.1016/j.bjane.2013.06.014.
[21]Gebhardt V,Hausen S,Weiss C,et al.Using chloroprocaine for spinal anaesthesia in outpatient knee-arthroscopy results in earlier discharge and improved operating room efficiency compared to mepivacaine and prilocaine[J].Knee Surg Sports Traumatol Arthrosc,2018(26):167.doi:10.1007/s00167-018-5327-2.
[22]Gebhardt V,Herold A,Weiss C,et al.Dosage finding for low-dose spinal anaesthesia using hyperbaric prilocaine in patients undergoing perianal outpatient surgery[J].Acta Anaesthesiol Scand,2013,57(2):249-256.doi:10.1111/aas.12031.
[23]Gebhardt V,Kiefer K,Bussen D,et al.Retrospective analysis of mepivacaine,prilocaine and chloroprocaine for low-dose spinal anaesthesia in outpatient perianal procedures[J].Int J Colorectal Dis,2018,33(10):1469-1477.doi:10.1007/s00384-018-3085-8.
[24]Kucur M,Goktas S,Kaynar M,et al.Selective low-dose spinal anesthesia for transrectal prostate biopsy:a prospective and randomized study[J].J Endourol,2015,29(12):1412-1417.doi:10.1089/end.2015.0450.