不同局麻药腰麻对术后早期活动的影响

2020
09/04

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甲哌卡因与布比卡因腰麻对术后早期活动影响:一项随机对照试验。

 

分享一篇文献,关于腰麻选择不同药物对术后早期活动的影响。



原文链接

Schwenk ES, Kasper VP, Smoker JD, et al. Mepivacaine versus Bupivacaine Spinal Anesthesia for Early Postoperative Ambulation: A Randomized Controlled Trial [published online ahead of print, 2020 Jul 22]. Anesthesiology. 2020;10.1097/ALN.0000000000003480. doi:10.1097/ALN.0000000000003480

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摘要译文


甲哌卡因与布比卡因腰麻对术后早期活动影响:一项随机对照试验


背景:全髋关节置换术后能早期活动即可早期出院。临床上腰麻是首选的麻醉方式,但会导致术后活动延迟,尤其是布比卡因腰麻。甲哌卡因是一种中间作用的局部麻醉剂,可以比布比卡因更早地活动。本研究旨在验证如下假设:接受甲哌卡因腰麻的患者比接受高压或等压布比卡因腰麻的初次全髋关节置换术的患者能更早活动。


方法:这项随机对照试验选择美国麻醉师协会(ASA)1~3级,行初次全髋关节置换术的患者。患者1:1:1比例随机分成三组,分别接受52.5mg甲哌卡因腰麻、12.5mg高渗布比卡因腰麻或12.5mg等渗布比卡因腰麻。首要结果是在3到3.5小时之间活动。次要结果包括运动和感觉功能恢复、术后疼痛、阿片类药物消耗、暂时性神经症状、尿潴留、术中低血压、术中肌肉张力、当天出院、住院时间和30天再入院情况。


结果:154例患者中,50例接受甲哌卡因治疗,53例接受高渗布比卡因治疗,51例接受等渗布比卡因治疗。组间患者特征相似。在3到3.5小时活动情况,甲哌卡因组50名患者中有35名(70.0%)达到该终点,其次是高渗布比卡因组53名患者中的20名(37.7%),等渗布比卡因组51名患者中有9名(17.6%)达到终点(P<0.001)。甲哌卡因组运动功能恢复较早。仅在术后早期,甲哌卡因患者的疼痛和阿片类药物消耗量较高。对于非卧床状态,50例甲哌卡因患者中23例(46.0%),53例高渗布比卡因患者中13例(24.5%)和51例等渗布比卡因患者中11例(21.5%)当天出院(P=0.014)。甲哌卡因患者住院时间最短。在短暂的神经症状、尿潴留、低血压、肌肉紧张或头晕方面没有差异。


结论:与高渗布比卡因和等渗布比卡因患者相比,甲哌卡因患者术后活动早,当天出院的可能性更大。如果腰麻是首选的麻醉方式,甲哌卡因对门诊全髋关节置换术患者是有益的。


关于这个话题我们已经知道的:


全髋关节置换术后的早期活动是达到出院准备的关键。全髋关节置换术的腰麻药物尚未确定,该麻醉药应能平衡镇痛和早期活动。


这篇文章告诉我们的是新的:


在这项涉及154名患者的随机、三组研究中,与等渗或高渗布比卡因组相比,在注射后3至3.5小时内,甲哌卡因腰麻组的患者行走3至3.5小时的人数更多。同样,甲哌卡因组实现当天出院的患者比其他实验组的患者多。


Mepivacaine versus Bupivacaine Spinal Anesthesia for Early Postoperative Ambulation: A Randomized Controlled Trial


Background: Early ambulation after total hip arthroplasty predicts early discharge. Spinal anesthesia is preferred by many practices but can delay ambulation, especially with bupivacaine. Mepivacaine, an intermediate-acting local anesthetic, could enable earlier ambulation than bupivacaine. This study was designed to test the hypothesis that patients who received mepivacaine would ambulate earlier than those who received hyperbaric or isobaric bupivacaine for primary total hip arthroplasty.


Methods: This randomized controlled trial included American Society of Anesthesiologists Physical Status I to III patients undergoing primary total hip arthroplasty. The patients were randomized 1:1:1 to 52.5 mg of mepivacaine, 11.25 mg of hyperbaric bupivacaine, or 12.5 mg of isobaric bupivacaine for spinal anesthesia. The primary outcome was ambulation between 3 and 3.5 h. Secondary outcomes included return of motor and sensory function, postoperative pain, opioid consumption, transient neurologic symptoms, urinary retention, intraoperative hypotension, intraoperative muscle tension, same-day discharge, length of stay, and 30-day readmissions.


Results: Of 154 patients, 50 received mepivacaine, 53 received hyperbaric bupivacaine, and 51 received isobaric bupivacaine. Patient characteristics were similar among groups. For ambulation at 3 to 3.5 h, 35 of 50 (70.0%) of patients met this endpoint in the mepivacaine group, followed by 20 of 53 (37.7%) in the hyperbaric bupivacaine group, and 9 of 51 (17.6%) in the isobaric bupivacaine group (P < 0.001). Return of motor function occurred earlier with mepivacaine. Pain and opioid consumption were higher for mepivacaine patients in the early postoperative period only. For ambulatory status, 23 of 50 (46.0%) of mepivacaine, 13 of 53 (24.5%) of hyperbaric bupivacaine, and 11 of 51 (21.5%) of isobaric bupivacaine patients had same-day discharge (P = 0.014). Length of stay was shortest in mepivacaine patients. There were no differences in transient neurologic symptoms, urinary retention, hypotension, muscle tension, or dizziness.


Conclusions: Mepivacaine patients ambulated earlier and were more likely to be discharged the same day than both hyperbaric bupivacaine and isobaric bupivacaine patients. Mepivacaine could be beneficial for outpatient total hip arthroplasty candidates if spinal is the preferred anesthesia type. 


WHAT WE ALREADY KNOW ABOUT THIS TOPIC: 

Early ambulation after total hip arthroplasty is key to achieving readiness for dischargeThe spinal anesthetic for total hip arthroplasty that balances pain control with timely resolution of motor block has not been identified.


WHAT THIS ARTICLE TELLS US THAT IS NEW: 

In this randomized, three-arm study involving 154 patients, more individuals in the mepivacaine spinal group ambulated 3 to 3.5 h after injection than did individuals in either the isobaric or hyperbaric bupivacaine groupLikewise, more patients in the mepivacaine group achieved same-day discharge than patients in the other experimental groups.


本文由“小麻哥的日常”授权转载

本文由作者自行上传,并且作者对本文图文涉及知识产权负全部责任。如有侵权请及时联系(邮箱:guikequan@hmkx.cn
关键词:
麻醉,治疗,髋关节

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