超声引导下硬膜外和蛛网膜下腔麻醉在肛肠手术中的比较：一项随机对照试验

超声引导下硬膜外和蛛网膜下腔麻醉在肛肠手术中的比较：一项随机对照试验

贵州医科大学     麻醉与心脏电生理课题组

翻译：安丽  编辑：张中伟  审核：曹莹

罂 粟 摘 要   

背景：本研究的目的是观察超声引导下蛛网膜下腔麻醉(SA)和硬膜外麻醉(CEB)对围手术期肛肠手术患者效果满意度的影响。

方法：106例患者随机分配接受蛛网膜下腔麻醉组(SA组)和硬膜外麻醉组(CEB组)，其中11例患者被排除。最后95例纳入研究，其中SA组48例，CEB组47例进行数据分析。主要观察指标是患者对麻醉效果的满意度。次要观察指标包括术后2、4、8、16、24和48小时休息时疼痛评分（NRS评分）、首次要求镇痛的时间、镇痛需求、幻肢综合征(PLS)发生率、肠功能恢复的时间、下床活动时间、术后恶心呕吐(PONV)发生率、术中平均动脉压(MAP)降低发生率[较基线降低20%]和外科医生满意度。

结果：与CEB组相比，SA组患者对麻醉效果的满意度显著降低(分别SA组为20.8%，CEB组为68.1%)。与SA组相比，休息时NRS评分术后4、8、16和24 h 显著降低。SA组患者首次申请镇痛的时间明显早于CEB组患者。CEB组的镇痛需求、PLS发生率、PONV发生率和术中MAP降低发生率[比基线降低20%]均显著降低。两组之间在肠功能恢复的时间、下床活动时间和外科医生满意度上无显著差异。

结论：超声引导下相对于蛛网膜下腔麻醉，硬膜外麻醉在肛肠手术中，患者有较高的满意度。

原始文献来源：Shibiao Chen . Aiping Wei . Jia Min . Lei Li . Yang Zhang.Comparison of Ultrasound-Guided Caudal Epidural Blocks and Spinal Anesthesia for Anorectal Surgery: A Randomized Controlled Trial.Pain Ther (2022) 11:713–721.doi.org/10.1007/s40122-022-00389-7.

英文原文   

Comparison of Ultrasound-Guided Caudal Epidural

Blocks and Spinal Anesthesia for Anorectal Surgery:

A Randomized Controlled Trial

Abstract

Introduction: The aim of this study is to observe the effect of spinal anesthesia (SA) and ultrasound-guided caudal epidural blocks (CEB) on perioperative satisfaction in patients undergoing anorectal surgery.

Methods: A group of 106 patients were randomly allocated to receive either SA (the SA group) or CEB (the CEB group), and 11 patients were excluded. Finally, 95 patients were left, with 48 in the SA group and 47 in the CEB group for data analysis. The primary endpoint was patient satisfaction with the quality of their anesthetic technique. The secondary outcome measures included postoperative pain at 2, 4, 8, 16, 24, and 48 h after surgery at rest, time to first

analgesic request, analgesia requirements, incidence of phantom limb syndrome (PLS), time until return of bowel function, time to ambulation, incidence of postoperative nausea and vomiting (PONV), intraoperative mean arterial pressure (MAP) reduction [20% from baseline, and surgeon satisfaction.

Results: A significantly lower proportion of patients in the SA group was highly satisfied with the quality of their anesthetic technique compared with the CEB group (20.8% versus68.1%). NRS scores at rest were significantly lower at 4, 8, 16, and 24 h after surgery in the CEB group compared with the SA group. The time to first analgesic request was significantly earlier for patients in the SA group compared with patients in the CEB group. Analgesia requirements, the incidence of PLS, the incidence of PONV, and intraoperative MAP reduction [ 20% from baseline were significantly decreased in the CEB group. There were no significant differences between the groups in time until return of bowel function, surgeon satisfaction, or time to ambulation.

Conclusions: Ultrasound-guided caudal epidural blocks have higher patient satisfaction compared with spinal anesthesia.

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