目的:这项前瞻性研究探讨了在椎管麻醉下进行腹腔镜盆腔手术的可行性,并分析了术中的副作用。像疼痛,恶心,和呕吐物,915名患者。
方法:对915例患者(3212例患者在脊椎麻醉下进行了腹腔镜盆腔手术)在局部麻醉下进行腹腔镜手术的实施和表现与BMI(体重指数)的关系进行了分析。肥胖,手术过程中的疼痛,腹膜内mmHgCO2气体压力,和手术并发症。
结果:BMI>30,腹腔粘连,手术持续时间增加,出血,腹膜内CO2压力升高是脊髓麻醉下腹腔镜手术中疼痛的主要原因。体重过轻的患者,另一方面,与正常体重相比,当腹内压力增加时疼痛较少。疼痛的出现,恶心,10.3%的病人出现呕吐,这些事件很容易管理和治疗。他们没有影响外科医生的工作或手术过程。
结论:根据这些观察,对于没有禁忌症的患者,我们建议将脊髓麻醉作为腹腔镜手术的首选。据我们所知,这项临床研究构成了最大的关于腹腔镜盆腔手术腰麻的临床观察和数据集。
背景:ISRCTN38987,2019年12月10日。
OBJECTIVE: This prospective study investigated the feasibility of performing laparoscopic pelvic surgery under spinal anesthesia and analyzed the intraoperative side effects, like pain, nausea, and vomitus, of 915 patients.
METHODS: The implementation and performance of laparoscopic surgery under local anesthesia on 915 patients (out of a total of 3212 who underwent laparoscopic pelvic surgery under spinal anesthesia) were analyzed in relation to BMI (body mass index), obesity, pain during surgery, amount of intraperitoneal mmHg CO2 gas pressure, and surgical complications.
RESULTS: BMI > 30, intra-abdominal adhesions, increased duration of the operation, bleeding, and increased intraperitoneal CO2 pressure were statistically significant as the main causes of pain during laparoscopic surgery under spinal anesthesia. Underweight patients, on the other hand, had less pain when intra-abdominal pressure increased compared to those of normal weight. The appearance of pain, nausea, and vomitus occurred in 10.3% of patients, and these events were easy to manage and treat. They did not affect the surgeon\'s work or the course of the operation.
CONCLUSIONS: In light of these observations, we are proposing spinal anesthesia for laparoscopic surgery as the first choice in patients who have no contraindications. To the best of our knowledge, this clinical study constitutes the largest clinical observation and dataset concerning spinal anesthesia in laparoscopic pelvic surgery.
BACKGROUND: ISRCTN38987, 10 December 2019.