背景:住院时间(LOS)是所有类型手术中的重要关注点,并制定了增强术后恢复(ERAS)方案以改善围手术期管理和预后,这需要多学科管理。在疼痛控制方面,建议术中区域麻醉和术后阿片类药物保留镇痛.对于开放性脊柱手术,我们的目的是结合胸段硬膜外镇痛,以减少疼痛和阿片类药物相关的副作用,从而加快复苏。
目的:本研究旨在比较全麻与单纯胸段硬膜外注射联合全麻的全椎板切除术融合后的住院时间。
方法:随机单盲对照研究。
方法:选择了38例择期开放椎板切除术并进行I级和III级融合的患者。
方法:LOS,术后疼痛,24小时病人控制的吗啡消耗,患者满意度评分,和其他阿片类药物相关的副作用被记录。
方法:患者随机选择在T11-T12或T12-L1接受标准全身麻醉(GA)或GA联合单次胸段硬膜外麻醉,用10mL0.25%布比卡因阻滞,还有4毫克吗啡.
结果:组间人口统计学变量没有显著差异。联合硬膜外和/或GA的LOS显着低于对照组(3.78±0.81[平均值±标准偏差]和4.79±1.51天,分别;p=.017)。麻醉后监护病房的数字评分(休息时),术后24小时吗啡消耗量(mg),操作时间,硬膜外组的失血量明显降低。接受联合硬膜外和/或GA的患者更有可能报告更高的患者满意度(p=.008)。然而,术中低血压的发生率在硬膜外组明显较高(72.2%vs.21.1%,p=.003)。两组患者的不良事件发生率和手术野评分没有差异。
结论:择期腰椎手术患者的下胸硬膜外和/或GA联合治疗与LOS降低相关。
BACKGROUND: Length of hospital stay (LOS) is an important concern in all types of surgery, and the enhanced recovery after surgery (ERAS) protocol has been developed to improve perioperative management and outcomes, which require multidisciplinary management. In terms of pain control, intraoperative regional anesthesia and postoperative opioid-sparing analgesia are recommended. For open spine surgery, we aimed to combine thoracic epidural analgesia to reduce pain and opioid-related side effects, thereby hastening recovery.
OBJECTIVE: This study aimed to compare the length of hospital stay after open complete laminectomy with fusion between general anesthesia and combined general anesthesia involving a single thoracic epidural injection.
METHODS: A randomized single-blinded controlled study.
METHODS: Thirty-eight patients scheduled for elective open laminectomy with fusion between I and III levels were selected.
METHODS: LOS, postoperative pain, patient-controlled morphine consumption at 24 hours, patient satisfaction score, and other opioid-related side effects were recorded.
METHODS: Patients were randomly selected to receive standard general anesthesia (GA) or GA combined with a single-shot thoracic epidural at T11-T12 or T12-L1, a block with 10 mL of 0.25% bupivacaine, and 4 mg of morphine.
RESULTS: There were no significant differences in the demographic variables between groups. LOS was significantly lower in the combined epidural and/or GA than in the control group (3.78±0.81 [mean±standard deviation] and 4.79±1.51 days, respectively; p=.017). Numeric rating score (at rest) at the post-anesthesia care unit, 24 hours postoperative morphine consumption (mg), operating time, and blood loss were significantly lower in the epidural group. Patients who received combined epidural and/or GA were more likely to report higher patient satisfaction (p=.008). However, the incidence of intraoperative hypotension was significantly higher in the epidural group (72.2% vs. 21.1%, p=.003). The incidences of adverse events and surgical field rating scores did not differ between the 2 patient groups.
CONCLUSIONS: Combined lower thoracic epidural and/or GA in patients undergoing elective lumbar spine surgery was associated with decreased LOS.