皮肤内镜腰椎切除术的外周麻醉与局部麻醉:系统性审查和元分析
James Mooney1, Nicholas Erickson1, Nicholas Laskay1
1Department of Neurosurgery, University of Alabama at Birmingham, AL.
Clinical spine surgery
|June 22, 2023
概括
局部麻醉 (LA) 可能比外周麻醉 (EA) 更好地缓解皮肤内镜腰椎切除术 (PELD) 的疼痛,尽管这两种方法都是安全的. 需要进一步的研究来证实EA的短期益处.
科学领域:
- 神经外科 神经外科
- 麻醉学 麻醉学
- 脊柱外科手术 脊柱外科手术
背景情况:
- 穿皮内镜腰椎切除术 (PELD) 为全身麻醉 (GA) 提供了替代方案,包括局部麻醉 (LA) 和外周麻醉 (EA).
- 对于PELD,LA与EA在患者报告的结果 (PRO) 和并发症方面的比较有效性尚不清楚.
- 了解这些差异对于优化PELD程序和患者康复至关重要.
研究的目的:
- 系统地审查和比较患者报告的结果 (PROs) 和在局部麻醉 (LA) 和外周麻醉 (EA) 下PELD后的并发症率.
- 评估麻醉类型对PELD后疼痛评分 (VAS) 和功能状态 (ODI) 的影响.
- 评估LA和EA之间的手术结果,包括PELD的并发症率,复发性磁盘和重新手术率.
主要方法:
- 从数据库创建到2021年8月16日发表的研究的系统审查和元分析,来源于PubMed,EMBASE和SCOPUS.
- 纳入标准要求研究报告PRO数据,并对LA或EA下进行的PELD进行超过6个月的随访.
- 收集的数据包括背部/腿部疼痛的视觉模拟量表 (VAS),奥斯威斯特残疾指数 (ODI) 评分,并发症率 (硬膜切除,重新手术等). ) 的情况.
主要成果:
- 该审查包括56项研究,涉及4465名患者 (366名EA,4099名LA).
- 在LA和EA组之间,整体并发症率,持续性切除,停留时间,复发性磁盘,和重新手术率是可比的.
- 局部麻醉 (LA) 在随访时在VAS背部/腿部和ODI得分上显示出明显的改善,相比之下,外周麻醉 (EA) 在VAS背部得分上没有显著改善.
结论:
- 外周麻醉 (EA) 为PELD提供了局部麻醉 (LA) 的安全替代方案,有可能提高患者的舒适度.
- 研究的局限性包括显著的偏见和异质性,这需要谨慎地解释研究结果.
- 进一步的研究是必要的,以确定EA是否提供优越的短期患者报告结果的好处比LA在PELD.
相关概念视频
Local Anesthetics: Clinical Application as Epidural Anesthesia
460
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
460
Local Anesthetics: Clinical Application as Spinal Anesthesia
684
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
684
Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia
479
Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
One of the advantages of...
479
Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia
1.1K
Depending on the target organ, local anesthetics (LAs) can be administered via various routes. In surface anesthesia, LAs are applied directly to the surface of the skin or mucous membranes. It is widely used for topical skin numbing before venipuncture or minor surgical procedures. Commonly used surface local anesthetics are lidocaine or benzocaine sprays or creams. Surface anesthesia occurs within 5 minutes and lasts for about 60 minutes. One of the main disadvantages of topical anesthesia is...
1.1K
Local Anesthetics: Pharmacokinetics
809
The potency and duration of action of local anesthetics (LAs) are determined by their pharmacokinetics. Pharmacokinetics describes how LAs are absorbed, distributed, metabolized, and eliminated from the body. When administered to the vascular tissues, LAs are quickly absorbed and enter the systemic circulation, reducing their localized effects. Adding vasoconstrictors such as epinephrine to LAs reduces their absorption into the systemic circulation, making them clinically effective. The...
809
Local Anesthetics: Differential Sensitivity of Nerve Fibers
878
Local anesthetics (LAs) block the sodium channels of nerve trunks, sensory nerve endings, and neuromuscular junctions. Although LAs can block all kinds of nerves, the sensitivity of nerve fibers differs according to nerve types and structures. LAs are known to block myelinated fibers faster than unmyelinated ones. Also, they block pain or sensory neurons at low concentrations without affecting the motor neurons involved in muscle contractions. This helps relieve labor pain without affecting the...
878


