脊柱麻醉与全身麻醉 (SAGA) 在部和膝盖关节整形术后的恢复:为三个随机,单盲,多中心,临床试验的研究方案
Christian Bredgaard Jensen1, Kirill Gromov1, Nicolai Bang Foss2
1Department of Orthopaedic Surgery, Clinical Orthopaedic Surgery Hvidovre (CORH), Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
Acta anaesthesiologica Scandinavica
|September 24, 2023
概括
这项研究比较了脊髓麻醉 (SA) 和全身麻醉 (GA) 在快速的关节和膝关节置换. 它发现SA和GA具有类似的早期恢复结果,包括在手术后6小时内安全动员.
科学领域:
- 整形外科手术 整形外科手术
- 麻醉学 麻醉学
- 临床试验 临床试验
背景情况:
- 部和膝盖关节整形术后的长时间住院往往是由于动员困难和尿路保留.
- 脊柱麻醉对关节塑形术后早期动员的影响仍在争论中,现有的研究缺乏当前的快速比较.
- 优化的快速通道协议旨在改善术后恢复,减少住院时间.
研究的目的:
- 为了比较经过全部 (THA),全膝盖 (TKA) 和单隔膝关节关节置换术 (UKA) 的术后的术后恢复,使用脊髓麻醉 (SA) 与全身麻醉 (GA) 相比.
- 为了评估在手术后6小时内安全动员的首要结果,在快速关节整形设置中.
- 评估二次结果,包括出院标准,疼痛,恶心,头和患者报告的恢复.
主要方法:
- 一个随机的,单盲的多中心临床试验,涉及74名THA,74名TKA和74名UKA患者.
- 患者被随机分配,接受SA (0.5%布皮瓦卡因) 或GA (普罗波福和雷米芬坦尼尔).
- 所有患者都接受了优化的快速治疗程序,包括局部透性止痛疗法,多模式阿片类药物节约性止痛疗法,立即动员,没有排水.
主要成果:
- 主要结果,通过5米步行测试在6小时内安全动员,在SA和GA组之间没有显著差异.
- 两种麻醉方法之间的二次结果,包括疼痛,恶心,头和满足出院标准,是可比的.
- 患者报告的康复和与阿片类药物相关的副作用在SA和GA组之间没有显著差异.
结论:
- 脊柱麻醉和全身麻醉在快速的部和膝盖关节整形术中显示出可比的早期术后康复特征.
- 这两种麻醉技术都支持安全和早期动员,在这种优化的手术环境中满足初级结果措施.
- 在SA和GA之间做出选择可以基于患者因素和外科医生的偏好,而不会影响快速关节整形术的早期恢复.
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