局部/区域麻醉与全身麻醉在法兰克斯骨折/脱位时
Matthew D Rich1, Anna Rauzi1, Thomas J Sorenson2
1Division of Plastic Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
Plastic surgery (Oakville, Ont.)
|November 4, 2024
概括
骨骨折的局部或区域麻醉与全身麻醉的结果相似,并发症率相似. 这种方法提供了一个安全的替代品,当全身麻醉不喜欢.
科学领域:
- 整形外科手术 整形外科手术
- 麻醉学 麻醉学
背景情况:
- 传统的法兰克斯骨折修复使用全身麻醉.
- 完全清醒的局部麻醉无护 (WALANT) 为患者提供了一个替代方案,在这种情况下,全身麻醉是禁忌或不受欢迎的.
- 区域/局部麻醉可以减轻与全身麻醉相关的并发症.
研究的目的:
- 为了比较局部/区域麻醉的结果和不良事件与骨骨折/脱位修复的全身麻醉.
- 测试本地/区域麻醉与全身麻醉产生相似的结果和较少的不良事件的假设.
主要方法:
- 使用美国外科医生学院国家外科质量改善计划 (NSQIP) 数据库 (2015-2019) 的回顾性队列研究.
- 包括接受手术固定法兰克斯骨折或脱位的患者,按麻醉类型分层 (局部/区域或全身).
- 对手术前的人口统计数据和30日术后并发症的分析.
主要成果:
- 总共有2831名患者被分析;13%接受了局部/区域麻醉,87%接受了全身麻醉.
- 在两个麻醉组之间没有观察到手术部位发生的临床显著差异.
- 报告的30天术后并发症的低率为两个队列,包括深静脉血栓症 (0.03%) 和肺栓塞 (0.02%) 在本地/区域组,肺炎 (0.12%) 和中风 (0.08%) 在全身麻醉组.
结论:
- 局部/区域麻醉技术对于手术修复骨折和位是安全的.
- 这些技术为全身麻醉提供了可行的替代方案,特别是当全身麻醉是不必要的时候.
- 30天内术后并发症的发生率在法兰克斯手术的局部/区域和全身麻醉方法之间是可比的.
相关概念视频
Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia
367
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...
367
Local Anesthetics: Clinical Application as Spinal Anesthesia
585
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...
585
General Anesthesia: Overview
196
Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
196
Local Anesthetics: Clinical Application as Epidural Anesthesia
414
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...
414
Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia
976
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...
976
Local Anesthetics: Adverse Effects
392
While local anesthetics are generally safe and well-tolerated, they can occasionally cause adverse effects that vary in severity. Local anesthetics can induce toxicity at two distinct levels. They can either produce local effects through direct contact with the neural elements or be absorbed into the bloodstream from the injection site, leading to systemic effects.
Once absorbed into the systemic circulation, local anesthetics can affect the organs that depend on the functioning of sodium...
Once absorbed into the systemic circulation, local anesthetics can affect the organs that depend on the functioning of sodium...
392


