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首页> 外文期刊>Medicine. >Cervical plexus anesthesia versus general anesthesia for anterior cervical discectomy and fusion surgery: A randomized clinical trial
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Cervical plexus anesthesia versus general anesthesia for anterior cervical discectomy and fusion surgery: A randomized clinical trial

机译：颈丛神经麻醉与全身麻醉进行颈椎前路椎间盘切除术和融合术：一项随机临床试验

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Both general anesthesia (GA) and cervical plexus anesthesia (CPA) can be used for anterior cervical discectomy and fusion (ACDF) surgery. The aim of this study was to evaluate the influence of anesthetic techniques on perioperative mortality and morbidity in patients undergoing cervical surgery. From January 2008 to December 2015, 356 patients who underwent 1-level ACDF for cervical spinal myelopathy were prospectively reviewed. They were assigned to receive GA (group A) and CPA (group B). The analgesic efficacy of the block was assessed by anesthesia preparation time, the maximum heart rate, and mean arterial blood pressure changes compared with the baseline, time of postoperative revival, and duration of recovery stay. Duration of surgery, blood loss, and anesthesia medical cost were also recorded. Numerical rating scale (NRS) was used to evaluate pain at different time points. Postoperative nausea and vomiting (PONV) was assessed, and postoperative average administered dosages of meperidine and metoclopramide were also recorded. The spinal surgeon satisfaction, anesthetist satisfaction, and patient satisfaction were assessed. Both the anesthesia induction time and postoperative revival time were longer in group A than that in group B; both the duration of surgery and recovery stay were also longer in group A than that in group B, whereas there was no difference in blood loss between the 2 groups. The average dosage of both meperidine and metoclopramide was more in group A than that in group B, and the anesthesia medical cost was greater in group A than that in group B. There were no significant differences in baseline data of systolic blood pressure, diastolic blood pressure, and heart rate between the 2 groups. But the intraoperative data of systolic blood pressure, diastolic blood pressure, and heart rate were higher/larger in group B than that in group A. In group A, there was no complaint of pain in the surgery procedure, but the pain increased after GA, with highest degree at 8 hours postoperation; then the pain degree decreased, and the NRS was 1 at 24 hours postoperation. In group B, intraoperative pain was NRS 4, and pain degree decreased from 4 hours postoperation; the NRS was 2 at 24 hours postoperation. The incidence of severe PONV was higher in group A than that in group B. There was no significant difference in the spinal surgeon satisfaction and anesthetist satisfaction for the anesthetic techniques. There was significant difference in patient satisfaction between the 2 groups, with high satisfaction for GA. General anesthesia is superior to CPA in maintaining better intraoperative hemodynamic stability and providing high patient satisfaction with no intraoperative pain for patients receiving ACDF, but it entails longer surgery and anesthesia time, and requires more postoperative analgesic and anesthesia cost.
机译：全身麻醉（GA）和颈丛神经麻醉（CPA）均可用于颈椎前路椎间盘切除术和融合术（ACDF）。这项研究的目的是评估麻醉技术对宫颈手术患者围手术期死亡率和发病率的影响。从2008年1月至2015年12月，对356例接受过1级ACDF治疗的颈椎脊髓病患者进行了前瞻性检查。他们被分配接受GA（A组）和CPA（B组）。通过麻醉准备时间，最大心率和平均动脉血压变化（与基线相比），术后恢复时间和恢复时间来评估阻滞的镇痛效果。还记录了手术时间，失血量和麻醉医疗费用。使用数字评分量表（NRS）评估不同时间点的疼痛。评估术后恶心和呕吐（PONV），并记录术后平均哌替啶和胃复安的剂量。评估脊柱外科医生的满意度，麻醉师的满意度和患者的满意度。 A组的麻醉诱导时间和术后恢复时间均长于B组。 A组的手术时间和恢复停留时间均长于B组，而两组之间的失血量无差异。 A组的甲哌丁啶和甲氧氯普胺的平均剂量均高于B组，而A组的麻醉医疗费用高于B组。收缩压，舒张期血压的基线数据无显着差异两组之间的血压和心率。但是B组的术中收缩压，舒张压和心率数据高于/大于A组。在A组，手术过程中无疼痛症状，但GA后疼痛增加，术后8小时最高学位;然后疼痛程度降低，术后24小时NRS为1。 B组术中疼痛为NRS 4，术后4小时疼痛程度有所减轻。术后24小时NRS为2。 A组严重PONV的发生率高于B组。麻醉技术对脊柱外科医生的满意度和麻醉师的满意度无显着差异。两组的患者满意度之间存在显着差异，对GA的满意度较高。全身麻醉在维持更好的术中血流动力学稳定性并为接受ACDF的患者提供更高的患者满意度且无术中疼痛方面优于CPA，但它需要更长的手术和麻醉时间，并且需要更多的术后镇痛和麻醉费用。

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