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首页> 外文期刊>Revista Brasileira de Anestesiologia >Anestesia peridural lombar ou bloqueio do plexo lombar combinados à anestesia geral: eficácia e efeitos hemodinamicos na artroplastia total do quadril
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Anestesia peridural lombar ou bloqueio do plexo lombar combinados à anestesia geral: eficácia e efeitos hemodinamicos na artroplastia total do quadril

机译：腰麻硬膜外麻醉或腰丛神经阻滞联合全身麻醉：全髋关节置换术的疗效和血液动力学影响

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BACKGROUND AND OBJECTIVES: Anesthesia for total hip arthroplasty (THA) is a challenge due to the advanced age and associated diseases of patients. The objective of this study was to evaluate whether the efficacy of the nociceptive blockade, secondary hemodynamic effects, difficulty to execute the technique, and influence in intraoperative bleeding of lumbar plexus block combined with general anesthesia is equivalent to epidural lumbar block in patients undergoing THA. METHODS: Patients with physical status ASA I to III were randomly separated into two groups, Epidural and Lumbar. In the Epidural group, continuous epidural lumbar block with 10 to 15 mL of 0.5% ropivacaine was performed. Patients in the Lumbar group underwent posterior lumbar plexus block with 0.4 mL.kg-1 of 0.5% ropivacaine. All patients underwent general anesthesia. The difficulty to perform the technique, its efficacy, and secondary hemodynamic effects were evaluated. RESULTS: Forty-one patients were included in this study. The length of time to execute the epidural block was shorter, but the number of attempts to position the needle was similar in both groups. Epidural block was more effective. In the Lumbar group, an increase in diastolic blood pressure and mean arterial pressure (MAP) and in the double product was observed after the incision, and anesthetic consumption was greater. After the blockade, MAP was lower 50, 60, and 70 minutes after the epidural block. Bleeding was similar in both groups. CONCLUSIONS: Nociceptive blockade, which was not associated with hemodynamic instability when combined with general anesthesia, was more effective in epidural block. Lumbar plexus block proved to be a useful technique when combined with general anesthesia when epidural block is contraindicated.
机译：背景与目的：全髋关节置换术（THA）的麻醉由于患者的高龄及相关疾病而成为一项挑战。这项研究的目的是评估在接受THA的患者中，伤害性阻滞的疗效，继发的血液动力学效应，实施该技术的难度以及对腰丛神经阻滞加全身麻醉对术中出血的影响是否等同于硬膜外腰椎阻滞。方法：将身体状况为ASA I至III的患者随机分为两组，硬膜外和腰椎。在硬膜外组中，使用10％至15 mL的0.5％罗哌卡因进行连续硬膜外腰段阻滞。腰椎组患者用0.4 mL.kg-1的0.5％罗哌卡因进行腰后神经丛阻滞。所有患者均接受全身麻醉。评估了执行该技术的难度，其功效以及继发的血液动力学效应。结果：本研究纳入41例患者。执行硬膜外阻滞的时间较短，但两组中定位针的尝试次数相似。硬膜外阻滞更为有效。在腰椎组，切开后观察到舒张压和平均动脉压（MAP）的增加以及双重产品的增加，麻醉药的消耗量更大。封锁后，硬膜外阻滞后50、60和70分钟，MAP降低。两组的出血相似。结论：伤害性阻滞在硬膜外阻滞中更有效，后者在与全身麻醉联合使用时与血流动力学不稳定无关。当禁忌硬膜外阻滞时，与全麻联合应用腰丛神经阻滞是一种有用的技术。

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