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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >NEURAXIAL ANESTHESIA FOR HIP ARTHROSCOPY IS ASSOCIATED WITH DECREASED IMMEDIATE POSTOPERATIVE PAIN SCORES AND OPIOID REQUIREMENTS COMPARED TO GENERAL ANESTHESIA
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NEURAXIAL ANESTHESIA FOR HIP ARTHROSCOPY IS ASSOCIATED WITH DECREASED IMMEDIATE POSTOPERATIVE PAIN SCORES AND OPIOID REQUIREMENTS COMPARED TO GENERAL ANESTHESIA

机译：与全身麻醉相比，髋关节视镜检查的神经麻醉与髋关节关节镜检查的直接术后疼痛评分和阿片类药物

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Background: Hip arthroscopy is most commonly performed utilizing general anesthesia. Studies in hip and knee arthroplasty have shown an association between neuraxial anesthesia and lower rates of perioperative adverse events, lower post-operative pain scores, and lower dosing of postoperative systemic analgesics when compared to general anesthesia. A direct comparison between neuraxial and general anesthesia in hip arthroscopy has not previously been investigated. Hypothesis/Purpose: We sought to identify the immediate post-operative differences in opioid use, pain scores, and post-anesthesia care unit (PACU) length of stay (LOS) after hip arthroscopy related to the type of anesthesia used for the surgical procedure. Methods: Patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) with labral tears by a single surgeon at an academic center between October 2017 and July 2019 were retrospectively reviewed. The primary outcome was PACU opioid administration, measured by morphine equivalents (MEQ). Secondary parameters included total LOS, post-incision LOS, PACU LOS and PACU arrival/discharge pain scores. Analyses conducted were t-tests, Wilcoxon rank sum tests, or chi-square tests. Results: A total of 129 patients met inclusion criteria for this study; 54 males and 75 females, with an average age of 28 (±10.1) years. 52 (40.3%) had general anesthesia and 77 (59.7%) had neuraxial anesthesia, including spinal, epidural, and combined spinal-epidural anesthesia which were intermixed throughout the study period. Intraoperative and PACU opioid administration demonstrated a significant difference in medians. Neuraxial methods required a lower MEQ in both the operating room (30.0 vs 53.9, p = 0.001) and PACU (18.2 vs 31.2, p = 0.002). Neuraxial anesthesia had lower median PACU arrival and discharge pain scores (0.0 vs. 5.0, p = 0.001, 3.0 vs. 4.0, p = 0.013). There was no statistically significant difference in post-incision LOS, or traction time. General anesthesia was associated with a longer PACU phase 1 time (1.0 vs. 1.3 hrs, p = 0.005). No major adverse events such as death, disability, or prolonged hospitalization occurred in either group. Conclusion: Neuraxial anesthesia use in routine hip arthroscopy was associated with lower immediate postoperative pain scores, lower intraoperative and immediate postoperative opioid requirements, and may be associated with shorter anesthesia recovery time without any major adverse events when compared to general anesthesia.
机译：背景：髋关节镜检查最常使用全身麻醉。与全身麻醉相比，髋关节和膝关节置换术的研究表明了神经麻醉和围手术期不良事件的较低速度，术后疼痛评分的率和较低的术后全身镇痛药。先前没有研究髋关节视镜中神经麻醉和全身麻醉之间的直接比较。假设/目的：我们试图确定阿片类药物使用，疼痛评分和麻醉后护理单位（PACU）髋关节关节镜检查后的患者的术后差异（PACU）与用于外科手术的麻醉类型。方法：2017年10月至2019年10月至2019年7月在2019年10月至2019年7月在2019年学术中心患有股骨孢子镜患者的髋关节动脉镜（FAIS）的患者。主要结果是PACU阿片类药物，通过吗啡等当量（MEQ）测量。辅助参数包括总LOS，切口后LOS，PACU LOS和PACU到达/放电疼痛评分。进行的分析是T检验，Wilcoxon等级和测试或Chi-Square测试。结果：共有129名患者符合本研究的纳入标准; 54名男性和75名女性，平均年龄为28（±10.1）岁。 52（40.3％）全身麻醉，77（59.7％）具有神经麻醉，包括脊柱，硬膜外和组合脊柱硬膜外麻醉，它们在整个研究期间混合。术中和PACU阿片类药物施用中位数均有显着差异。神经方法需要在手术室（30.0 Vs 53.9，P = 0.001）和PACU（18.2 Vs 31.2，P = 0.002）中的下部MEQ。神经麻醉具有较低的中位数吐温到达和排出疼痛评分（0.0 <0.0，P = 0.001,3.0，3.0，P = 0.013）。切口后滞后或牵引时间没有统计学上显着差异。全身麻醉与较长的PACU阶段1次（1.0 vs.1.3小时，P = 0.005）相关。在任一组中没有发生死亡，残疾或长期住院的主要不良事件。结论：常规髋关节镜检查的神经麻醉与术后术后疼痛评分较低，术中和立即术后阿片类药物需求相关，可能与与全身麻醉相比，没有任何主要不良事件的短暂麻醉恢复时间相关。

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