超声引导下的鼻骨神经节阻滞治疗鼻窦镜手术后出现躁动的疗效：一项随机双盲对照研究。

IF 3.7 3区医学 Q1 ANESTHESIOLOGY

Anaesthesia Critical Care & Pain Medicine Pub Date : 2024-10-02 DOI:10.1016/j.accpm.2024.101429

Rasha Hamed , Loay Gamal , Saeid Elsawy , Mohammed Abdelmoneim Baker , Yara Hamdy Abbas

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引用次数: 0

摘要

背景：据报道，鼻腔手术在全身麻醉后出现躁动的发生率很高。出院躁动（EA）会增加手术部位出血、跌落手术台、拔除导管和静脉管路以及自行拔管的风险。本研究调查了神经阻滞在 EA 中的作用：本研究评估了超声引导下的脊神经节阻滞（SPGB）对鼻窦镜手术后 EA 的影响。主要结果是 EA 的发生率。次要结果包括手术野的质量、出血量、吸入麻醉、MAC、PACU 的 VAS、术后镇痛持续时间和 24 小时阿片类药物总消耗量：这项双盲随机对照研究共招募了 120 名患者，其中 110 人完成了研究。他们被随机分配到两个相同的组别：G1组接受全身麻醉和双侧椎旁神经节阻滞（SPBG），每侧5毫升2%利多卡因；G2组（对照组）接受全身麻醉和双侧椎旁生理盐水注射，每侧5毫升：结果：与 G2 相比，G1 的 EA 发生率明显降低（20% 对 64%）。与 G2 相比，G1 的术中出血量明显减少，手术视野质量明显提高。与 G2 相比，G1 在 PACU 中的疼痛严重程度明显降低，术后 24 小时的阿片类药物用量也明显减少。此外，G1 的术后镇痛时间明显长于 G2（9 小时对 3 小时）：SPGB有效降低了鼻窦镜手术后EA的发生率、严重程度和持续时间。此外，SPGB 减少了鼻窦手术后的术中出血，改善了手术视野质量，延长了术后镇痛时间，减少了 24 小时阿片类药物的用量：注册：国家临床试验注册中心，NCT04168879。

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Efficacy of ultrasound guided sphenopalatine ganglion block in management of emergence agitation after sinoscopic nasal surgery: a randomized double-blind controlled study

Background

Nasal surgery has a reported high incidence of agitation during emergence from general anesthesia. Emergence Agitation (EA) increases the risk of surgical site bleeding, falling off the operating table, removal of catheters and intravenous lines, and self-extubation. This study investigated the role of nerve block in EA.

Objectives

This study evaluated the effect of ultrasound-guided sphenopalatine ganglion block (SPGB) on EA after sinoscopic nasal surgery. The primary outcome was the incidence of EA. Secondary outcomes included the quality of the surgical field, bleeding volume, inhalational anesthesia, MAC, VAS in the PACU, postoperative analgesia duration, and total 24 -h opioid consumption.

Patients and methods

This double-blind, randomized controlled study enrolled 120 patients, of whom 110 completed the study. They were randomly allocated into two equal groups: G1, which received general anesthesia and a bilateral sphenopalatine ganglion block (SPBG) with 5 mL lidocaine 2% on each side, and G2 (control), which received general anesthesia and a bilateral sphenopalatine saline injection of 5 mL on each side.

Results

A significant decrease in the incidence of EA was found in G1 compared to G2 (20% vs. 64%). Intraoperative bleeding volume was significantly lower, and surgical field quality was significantly higher in G1 compared to G2. Pain severity was significantly lower in G1 in the PACU, and 24 h postoperative opioid consumption was significantly reduced compared to G2. Additionally, postoperative analgesia duration was significantly longer in G1 than in G2 (9 h vs. 3 h).

Conclusion

SPGB effectively reduced EA incidence, severity, and duration after sinoscopic nasal surgery. Furthermore, SPGB reduced intraoperative bleeding, improved surgical field quality, prolonged postoperative analgesia, and reduced 24 -h opioid consumption after sinoscopic nasal surgery.

Registration

National Clinical Trial Registry, NCT04168879.

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来源期刊

Anaesthesia Critical Care & Pain Medicine ANESTHESIOLOGY-

CiteScore

6.70

自引率

5.50%

发文量

150

审稿时长

18 days

期刊介绍： Anaesthesia, Critical Care & Pain Medicine (formerly Annales Françaises d''Anesthésie et de Réanimation) publishes in English the highest quality original material, both scientific and clinical, on all aspects of anaesthesia, critical care & pain medicine.