Ultrasound guided brachial plexus block plus TCI-propofol sedation provides better perioperative outcomes than inhalation general anesthesia in hemodialysis patients undergoing arteriovenous shunt surgery

臂神經叢阻斷術配合propofol鎮靜於接受動靜脈廔管手術之透析病人有較優之圍術期結果

莊文銘(Wen-Ming Chuang) ； 謝俊祺(Jockey Tse) ； 陳柏君(Po-Chun Chen) ； 林文嬌(Wen-Chiao Lin) ； 盧奕丞(I-Cheng LI) ； 蘇妙佩(Miao-Pei SU)

《疼痛醫學雜誌》 26卷2期 (2016/09) Pp. 69-76

摘要

Background: Both regional blocks and general anesthesia can be used in arteriovenous shunt surgery. The purpose of this study is to determine how the anesthetic technique influence perioperative outcomes in arteriovenous (AV) shunt surgery. Methods: Retrospective review anesthetic records of 60 hemodialysis patients undergoing AV shunt surgery. Patients were allocated into GA group (general anesthesia with volatile anesthetics) and RA group (regional anesthesia with propofol sedation). Regional anesthesia was done by ultrasound-guided brachial plexus block. The demographic data, anesthetic parameters (including intravenous and inhalational anesthetics, narcotics, and inotropic agents), intraoperative hemodynamics (including blood pressure, heart rate, and oxygen saturation), postoperative pain scale, and adverse events during recovery period were all recorded. Results: Postoperative pain intensity was significantly lower in RA group than GA group (1.1 ±1.9 vs. 3.7 ±3.3, P ＜0.01). Patients required postoperative analgesics less frequently in RA group than in GA group (3/30, 10% vs. 12/30, 40%, p＜O.OOI). The experience of nausea/vomiting, itching and dizziness was significant reduced in RA group. RA group also depicted better hemodynamic profile than GA group. In GA group, more patients required hemodynamic support with inotropic agent (p＜0.01). There was no significant difference in HR for each group during anesthesia. Conclusion: Ultrasound guided brachial plexus block reduces postoperative pain and provides better hemodynamic stability in hemodialysis patients undergoing arteriovenous shunt surgery than general anesthesia.

關鍵字

regional anesthesia ； general anesthesia ； arteriovenous shunt surgery

並列摘要

背景：區域麻醉及全身麻醉兩者皆可施行於動靜脈廔管手術，此研究之目的在於確立麻醉方式對於接受動靜脈廔管手術病人術圍期之影響。方法：回溯調查過去六十位病患接受動靜脈分流術麻醉紀錄，病患被分為全身麻醉組（使用揮發性麻醉藥）及區域麻醉組（超音波導引臂神經叢阻斷術加上異丙酚鎮靜），紀錄包含病患基本資料，麻醉參數（靜脈藥物，揮發性麻醉藥物，麻醉藥物，強心藥物），心跳速率，平均動脈壓，血氧飽和濃度及術後恢復紀錄（疼痛與術後合併症）。結果：區域麻醉組病患比全身麻醉組術後疼痛情形較輕微（痛分為1.1±1.9與3.7±3.3, P＜0.01），區域麻醉組術後噁心、嘔吐、皮膚癢、頭暈等合併症發生情況也較少（發生率為3/30, 10%與12/30, 40%, p＜0.001）。此外，在麻醉中，區域麻醉組比全身麻醉組有較穩定的血壓變化，全身麻醉組有較多病患在術中使用升壓劑，而心跳速率變化則沒有顯著差異。結論：對於接受動靜脈廔管手術的病患，超音波導引之臂神經叢阻斷術比全身麻醉能有效減少術後疼痛程度並提供較穩定的術中血液動力狀態。

並列關鍵字

區域麻醉 ； 全身麻醉 ； 動靜脈廔管手術