膝关节镜手术中局部麻醉和脊椎麻醉的临床比较

目的比较局部麻醉和脊椎麻醉在膝关节镜手术中的效果、可靠性及安全性.方法 自2008年6月至2010年5月对478例在脊椎麻醉或者局部麻醉下行膝关节镜检查的患者进行回顾性研究,其中局部麻醉186例（38.9%）,脊椎麻醉292例（61.1%）.局部麻醉患者用2%利多卡因加肾上腺素,局部及关节腔内注射,脊椎麻醉患者用0.75%布比卡因.对比以下指标：术中疼痛、患者及术者的满意度、术后疼痛、术后首次排尿时间、术后并发症.结果 局部麻醉和脊椎麻醉组中,分别有94.1%（175/186）和98.3%（287/292）的患者术中未感觉到疼痛;两组中分别有93.0%（173/186例）和96.2%（281/292例）的患者表示对麻醉效果满意或者很满意;术后6 h内患者疼痛比较,局部麻醉组与脊椎麻醉组间有统计学差异（P〈0.05）;术后首次排尿时间,局部麻醉组与脊椎麻醉组间有统计学差异（P〈0.05）;术后并发症的发生,两组间统计学上有明显差异,局部麻醉组明显低于脊椎麻醉组（P〈0.05）.结论 局部麻醉对于膝关节镜手术是一种简单、有效的麻醉方法,相比脊椎麻醉更具有可靠性和安全性,对于那些膝关节镜检查或者清理冲洗、游离体取出术甚至普通的半月板成形术均可采用局部麻醉下进行.

Efficacy of local and spinal anesthesia in knee arthroscopy

Objective To assess the efficacy, safety and complications of local and spinal anesthesia. Methods From June 2008 to May 2010, 478 cases of arthroscopy were retrospectively studied, including 186 cases of local anesthesia （LA group） and 292 cases of spinal anesthesia （SA group）. LA group received portal and intra-articular injection with 2% lidocaine and epinephrine. SA group received 0.75% bupivacaine. The following parameters were assessed： intraoperative pain, patient and surgeon satisfaction, postoperative pain, postoperative spontaneous urination and postoperative complication. Results In the LA and SA groups, 94. 1% （175/ 186 ） and 98.3% （287/ 292 ） of patients experienced no pain throughout the procedure, respectively; 93.0% （173/186） and 96.2% （281/292） of patients were either satisfied or very satisfied with their anesthesia. The need of postoperative analgesics in 6 hours was higher in SA compared with LA group （ P 〈 0. 05 ）. The time of postoperative spontaneous urination was significantly shorter in SA group compared with LA group （P 〈 0. 05 ）. The incidence of complications differed significantly between LA and SA groups （ P 〈 0. 05 ）. Conclusions Knee arthroscopic surgery under local anesthesia is simple and efficacy. Furthermore, it＇ s safer than spinal anesthesia. For patients who are undergoing intra-articular disorders requiring diagnostic arthroscopy and some simple arthroscopic surgery, this technique can be applied.