Antiemetics in outpatient regional anesthesia for invasive orthopedic surgery.
Antiemetics in outpatient regional anesthesia for invasive orthopedic surgery.
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侵入性骨科手术门诊区域麻醉中的止吐药。
DOI：
10.1097/01.aia.0000166337.46380.0d
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发表时间：
2005
影响因子：
0.6
通讯作者：
Williams,BrianA
中科院分区：
文献类型：
--
作者：
Kentor,MichaelL;Williams,BrianA
使用挥发性药物（GAVA）和阿片类药物的传统全麻计划当然有利于麻醉部门和医院药房的特定项目预算，但这种技术充满了医院的“下游”费用，并且有可能引起患者的不满。有充分的证据表明，仅使用异丙酚进行诱导和维持的GA技术，或作为静脉镇静剂与区域麻醉（RA）联合使用的GA技术，术后恶心和/或呕吐（PONV）率明显低于GAVA技术，1-3因为挥发性药物和阿片类药物被认为是PONV的主要原因。仅使用异丙酚代替挥发性药物被认为是预防PONV的一种重要但不完整的方法。在一项研究中，需要3种止吐药，每种止吐药具有不同的作用机制，以在接受GAVA和接受异丙酚全静脉注射技术的患者中产生相同的PONV结果。5不加GA的RA技术历来被认为对PONV有保护作用，6但最近的研究表明，在同一类型的外科手术中比较不同的RA技术时，PONV的发生率可能存在显著差异。事实上，接受单次注射外周神经阻滞技术的住院患者，后来使用阿片类药物的患者控制静脉镇痛（PCIVA）装置，与使用PCIVA装置的GAVA患者相比，似乎没有任何显著的止呕吐预防益处。相比之下，接受持续外周神经阻滞持续镇痛的住院患者可获得额外的PONV预防益处。6
BackgroundA traditional general anesthesia plan with volatile agents (GAVA) and opioids is certainly favorable for specific line-item budgets of the anesthesia department and the hospital pharmacy, but this technique is fraught with “downstream” expenses for the hospital and carries with it a potential for patient dissatisfaction. It has been well-documented that GA techniques that exclusively use propofol for induction and maintenance, or as an intravenous sedative combined with regional anesthesia (RA), has a significantly lower postoperative nausea and/or vomiting (PONV) rate than do GAVA techniques, 1-3 because volatile agents and opioids are considered to be the leading causes of PONV. 4 Exclusive use of propofol instead of volatile agents is considered to provide an important but incomplete method of prevention of PONV. 4 In 1 study, 3 antiemetics, each having a different mechanism of action, are required to produce equivalent PONV outcomes in patients undergoing GAVA versus those undergoing propofol total intravenous technique. 5 RA techniques without GA are historically considered to be protective against PONV, 6 but recent research has indicated that there can be significant differences in the incidence of PONV when different RA techniques are compared for the same type of surgical procedure. 7 In fact, inpatients who are undergoing single-injection peripheral nerve block techniques who are later prescribed patient-controlled intravenous analgesic (PCIVA) devices with opioids do not appear to have any significant benefit of antiemetic prophylaxis versus similar patients undergoing GAVA with PCIVA devices. 6 In contrast, inpatients receiving sustained analgesia primarily with continuous peripheral nerve blocks are conferred additional PONV prevention benefits. 6