A systematic review of adjuncts for intravenous regional anesthesia for surgical procedures
A systematic review of adjuncts for intravenous regional anesthesia for surgical procedures
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DOI：
10.1007/bf03020416
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发表时间：
2002-01-01
期刊：
影响因子：
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通讯作者：
Peng, P
中科院分区：
文献类型：
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作者：
Choyce, A;Peng, P
目的：回顾静脉区域麻醉（IVRA）辅助麻醉在外科手术中的应用，包括术中效果（阻滞和止血带疼痛的效果）和术后镇痛。资料来源：系统检索（Medline, Embase，参考文献列表）进行了随机、对照和双盲研究，使用IVRA辅助手术。收集术中效果（阻滞和止血带疼痛的发生/抵消和质量）、术后效果（疼痛强度和镇痛药消耗）和副作用的数据。原始报告中指出的统计显著性和可能的临床相关性被考虑在内，以得出总体效益的判断。主要发现：29项研究符合所有纳入标准。包括1217名研究对象的数据。使用的辅助药物有阿片类药物（芬太尼、哌替啶、吗啡、舒芬太尼）、曲马多、非甾体抗炎药（非甾体抗炎药；酮洛酸、替诺昔康、乙酰水杨酸）、可乐定、肌肉松弛剂（阿曲库铵、泮库溴铵、米瓦库铵）、碳酸氢钠、钾和温度碱化。有很好的证据推荐非甾体抗炎药，特别是酮罗拉酸，用于改善术后镇痛。可乐定1杯（.）公斤（-1）似乎也能改善术后镇痛并延长止血带耐受性。阿片类药物通过这种途径是很差的；只有30毫克或更多的哌啶有实质性的术后益处，但代价是通缩后恶心，呕吐和头晕。肌肉松弛剂改善术中运动阻滞，帮助骨折复位。结论：非甾体抗炎药或可乐定辅助IVRA可改善术后镇痛，肌肉松弛剂可改善术后运动阻滞。
Purpose: To review the use of adjuncts to intravenous regional anesthesia (IVRA) for surgical procedures in terms of their intraoperative effects (efficacy of block and tourniquet pain) and postoperative analgesia.Source: A systematic search (Medline, Embase, reference lists) for randomized, controlled and double-blinded studies using adjuncts to IVRA for surgical procedures was conducted. Data were collected on intraoperative effects (onset/offset and quality of block and tourniquet pain), postoperative effects (pain intensity and analgesic consumption) and side effects recorded. Statistical significance as indicated in the original report and likely clinical relevance were taken into account to arrive at a judgment of overall benefit.Principal findings: Twenty-nine studies met all inclusion criteria. Data on 1,217 study subjects are included. Adjuncts used were opioids (fentanyl, meperidine, morphine, sufentanil), tramadol, nonsteroidal anti-inflammatory drugs (NSAIDs; ketorolac, tenoxicam, acetyl-salicylate), clonidine, muscle relaxants (atracurium, pancuronium, mivacurium), alkalinization with sodium bicarbonate, potassium and temperature. There is good evidence to recommend NSAIDs in general and ketorolac in particular, for improving postoperative analgesia. Clonidine 1 mug(.)kg(-1) also appears to improve postoperative analgesia and prolong tourniquet tolerance. Opioids are poor by this route; only meperidine 30 mg or more has substantial postoperative benefit but at the expense of postdeflation nausea, vomiting and dizziness. Muscle relaxants improve intraoperative motor block and aid fracture reduction.Conclusion: Using NSAIDs or clonidine as adjuncts to IVRA improves postoperative analgesia and muscle relaxant improves motor block.