Background: Pneumatic arterial tourniquet is a utilized strategy in limb surgeries to provide bloodless field to facilitate surgical procedure. Be that as it may, arterial tourniquet has numerous injurious impacts inc...Background: Pneumatic arterial tourniquet is a utilized strategy in limb surgeries to provide bloodless field to facilitate surgical procedure. Be that as it may, arterial tourniquet has numerous injurious impacts including hemodynamic changes and tourniquet-induced pain which sometimes can be severe and intolerable. Objectives: Our primary aim was to assess the impact of performing “Lumbar Plexus Block and sciatic nerve block” with General Anesthesia (GA) on the degree of arterial tourniquet-induced hemodynamic effects. On the other hand, our secondary aims were: amount of postoperative analgesic prerequisites, patient satisfactory score and documented side effects. Settings and Design: Ain Shams University, Orthopedic operating theatre;a prospective, randomized, double-blind study. Methods and Material: The physical status of 50 patients (both sexes) including I and II patients from American Society of Anesthesiologists, whose ages are from 20 - 40 years, is not so ideal when they are undergoing elective knee Arthroscopy. The duration lasts no more than ninety minutes under GA with application of tourniquet. Patients were allotted haphazardly to one of two groups. In Group C (Control group): Only GA. In Group B: LPB and sciatic nerve block were performed just before GA administration. Intraoperative hemodynamics was recorded at specific timings. Results: Incidence of tourniquet induced hypertension (TIH) was markedly less with Group B at: forty five, sixty, seventy five mins after tourniquet inflation and just before tourniquet deflation. Also, the total ketorolac consumption during first 24 hours of postoperative period was significantly less with Group B (p Conclusions: Combined Sciatic-Lumbar plexus blocks when combined with general anesthesia were very effective in attenuating TIH.展开更多
A nerve stimulation-guided lumbar plexus block is a well-established technique.It is not clear whether ultrasound guidance has additional value for this deep block technique.This study aimed to examine whether ultraso...A nerve stimulation-guided lumbar plexus block is a well-established technique.It is not clear whether ultrasound guidance has additional value for this deep block technique.This study aimed to examine whether ultrasound guidance using a paramedian transverse scan through the intertransverse space(PMTS-ITS)approach in combination with nerve stimulation reduces the onset time of a complete sensory block.Forty-four patients who were scheduled to undergo arthroscopic knee surgery with an ultrasound visibility score(UVS)of≥10 for the lumbar plexus were enrolled and randomly allocated to the ultrasound guidance with nerve stimulation group(group U-N)or nerve stimulation group(group N)in this prospective,randomized,parallel-group,active-controlled study.The primary outcome was the onset time of a complete sensory block.The results showed that the onset time of a complete sensory block to pinprick and cold was 10(10–40)min and 10(10–40)min in group U-N,respectively,and 30(10–40)min and 20(10–40)min in group N(P=0.005,P=0.004),respectively.The performance time was 658±87 s in group U-N and 528±97 s in group N(P<0.001).There was no(0%)patient who required 5 or more needle passes in group U-N and 6(27.3%)in group N(P=0.028).The block failure rate was 9.1%in group U-N and 31.8%in group N(P>0.05).In conclusion,ultrasound guidance using the PMTS-ITS approach in combination with nerve stimulation led to a faster onset of a complete sensory block than nerve stimulation alone for a lumbar plexus block in patients with a UVS≥10.Ultrasound guidance with nerve stimulation significantly decreased the number of patients who required 5 or more needle passes.展开更多
目的:探讨超声引导下腰骶丛神经阻滞联合全麻对行髋关节置换术老年病人术后谵妄(POD)的影响。方法:选取髋关节置换术老年病人80例,随机分为腰骶丛神经阻滞联合全麻组(h组)和全麻组(q组),各40例。2组病人均采用喉罩通气,维持脑电双频指数...目的:探讨超声引导下腰骶丛神经阻滞联合全麻对行髋关节置换术老年病人术后谵妄(POD)的影响。方法:选取髋关节置换术老年病人80例,随机分为腰骶丛神经阻滞联合全麻组(h组)和全麻组(q组),各40例。2组病人均采用喉罩通气,维持脑电双频指数40~60,术后静脉自控镇痛(PCA)。比较2组病人术中麻醉药物用量、手术相关指标;采用视觉模拟量表(VAS)评估病人术后疼痛情况;于术前(D0)、术后第1(D1)、3(D3)、7(D7)天分别测定病人意识模糊评估量表(CAM)评分,并抽取静脉血检测白细胞介素(IL)-1β、IL-6、肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)和S100β蛋白水平。结果:与q组相比,h组病人术中麻醉药物用量、术后拔管时间、术后24 h PCA次数、术后各时间点VAS评分、首次下床时间及出院时间均明显减少(P<0.01);h组术后IL-1β、IL-6、TNF-α、CRP、S100β蛋白水平、CAM评分及POD发生率均明显低于q组(P<0.01)。结论:超声引导下腰骶丛神经阻滞联合全麻较单纯全麻,可减少行髋关节置换术的老年病人麻醉药用量,完善镇痛,降低炎性反应和POD发生率,有助于病人术后快速康复。展开更多
目的:探究腹股沟韧带上髂筋膜间隙与骶丛神经阻滞在老年股骨粗隆间骨折手术中的应用价值。方法:选取2022年8月—2023年8月于黄石工矿医院进行股骨粗隆间骨折手术治疗的66例老年患者作为研究对象,采用随机数表法将患者分为常规阻滞组(腰...目的:探究腹股沟韧带上髂筋膜间隙与骶丛神经阻滞在老年股骨粗隆间骨折手术中的应用价值。方法:选取2022年8月—2023年8月于黄石工矿医院进行股骨粗隆间骨折手术治疗的66例老年患者作为研究对象,采用随机数表法将患者分为常规阻滞组(腰交感神经阻滞)和联合阻滞组(腹股沟韧带上髂筋膜间隙联合骶丛神经阻滞),各33例。比较两组术中相关指标、麻醉满意度、疼痛程度及不良反应。结果:联合阻滞组感觉和运动阻滞起效时间和完全时间长于常规阻滞组,麻醉满意度高于常规阻滞组,差异有统计学意义(P<0.05)。联合阻滞组手术切皮即刻和手术结束即刻视觉模拟评分法(VAS)评分高于常规阻滞组,而术后24 h VAS评分低于常规阻滞组,差异有统计学意义(P<0.05);但两组手术开始后30 min VAS评分比较,差异无统计学意义(P>0.05)。联合阻滞组头痛、恶心、呕吐及尿潴留发生率低于常规阻滞组,差异有统计学意义(P<0.05);两组均未发生严重并发症。结论:老年股骨粗隆间骨折手术患者给予腹股沟韧带上髂筋膜间隙联合骶丛神经阻滞,可提升镇痛、镇静效果,提升麻醉满意度,并减少术后不良反应。展开更多
文摘Background: Pneumatic arterial tourniquet is a utilized strategy in limb surgeries to provide bloodless field to facilitate surgical procedure. Be that as it may, arterial tourniquet has numerous injurious impacts including hemodynamic changes and tourniquet-induced pain which sometimes can be severe and intolerable. Objectives: Our primary aim was to assess the impact of performing “Lumbar Plexus Block and sciatic nerve block” with General Anesthesia (GA) on the degree of arterial tourniquet-induced hemodynamic effects. On the other hand, our secondary aims were: amount of postoperative analgesic prerequisites, patient satisfactory score and documented side effects. Settings and Design: Ain Shams University, Orthopedic operating theatre;a prospective, randomized, double-blind study. Methods and Material: The physical status of 50 patients (both sexes) including I and II patients from American Society of Anesthesiologists, whose ages are from 20 - 40 years, is not so ideal when they are undergoing elective knee Arthroscopy. The duration lasts no more than ninety minutes under GA with application of tourniquet. Patients were allotted haphazardly to one of two groups. In Group C (Control group): Only GA. In Group B: LPB and sciatic nerve block were performed just before GA administration. Intraoperative hemodynamics was recorded at specific timings. Results: Incidence of tourniquet induced hypertension (TIH) was markedly less with Group B at: forty five, sixty, seventy five mins after tourniquet inflation and just before tourniquet deflation. Also, the total ketorolac consumption during first 24 hours of postoperative period was significantly less with Group B (p Conclusions: Combined Sciatic-Lumbar plexus blocks when combined with general anesthesia were very effective in attenuating TIH.
文摘A nerve stimulation-guided lumbar plexus block is a well-established technique.It is not clear whether ultrasound guidance has additional value for this deep block technique.This study aimed to examine whether ultrasound guidance using a paramedian transverse scan through the intertransverse space(PMTS-ITS)approach in combination with nerve stimulation reduces the onset time of a complete sensory block.Forty-four patients who were scheduled to undergo arthroscopic knee surgery with an ultrasound visibility score(UVS)of≥10 for the lumbar plexus were enrolled and randomly allocated to the ultrasound guidance with nerve stimulation group(group U-N)or nerve stimulation group(group N)in this prospective,randomized,parallel-group,active-controlled study.The primary outcome was the onset time of a complete sensory block.The results showed that the onset time of a complete sensory block to pinprick and cold was 10(10–40)min and 10(10–40)min in group U-N,respectively,and 30(10–40)min and 20(10–40)min in group N(P=0.005,P=0.004),respectively.The performance time was 658±87 s in group U-N and 528±97 s in group N(P<0.001).There was no(0%)patient who required 5 or more needle passes in group U-N and 6(27.3%)in group N(P=0.028).The block failure rate was 9.1%in group U-N and 31.8%in group N(P>0.05).In conclusion,ultrasound guidance using the PMTS-ITS approach in combination with nerve stimulation led to a faster onset of a complete sensory block than nerve stimulation alone for a lumbar plexus block in patients with a UVS≥10.Ultrasound guidance with nerve stimulation significantly decreased the number of patients who required 5 or more needle passes.
文摘目的:探讨超声引导下腰骶丛神经阻滞联合全麻对行髋关节置换术老年病人术后谵妄(POD)的影响。方法:选取髋关节置换术老年病人80例,随机分为腰骶丛神经阻滞联合全麻组(h组)和全麻组(q组),各40例。2组病人均采用喉罩通气,维持脑电双频指数40~60,术后静脉自控镇痛(PCA)。比较2组病人术中麻醉药物用量、手术相关指标;采用视觉模拟量表(VAS)评估病人术后疼痛情况;于术前(D0)、术后第1(D1)、3(D3)、7(D7)天分别测定病人意识模糊评估量表(CAM)评分,并抽取静脉血检测白细胞介素(IL)-1β、IL-6、肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)和S100β蛋白水平。结果:与q组相比,h组病人术中麻醉药物用量、术后拔管时间、术后24 h PCA次数、术后各时间点VAS评分、首次下床时间及出院时间均明显减少(P<0.01);h组术后IL-1β、IL-6、TNF-α、CRP、S100β蛋白水平、CAM评分及POD发生率均明显低于q组(P<0.01)。结论:超声引导下腰骶丛神经阻滞联合全麻较单纯全麻,可减少行髋关节置换术的老年病人麻醉药用量,完善镇痛,降低炎性反应和POD发生率,有助于病人术后快速康复。
文摘目的:探究腹股沟韧带上髂筋膜间隙与骶丛神经阻滞在老年股骨粗隆间骨折手术中的应用价值。方法:选取2022年8月—2023年8月于黄石工矿医院进行股骨粗隆间骨折手术治疗的66例老年患者作为研究对象,采用随机数表法将患者分为常规阻滞组(腰交感神经阻滞)和联合阻滞组(腹股沟韧带上髂筋膜间隙联合骶丛神经阻滞),各33例。比较两组术中相关指标、麻醉满意度、疼痛程度及不良反应。结果:联合阻滞组感觉和运动阻滞起效时间和完全时间长于常规阻滞组,麻醉满意度高于常规阻滞组,差异有统计学意义(P<0.05)。联合阻滞组手术切皮即刻和手术结束即刻视觉模拟评分法(VAS)评分高于常规阻滞组,而术后24 h VAS评分低于常规阻滞组,差异有统计学意义(P<0.05);但两组手术开始后30 min VAS评分比较,差异无统计学意义(P>0.05)。联合阻滞组头痛、恶心、呕吐及尿潴留发生率低于常规阻滞组,差异有统计学意义(P<0.05);两组均未发生严重并发症。结论:老年股骨粗隆间骨折手术患者给予腹股沟韧带上髂筋膜间隙联合骶丛神经阻滞,可提升镇痛、镇静效果,提升麻醉满意度,并减少术后不良反应。
