Intrathecal morphine vs femoral nerve block for postoperative-analgesia after total knee arthroplasty:A two-year retrospective analysis

AIM To compare the efficacy of intrathecal morphine and single shot femoral nerve block for patients undergoing primary total knee arthroplasty.METHODS Data was extracted from electronic medical records and case-paper record files of patients who underwent unilateral primary total knee arthroplasty under spinal anesthesia using bupivacaine 12.5 mg with intrathecal morphine(ITM) 0.2 mg and under general anesthesia(GA) with single shot femoral nerve block(FNB) using 20 m L 0.5% bupivacaine at our hospital in 2013 and 2014.All patients had received peri-articular infiltration as per the hospital protocol.Data for gender,age,weight,American Society of Anesthesiologists status,total surgical time,postoperative pain score using visual analogue scale(VAS) from 1 to 10 at 6 h,12 h and 24 h postoperatively,24 h opioid consumption,use of oral multimodal analgesia,postoperative high dependency unit(HDU) admission and the time to discharge from the hospital was collected.The data was analyzed using Mann-Whitney U test for continuous variables and Fischer's exact-t-test for categorical variables.RESULTS Twenty-two patients in ITM group and 32 patients in FNB group were analyzed.Median pain scores using VAS in ITM group were significantly lower at 6 h(0.0 vs 2.0,P<0.001),12 h(0.0 vs 2.0,P<0.001) and 24 h(0.0 vs 2.0,P<0.001) postoperatively.Also,postoperative morphine consumption in ITM group was significantly lower(P<0.001).However,median of nonsteroid anti-inflammatory drug unit requirement in 24 h postoperatively was statistically significant higher in ITM compared to FNB group(2.0 vs 1.0,P=0.025).The difference in postoperative paracetamol consumption in 24 h was not statistically significant(P=0.147).There was no significant difference in the postoperative HDU admission or time to discharge from the hospital.No respiratory depression in either group was noticed.CONCLUSION The ITM group patients had much lower pain scores and morphine requirement in the first 24 hour postoperatively compared to FNB group.

Effectiveness of the Suprainguinal Ultrasound-Guided Block for the Management of Postoperative Pain after Application of a Total Hip Prosthesis

Objective: To assess the effectiveness of ultrasound-guided supraginguinal block (SIB) in the management of pain after total hip replacement. Material and Methods: This was a prospective, randomized, single-blind controlled study carried out in the anesthesia-intensive care unit of the Donka National Hospital in Conakry, over a period of 06 months (01/01/2020 to 30/06/2020). It concerned 32 patients: 16 patients in the “ultrasound-guided SIB” group and 16 patients in the “standard analgesia” group. Results: The pain scores assessed by the simple verbal scale and collected at the different time intervals (6H, 12H, 24H, 36H, 48H) showed mean scores < 1 in the ultrasound-guided SIB group while the mean scores were ≤3 in the standard analgesia group (P < 0.001). On movement, the mean pain scores were ≤1 for the ultrasound-guided SIB group versus mean scores > 3 in the standard analgesia group (P < 0.001). The time to mobilization was greater than 48 hours in all patients in the standard analgesia group while it was less than 48 hours in the majority of patients (75%) in the ultrasound-guided SIB group. Nausea and vomiting were the most observed side effects. We did not observe any respiratory distress. The length of day hospitalization of patients in the ultrasound-guided SIB group was on average 5.50 ± 0.52 compared with 13.44 ± 1.55 in the group of standard analgesia patients (P = 0.001). The vast majority of patients in the ultrasound-guided SIB group were satisfied and unhappy in the standard analgesia group. Conclusion: Our study demonstrated that echo-guided SIB provided better analgesia compared to standard analgesia for the management of postoperative pain after total hip replacement.

Comparason of Peri-Articular Multimodal Drug Injection with Femoral and Sciatic Nerve Block after Total Knee Arthroplasty

Good perioperative analgesia following total knee arthroplasty facilitates rehabilitation and may reduce hospital stay. We present the patient analgesic requirements and rehabilitation of a prospective single surgeon series after the introduction of a multimodal drug injection during his total knee arthroplasty. Basic epidemiological data as well as analgesic, antiemetic requirements and time to straight leg raised was collected on 27 consecutive patients (group 1) whom received the multimodal drug injection, consisting of levobupivacaine, ketorolac and adrenaline at the time of their total knee arthroplasty under spinal anaesthesia. Their rehabilitation was compared to a retrospective review of patients who were case matched by age and sex (group 2n = 26), whom had received the unit standard of spinal anaesthetic and a femoral and sciatic block at the time of their operation. Patients in group 1 had significantly lower analgesic and antiemetic requirements than group 2. Group 1 also had a significantly shorter hospital stay. We have demonstrated that periarticular multimodal drug injection can improve perioperative analgesia and mobilisation following total knee arthroplasty as well as reducing opioid requirements and side effects.

老年全髋关节置换关节囊周围神经阻滞中右美托咪定与罗哌卡因的量效关系

背景:右美托咪定和罗哌卡因是2种常用于老年全髋关节置换过程中的局部麻醉药物和辅助药物,可在行髋关节周围神经阻滞中提供镇静和止痛效果。目的:探究右美托咪定与罗哌卡因在老年全髋关节置换患者髋关节囊周围神经阻滞中持续镇静的量效关系。方法:按倾向性匹配法进行1∶1匹配,选择2021年1月至2023年1月在广州中医药大学东莞医院接受全髋关节置换治疗的120例老年患者为研究对象,匹配后分为2组,观察组60例给予罗哌卡因和1μg/kg右美托咪定的混合液20 mL行髋关节囊周围神经阻滞,对照组60例给予罗哌卡因20 mL行髋关节囊周围神经阻滞。对比分析两组患者的一般资料、围术期指标、术后镇痛情况、血流动力学指标、炎性因子、应激指标、麻醉后不良反应、住院时间及术后并发症发生情况。采用Probit法计算罗哌卡因髋关节囊周围神经阻滞的半数有效药物剂量及95%有效药物剂量。结果与结论:(1)观察组术后镇痛情况优于对照组,两组在术后6 h动态、12 h静息、12 h动态、24 h静息、24 h动态、48 h静息、48 h动态的目测类比评分以及首次按压静脉连接患者自控镇痛泵时间、术后24,48 h按压患者自控镇痛泵次数间差异有显著性意义(P <0.05);(2)两组患者拔管、术后12 h时的平均动脉压及拔管时的心率相比差异有极显著性意义(P <0.01);(3)术后24,48 h观察组的白细胞介素6、肿瘤坏死因子α、肾上腺素、去甲肾上腺素水平均低于对照组,差异有极显著性意义(P <0.01);(4)两组患者的住院时间相比差异有极显著性意义(P <0.01),术后并发症发生情况无显著性差异(P> 0.05);(5)右美托咪定复合罗哌卡因行髋关节囊周围神经阻滞反应的半数有效药物剂量为0.164%,95%有效药物剂量为0.188%;单纯罗哌卡因行髋关节囊周围神经阻滞反应的半数有效药物剂量为0.194%,95%有效药物剂量为0.276%;(6)提示使用右美托咪定复合罗哌卡行髋关节囊周围神经阻滞,可有效缓解老年患者全髋关节置换后的疼痛情况,有助于维持患者血流动力学的稳定性,减少术后炎症及应激反应,缩短住院时间,并且右美托咪定在有效行髋关节囊周围神经阻滞反应前提下可减少罗哌卡因用量。

Reducing costly falls after total knee arthroplasty

AIM To investigate whether adductor canal nerve block(ACB) reduces patient falls when compared to femoral nerve block(FNB) after total knee arthroplasty(TKA). METHODS We conducted an institutional review of all-cause falls after TKA from January 2013 to August 2016 using a quality improvement database. Our inclusion criteria were patients with diagnosis of primary knee osteoarthritis who underwent primary unilateral TKA with either a FNB or an ACB and sustained a fall during their hospitalization. We excluded patients who had revision TKA and extensor mechanism reconstruction. We also excluded patients with a history of post-traumatic arthritis, prior history of lower extremity fracture, history of neurological disease, or cerebrovascular disease. RESULTS A total of 834 patients had TKA with femoral nerve block and knee immobilizer(FNB + KI). Of those patients, 11(1.3%) experienced a fall during their hospital stay. In contrast, 791 patients had TKA with ACB. Of those patients, only one(0.13%) patient fall was recorded within this group. We used the Fisher's exact test to compare the differences between the two groups. The difference between the two groups achieves statistical significance(P = 0.006). We also found that 11 out of the 12 patients that fell had a right TKA procedure while one patient had a left TKA procedure. Nine out of twelve patients that fell were female, while only three patients were male.CONCLUSION Given the reduction in the number of falls with ACB, it is recommended that ACB be considered the preferred analgesia for patients undergoing a TKA procedure.

A Retrospective Comparison of Interscalene Continuous Catheter Verse Single-Injection with Liposomal Bupivacaine in Total Shoulder Arthroplasty

Background: One common method of pain control for total shoulder arthroplasty is long-duration delivery of local anesthetic via interscalene brachial plexus block (ISB) with a continuous catheter. Alternatively, liposomal bupivacaine has also been administered as an ISB as a means to prolong the analgesic effect. This study was completed to measure the non-inferiority of single-injection ISB with liposomal bupivacaine compared with ISB continuous catheter for total shoulder arthroplasty. Methods: We performed a retrospective chart review of patients who underwent total shoulder arthroplasty using either an ISB continuous catheter or a single injection ISB with liposomal bupivacaine for post operative analgesia. The primary goal of this study was to determine if single-injection with liposomal bupivacaine conferred non-inferior pain scores compared to the continuous catheter. Secondary outcomes evaluated oxygen saturation as a measure of hemidiaphragmatic paresis, post operative opioid requirements, and difference in cost. Results: We identified 333 patients for the study: 126 received continuous catheter and 207 received single-injection with liposomal bupivacaine. The median length of stay was 1 day. Pain scores for those treated with single-injection with liposomal bupivacaine were non-inferior to pain scores of those treated with the continuous catheter on post-op days 0, 1 and 2. Pain scores were lower for single-injection with liposomal bupivacaine patients on days 3 and 4, however they did not reach statistical significance. There was no significant difference in oxygen saturation between the two groups. Both groups had similar daily morphine milligram equivalent requirements. Liposomal bupivacaine ISB was also found to be less expensive. Conclusion: Single-injection ISB with liposomal bupivacaine provides non-inferior analgesia at a reduced cost compared with continuous catheter ISB for total shoulder arthroplasty.

Patient-specific instruments as a standard procedure in total knee arthroplasty: Logistics and postoperative radiological results in 70 patients

Serous Purpose: There is limited information in the literature surrounding the use of patient-specific instrumentation (PSI) by a large number of surgeons. This prospective observational study was therefore designed to evaluate the logistics of using PSI for total knee arthroplasty (TKA) in a multi-surgeon environment, as well as its accuracy in positioning components. Methods: Of 73 patients enrolled in this study, 3 were excluded after the surgeon decided intraoperatively to switch to conventional instrumentation. Results: Mean operative time was 77.6 minutes. The component size had to be changed in 19 patients and bone cuts corrected in 12. In 65 of the 70 cases (92.9%), mechanical alignment was within the optimal range from 3° varus to 3° valgus, with the remaining 5 cases considered outliers (7.1%). Mean overall mechanical alignment was 0.3° varus (standard deviation, ±2°). There was a distinct variance with regard to the position of the tibial component in the sagittal plane. Conclusions: PSI can be effectively incorporated in larger, multisurgeon practices. Although high accuracy was observed for overall mechanical alignment and component positioning in the frontal and sagittal planes, further attention must be paid to the tibial slope. We highly recommend the use of the extramedullary alignment rod to the proper position of the tibial block, as well as double-checking the slope before performing bone cuts.

超声引导下收肌管阻滞对老年膝关节置换术患者术后认知功能及静脉血栓栓塞形成的影响

目的探究超声引导下收肌管阻滞(ACB)对老年膝关节置换术(TKA)患者术后认知功能及静脉血栓栓塞形成的影响。方法收集2022年1月至2023年12月于湖北医药学院附属国药东风总医院进行TKA的80例老年患者的临床资料,根据镇痛方式的不同分为对照组(n=39,采用单纯蛛网膜下腔阻滞)和观察组(n=41,采用蛛网膜下腔阻滞+超声引导下ACB)。比较两组患者手术前后认知功能、手术前后疼痛情况、术后第7天的股四头肌肌力和关节活动度、不同年龄段患者术后静脉血栓栓塞发生情况以及术后不良反应发生情况。结果术前,两组患者的认知功能评分、疼痛评分、股四头肌肌力评分、关节活动度比较,差异均无统计学意义(P﹥0.05);观察组患者术后第3天、术后第7天的认知功能评分均高于对照组患者,差异均有统计学意义(P﹤0.05);术后12、48 h,观察组患者的疼痛评分均低于对照组患者,差异均有统计学意义(P﹤0.05);术后第7天,观察组患者的股四头肌肌力评分高于对照组患者,关节活动度大于对照组患者,差异均有统计学意义(P﹤0.05)。观察组65~70岁患者术后静脉血栓栓塞的发生率低于对照组,差异均有统计学意义(P﹤0.05);两组71~80岁患者术后静脉血栓栓塞的发生率比较,差异无统计学意义(P﹥0.05)。两组患者的术后不良反应总发生率比较,差异无统计学意义(P﹥0.05);均未出现呼吸抑制的不良反应。结论老年TKA患者应用超声引导下能够减少患者术后认知功能障碍和静脉血栓栓塞的发生,减轻术后疼痛感,减少对股四头肌肌力和关节活动度的影响,且具有安全性。

开腹子宫切除术中QLB-LSAL与双侧TAPB阻滞麻醉镇痛效果比较

目的:分析超声引导下外侧弓状韧带上腰方肌前路阻滞(QLB-LSAL)与双侧腹横肌平面阻滞(TAPB)在开腹子宫切除术(TAH)中的麻醉效果。方法:选取2022年1月-2023年1月本院择期行TAH患者95例,根据入院顺序按单双号分为48例QLB-LSAL组(超声引导下行双侧QLB-LSAL)和47例TAPB组(超声引导下行双侧TAPB),比较两组入室(T0)、切皮时(T1)、手术结束时(T2)、拔管时(T3)及离开麻醉恢复室时(T4)的心率(HR)及平均动脉压(MAP),比较术后48h舒芬太尼消耗量、补救镇痛例数及术后48h内镇痛泵按压次数,比较术后4h、8h、12h、24h静息及咳嗽时视觉疼痛模拟评分(VAS),统计两组术后不良反应和神经阻滞并发症发生情况。结果:两组MAP及HR均呈先上升后降低趋势,且QLB-LSAL组在T1和T2时低于TAPB组(P<0.05);QLB-LSAL组术后48h舒芬太尼消耗量(69.45±4.20μg)、补救镇痛(6.3%)及术后48h内镇痛泵按压(10.5±2.3次)均低于TAPB组(73.15±4.35μg、21.3%、12.2±4.4次)(均P<0.05);两组术后静息及咳嗽时VAS评分均呈降低趋势(P<0.05),两组术后4h、8h评分无差异(P>0.05),术后12h、24h静息及咳嗽时评分QLB-LSAL组低于TAPB组(均P<0.05);两组不良反应(6.3%、4.3%)无差异(P>0.05),两组均无神经阻滞情况发生。结论:相比于双侧TAPB阻滞,超声引导下QLB-LSAL阻滞在TAH中镇痛效果更佳,能有效降低镇痛药物使用剂量,减轻受术患者的疼痛应激反应。

Computational and Experimental Approaches for Evaluating Dose under a Block in TBI Geometry

Total Body Irradiation (TBI) patients are often treated at extended distances of several meters, with blocking made from high-Z materials placed close to the patients’ skin. Evaluating the dose under a block (e.g., for implanted medical device shielding purposes) in such a geometry is challenging. We compare the performance of two commonly used dose calculation algorithms, Anisotropic Analytical Algorithm (AAA) and Acuros XB, with Optically Stimulated Lumine- scence (OSLD) and ion chamber measurements in phantoms. The calculations and phantom measurements are also compared with in-vivo OSLD measure- ments. We find that OSLD and ion chamber measurements in phantom are good predictors of in-vivo measurements, while both AAA and Acuros XB sys- tematically overestimate the block transmission. We found Acuros XB to be accurate enough for a rough upper estimate (dose under block overestimated by 7% - 22%), while for AAA the overestimate was more severe (90% - 110%);the reason is that AAA does not account for the increase in pair production cro- ss-section in high-Z materials.

A Clinical Dosimetry Analysis of Total Body Irradiation for Leukemia Patients

Background and Purpose: To perform a retrospective in vivo dosimetry study of 129 total body irradiation (TBI) on leukemia and bone marrow transplant patients treated in our clinic from 2008 to 2011 and to find out if there is any indication of the necessity of developing a new efficient TBI approach. Materials and Methods: The in vivo dosimetry data of 129 patients treated with TBI between 2008 and 2011 were retrieved from the database and analyzed. These patients were mostly treated with the regime of a single fraction or 6 fractions with some exceptions of 8-fraction or 2-fraction treatments depending on the protocols that were applied. For every fraction of treatment, 10 pairs of diode dosimeters were used to monitor the doses to the midline of head, neck, arms, mediastinum, left lung, right lung, umbilicus, thigh, knee, and ankle for both AP and PA fields. The doses to the midline of the above body parts were considered to be the average of the AP and PA readings of each diode pair. Dose deviation from the prescribed value for each body part was studied by plotting the histogram of the frequency versus deviation and comparing this with the dose delivered to the midline of the umbilicus to where the dose was prescribed. The correlation of dose deviation to body part thickness was also studied. By studying the dose deviations, we can find the uniformity of general dose distributions for conventional TBI treatments. Results: The retrospective dosimetry study of the 129 TBI patient treatments indicates that for most of the patients treated in our clinic, the doses received by different body parts monitored with in vivo dosimetry were within the window of 10% difference from the prescribed dose. The inhomogeneity of dose on different body parts could be manually improved by using compensators, but the method is cumbersome and time consuming. The dose deviation in many histograms ranging from about ?10% to 10% indicates some incongruity of dose distribution. This could be due to the method of using lead compensators for a manual dose adjustment which could not ideally compensate for different body thicknesses everywhere. Conclusions: The conventional TBI could give uniform dose to the major body parts under the online in vivo dosimetry monitoring at the level of 10%, but the treatment procedure is cumbersome and time consuming. This implies the importance of developing a new and efficient TBI method by adopting modern radiation therapy technique.

超声引导下连续股神经阻滞对膝关节置换术后炎症及氧化应激反应的影响

目的旨在分析超声引导股神经阻滞用于膝关节置换术后患者的效果。方法纳入自2019年1月至2022年12月在本院接受全膝关节置换手术的60例患者,随机分为观察组(n=30)和对照组(n=30),分别接受连续股神经阻滞镇痛和静脉自控镇痛。在术后6 h、24 h、48 h时评估视觉模拟评分(VAS)。在术后即刻、24 h、72 h检测血清白介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)、超氧化物歧化酶(SOD)、丙二醛(MDA)和脂质过氧化氢(LHP)水平。记录术后72 h内出现的不良反应。结果两组患者的基础资料具有可比性,术后24 h、48 h观察组患者的VAS评分均低于对照组(P<0.05)。术后24 h和术后72 h,观察组血清CRP、IL-6、TNF-α、MDA和LHP水平均显著低于对照组(P<0.05),SOD水平显著高于对照组(P<0.05)。术后72 h内,观察组的不良反应率为3.3%,明显低于对照组的10%。结论超声连续股神经阻滞能有效降低患者术后疼痛,抑制炎症及氧化应激反应。

超声引导腰方肌阻滞技术在腹腔镜全子宫切除术中的应用

目的 探讨超声引导腰方肌阻滞技术在腹腔镜全子宫切除术中的应用效果。方法 选择2022年1月至2023年6月在寿光市人民医院实施全身麻醉气管插管下腹腔镜全子宫切除术的80例患者,按照随机数字表法分为两组,各40例。对照组采取气管插管全身麻醉,观察组在对照组基础上于全身麻醉诱导前实施超声引导腰方肌阻滞术。比较两组术后12h疼痛评分及血清P物质水平、并发症发生情况、镇痛泵按压次数、单次追加镇痛药物次数。结果 观察组术后12h疼痛评分、血清P物质水平低于对照组(P<0.05);观察组麻醉复苏阶段并发症总发生率低于对照组(P<0.05);观察组镇痛泵按压次数及单次追加镇痛药物次数少于对照组(P <0.05)。结论 超声引导腰方肌阻滞技术在腹腔镜全子宫切除术中的应用效果较好,能够减轻术后疼痛,降低并发症发生率,减少镇痛泵按压次数及单次追加镇痛药物次数。

分析多模式镇痛下持续髂筋膜间隙阻滞与收肌管阻滞对老年患者全膝关节置换术后快速康复的影响

目的探讨对老年人全膝关节置换术患者在多模式镇痛下分别给予超声引导下持续髂筋膜间隙阻滞以及收肌管阻滞对术后快速康复的影响。方法随机选取2020年2月—2022年11月常州市中医医院收治的60例老年人全膝关节置换术患者为研究对象,以随机数表法分为研究组和参照组,每组30例。参照组在多模式镇痛基础下施以超声引导下持续髂筋膜间隙阻滞,研究组在多模式镇痛基础下施以超声引导下持续收肌管阻滞。对比两组患者动态视觉模拟评分法(Visual Analogue Scale,VAS)评分、术后各时间点静息状态VAS评分、美国特种外科医院膝关节评分量表(Hospital for Special Surgery Knee Score,HSS)评分以及膝关节关节活动度(Range of Motion,ROM)。结果术后6、12、24、48 h,两组VAS评分比较,差异无统计学意义(P均>0.05)。研究组HSS评分为(71.25±7.25)分,高于参照组的(63.55±6.79)分,差异有统计学意义(t=4.246,P<0.05)。术后3、7、10、12 d,研究组ROM均高于参照组,差异有统计学意义(P均<0.05)。结论临床对老年人全膝关节置换术患者在给予镇痛干预期间,同超声引导下持续髂筋膜间隙阻滞比较,超声引导下持续收肌管阻滞方法的有效应用,可对患者的术后早期康复给予明显促进。

右美托咪定复合罗哌卡因收肌管阻滞辅助全身麻醉在全膝关节置换术中的应用效果

目的:探讨右美托咪定复合罗哌卡因收肌管阻滞辅助全身麻醉在全膝关节置换术(TKA)中的应用效果。方法:选取2019年3月至2020年3月于该院行TKA治疗的110例膝关节病患者进行前瞻性研究,按照随机数字表法将其分为观察组和对照组各55例。在全身麻醉基础上,对照组采用罗哌卡因行超声引导下收肌管阻滞,观察组采用右美托咪定复合罗哌卡因行收肌管阻滞。比较两组神经阻滞效果[感觉阻滞起效时间(OTSB)、运动阻滞起效时间(OTMB)、感觉阻滞持续时间(DSB)、运动阻滞持续时间(DMB)]、术中血流动力学指标[麻醉诱导完成后(T_(0))、切皮时(T_(1))、手术开始后30 min(T_(2))、术毕时(T_(3))的平均动脉压(MAP)和心率]水平、术后疼痛[视觉疼痛模拟评分法(VAS)]评分、麻醉药物用量、术后镇痛泵按压次数及不良反应发生率。结果:两组OTSB、OTMB比较,差异均无统计学意义(P>0.05);观察组DSB、DMB均长于对照组,差异有统计学意义(P<0.05);T_(1)、T_(2)、T_(3)时,观察组MAP、心率水平均低于对照组,差异有统计学意义(P<0.05);观察组术后12、24、48 h时的VAS评分均低于对照组,差异有统计学意义(P<0.05);观察组丙泊酚、舒芬太尼、瑞芬太尼用量及术后镇痛泵按压次数均少于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:右美托咪定复合罗哌卡因收肌管阻滞辅助全身麻醉用于TKA患者可缩短麻醉起效时间,延长神经阻滞持续时间,维持术中血流动力学稳定,提高术后疼痛效果,减少术中及术后麻醉药物用量,且不增加不良反应。

不同麻醉方式对老年全膝关节置换术早期预后的影响:一项单中心回顾性研究

目的 探讨不同麻醉方式对老年全膝关节置换术后早期预后的影响。方法 回顾性分析2018年10月至2021年9月在我院骨科行单侧全膝关节置换术病人的临床资料,根据麻醉方式分为全身麻醉组(GA组)、复合麻醉组(CA组)、外周神经阻滞组(PNB组)和腰麻组(SA组),与GA组和CA组比较,PNB组和SA组病人美国麻醉医师协会(ASA)分级,合并症比率更高,差异有统计学意义(P<0.05)。记录病人的一般资料、手术时间、麻醉时间、术后恢复室(PACU)观察时间和术后住院天数;记录低血压、血管活性药物泵注、术后24 h补救镇痛、舒芬太尼用量、术后炎性指标和48 h内并发症的发生率。结果 与GA组、CA组比较,PNB组和SA组病人低血压、低氧血症、血管活性药物泵注、急性心肌损伤、术后谵妄、术后恶心呕吐(PONV)、补救镇痛、入住ICU的发生率更低,舒芬太尼用量、炎性指标水平更低,术后PACU观察时间和住院时间缩短,差异均有统计学意义(P<0.05)。与GA组比较,CA组术中舒芬太尼用量、术中低血压、血管活性药物泵注和补救镇痛率显著降低,差异有统计学意义(P<0.05)。结论 与全身麻醉和复合麻醉相比,外周神经阻滞和腰麻是老年病人全膝关节置换术推荐的麻醉方式,可以改善早期预后。

弓状韧带上腰方肌阻滞对妇科腹腔镜全子宫切除术后镇痛的影响

目的 探讨弓状韧带上腰方肌阻滞对妇科腹腔镜全子宫切除术后镇痛的效果。方法选择择期行腹腔镜全子宫切除术患者100例,年龄35~64岁,BMI 18~28 kg/m^(2),ASAⅠ或Ⅱ级。采用随机数字表法将患者分为两组:弓状韧带上腰方肌阻滞联合全麻组(AL)和全麻组(CG),每组50例。AL组给予0.375%罗哌卡因40 ml行弓状韧带上腰方肌阻滞联合全身麻醉。CG接受常规气管插管全身麻醉。记录手术时间、瑞芬太尼和丙泊酚总用量,术后2、12、24和48 h静息和活动(翻身)时VAS疼痛评分、术后48 h内镇痛泵有效按压次数,头晕、恶心呕吐、呼吸抑制、瘙痒等麻醉相关不良反应发生情况。结果 与CG组比较,AL组瑞芬太尼和丙泊酚总用量、术后48 h内镇痛泵有效按压次数明显减少(P<0.05),术后2、12、24和48 h静息和活动时VAS疼痛评分明显降低(P<0.05),头晕、恶心呕吐、瘙痒等麻醉相关不良反应发生率明显降低(P<0.05)。两组手术时间差异无统计学意义。结论 弓状韧带上腰方肌阻滞能够提高腹腔镜全子宫切除术的麻醉效果,减少麻醉和镇痛药物用量,减轻术后疼痛,减少不良反应。

Economic Valuation of Auctioned Tourist Hunting Blocks in Tanzania

Economic valuation of ecosystems is increasingly being recognized as an important exercise to inform sustainable utilization and conservation of natural assets. It helps in planning and establishing fair profit margins that accrue either directly or indirectly from the consumptive and non-consumptive uses of ecosystem goods and services. This paper is based on a study which estimated the economic values of tourist hunting blocks (HBs) in Tanzania using the Analytic Multicriteria Valuation Method (AMUVAM). The study used a sample size of 12 out of 24 vacant hunting blocks which were to be auctioned to potential hunting companies in December 2022. The economic values of HBs were estimated using the time horizon of 10 years (the mean tenure for winning company). The results show that the economic values ranged from USD 6,215,588 to USD 653,470,695 per hunting block and the Existence Value (EV) constituted about 19% of the Total Economic Value (TEV). EV ranged from USD 632,210 to USD 125,147,285. The study underscores the need for decisions to allocate ecosystems, such as HBs, to both direct and indirect uses, to be guided by a though understanding of their values. We further recommend building the capacity of staff charged with the role of managing and allocating uses of these ecosystems to enable them undertake economic valuation of ecosystems using both simple and more robust analytical tools, such as the GIS, relational databases, and worldwide websites based tools, like InVEST (Integrated Valuation of Environmental Services and Tradeoffs), ARIES (Artificial Intelligence for Ecosystem Services), and Co$ting Nature.

硫酸镁联合罗哌卡因髂筋膜阻滞对全膝关节置换手术止血带反应的疗效观察

目的:分析硫酸镁联合罗哌卡因髂筋膜阻滞对全膝关节置换术(TKA)止血带反应的影响。方法:选取2020年5月—2023年5月就诊的TKA患者90例,根据麻醉方法不同分为对照组和观察组,每组45例。对照组给予罗哌卡因髂筋膜阻滞,观察组在对照组基础上给予硫酸镁静脉滴注,对比两组不同时间点心率(HR)、平均动脉压(MAP)、炎症应激指标、罗哌卡因累积用量、镇痛泵按压次数、不良反应总发生率。结果:观察组止血带充气即刻(t_(1))HR,MAP与对照组比较,差异无统计学意义(P>0.05);观察组充气30 min后(t_(2))、充气60 min后(t_(3))、充气90 min后(t_(4))、松止血带时(t_(5))、拔管后(t_(6))HR,MAP均低于对照组,差异有统计学意义(P<0.05)。观察组术后24 h血清超氧化物歧化酶(SOD)水平高于对照组,血清丙二醛(MDA)、白细胞介素-6(IL-6)、C反应蛋白(CRP)水平均低于对照组,差异均有统计学意义(P<0.05)。观察组罗哌卡因累积用量、镇痛泵按压次数均低于对照组,差异均有统计学意义(P<0.05)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论:硫酸镁联合罗哌卡因髂筋膜阻滞可有效维持TKA患者术中血流动力学稳定,减轻止血带反应,抑制炎症及氧化因子释放,且未引发严重不良反应。

亚甲蓝复合罗哌卡因隐神经阻滞对全膝关节置换术患者术后镇痛效果的影响

目的探讨应用亚甲蓝复合罗哌卡因隐神经阻滞对全膝关节置换术(TKA)患者术后镇痛效果的影响。方法选择择期行全膝关节置换术患者60例,男24例,女36例,年龄60~75岁,BMI 18.5~30.0 kg/m^(2),ASAⅡ或Ⅲ级。采用随机数字表法将患者分为两组:亚甲蓝复合罗哌卡因组(MR组)和罗哌卡因组(R组),每组30例。腰-硬联合麻醉前,MR组采用0.10%亚甲蓝+0.25%罗哌卡因复合液20 ml行超声引导下隐神经阻滞,R组采用0.25%罗哌卡因20 ml行超声引导下隐神经阻滞。记录术后6、12、24、48、72 h患肢静息和活动时VAS疼痛评分,术后24、48、72 h患肢膝关节最大活动度(ROM)和股四头肌徒手肌力检查(MMT)评分,镇痛泵有效按压次数、补救镇痛例数和补救镇痛药首次追加时间。记录穿刺部位出血、感染、局部麻醉药物中毒、神经损伤、周围组织损伤等神经阻滞相关并发症的发生情况。结果与R组比较,MR组术后12、24、48、72 h静息时VAS疼痛评分明显降低(P<0.05),术后48、72 h活动时VAS疼痛评分明显降低(P<0.05),术后24、48、72 h患肢膝关节ROM明显增大(P<0.05),镇痛泵有效按压次数明显减少(P<0.05),补救镇痛率明显降低(P<0.05)。两组术后住院期间均未见神经阻滞相关并发症。结论超声引导下亚甲蓝复合罗哌卡因隐神经阻滞可增强TKA术后镇痛效果,延长镇痛作用时间,减少术后镇痛药的使用,有利于术后早期膝关节的功能锻炼。