We report a patient with severe pulmonary arterial hypertension (PAH) undergoing tibio-talo-calcaneal fusion due to Charcot joint. Despite the advancement in the management of PAH, the risks of anesthesia, surgery, an...We report a patient with severe pulmonary arterial hypertension (PAH) undergoing tibio-talo-calcaneal fusion due to Charcot joint. Despite the advancement in the management of PAH, the risks of anesthesia, surgery, and postoperative morbidity and mortality still remain high. A 46-year-old female was presented with severe PAH and end stage renal disease requiring hemodialysis three times a week. Ultrasound-guided sciatic, femoral, and obturator nerve blocks were performed with 0.5% levobupivacaine 15 ml, 10 ml, and 5 ml, respectively. All the blocks were successful, and the patient underwent uneventful anesthesia and surgery. In addition, the postoperative pain control lasted for 15 h and the patient was discharged on POD 5 without any complications. Therefore, ultrasound-guided sciatic, femoral, and obturator nerve blocks are valuable alternative to the general or neuraxial anesthesia in patients with severe pulmonary hypertension.展开更多
The Background and Objectives: A sciatic nerve block at the level of the popliteal fossa is frequently administered for post-operative analgesia for surgery below the knee. While ultrasound continues to gain popularit...The Background and Objectives: A sciatic nerve block at the level of the popliteal fossa is frequently administered for post-operative analgesia for surgery below the knee. While ultrasound continues to gain popularity as the technique of choice for guiding needle positioning during peripheral nerve blocks, practitioners can begin to utilize ultrasound to look for patterns of anatomical significance. Recognizing anatomical variations among different demographic populations can help practitioners improve in performing nerve blocks. We aim to determine if predictable variability exists in sciatic nerve bifurcation location and depth at the level of the popliteal fossa. Methods: After IRB approval, eligible subjects were screened for ASA I or II status and demographic data was collected. Fifty subjects were enrolled. The SonoSite MicroMaxx? with 38-mm broadband linear array, 13-6 MHz probe with color Doppler and image capturing capabilities was used for ultrasound measurements. With subject lying prone, the location of the sciatic nerve in relation to the popliteal crease and skin-to-nerve distance were assessed via ultrasound. Two independent investigators confirmed nerve location for measurements. Analyses were performed with SAS version 9.1 using Pearson Correlation Coefficients and regression analysis. Results: Gender stratification revealed that, while males were both taller and heavier, skin-nerve measurements for depth were consistently deeper in females (p-value 0.02). Independent of the right or left leg, male gender and increased height decreases the skin-nerve distance, while increased weight increases the distance. There was no correlation between patient characteristics and crease-nerve distance. In some subjects, variability of crease-nerve distance even existed between their right and left leg. Conclusion: We show that significant variability exists for actual sciatic nerve bifurcation location, or target injection site, with consistently deeper skin depth values for female patients when compared to male patients, accounting for height and weight. These findings suggest visualization techniques such as ultrasound may lead to better localization of ideal injection sites.展开更多
目的评价股神经阻滞联合关节腔浸润麻醉在膝关节镜手术中的安全性和有效性。方法选择滨州医学院附属医院骨关节外科2022年1月至6月因半月板损伤、游离体、骨性关节炎计划行单侧膝关节镜手术患者120例,随机分为股神经阻滞联合关节腔浸润...目的评价股神经阻滞联合关节腔浸润麻醉在膝关节镜手术中的安全性和有效性。方法选择滨州医学院附属医院骨关节外科2022年1月至6月因半月板损伤、游离体、骨性关节炎计划行单侧膝关节镜手术患者120例,随机分为股神经阻滞联合关节腔浸润麻醉组(F/I组)和腰硬联合麻醉组(CSEA组),每组60例。F/I组中男32例,女28例,年龄(38.75±11.35)岁;CSEA组中男25例,女35例,年龄(37.80±10.85)岁。比较两组术中补救例数、术后视觉模拟评分法(VAS)评分、术后感觉恢复时间及首次下地活动时间、术后并发症、住院花费及住院天数等指标的差异。采用t检验、χ^(2)检验、Fisher确切概率法。结果F/I组术后6 h VAS评分低于CSEA组[(2.08±0.61)分比(2.54±0.64)分],差异有统计学意义(t=-2.484,P=0.018)。F/I组感觉恢复时间长于CSEA组[(6.25±0.40)h比(3.60±0.31)h,首次下地活动时间短于CESA组[(2.99±1.05)h比(8.14±1.88)h],差异均有统计学意义(t=14.095、-12.263,均P<0.001)。术后并发症:F/I组术中加用麻醉发生率3.3%(2/60)、尿潴留发生率0、下肢静脉血栓发生率1.7%(1/60)、恶心呕吐发生率3.3%(2/60),CSEA组术中加用麻醉发生率0、尿潴留发生率10.0%(6/60)、下肢静脉血栓发生率5.0%(3/60)、恶心呕吐发生率16.7%(10/60),两组尿潴留、恶心呕吐发生率比较差异均有统计学意义(均P<0.05)。F/I组住院时间为(3.90±0.63)d、住院费用为(9612.67±507.15)元,CESA组分别为(5.27±0.75)d、(11401.52±530.01)元,差异均有统计学意义(t=-8.862、-15.425,均P<0.001)。结论股神经阻滞联合关节腔浸润麻醉在膝关节镜手术中能够减少术后并发症、缩短住院时间、降低住院费用,并提供良好的麻醉效果。展开更多
文摘We report a patient with severe pulmonary arterial hypertension (PAH) undergoing tibio-talo-calcaneal fusion due to Charcot joint. Despite the advancement in the management of PAH, the risks of anesthesia, surgery, and postoperative morbidity and mortality still remain high. A 46-year-old female was presented with severe PAH and end stage renal disease requiring hemodialysis three times a week. Ultrasound-guided sciatic, femoral, and obturator nerve blocks were performed with 0.5% levobupivacaine 15 ml, 10 ml, and 5 ml, respectively. All the blocks were successful, and the patient underwent uneventful anesthesia and surgery. In addition, the postoperative pain control lasted for 15 h and the patient was discharged on POD 5 without any complications. Therefore, ultrasound-guided sciatic, femoral, and obturator nerve blocks are valuable alternative to the general or neuraxial anesthesia in patients with severe pulmonary hypertension.
文摘The Background and Objectives: A sciatic nerve block at the level of the popliteal fossa is frequently administered for post-operative analgesia for surgery below the knee. While ultrasound continues to gain popularity as the technique of choice for guiding needle positioning during peripheral nerve blocks, practitioners can begin to utilize ultrasound to look for patterns of anatomical significance. Recognizing anatomical variations among different demographic populations can help practitioners improve in performing nerve blocks. We aim to determine if predictable variability exists in sciatic nerve bifurcation location and depth at the level of the popliteal fossa. Methods: After IRB approval, eligible subjects were screened for ASA I or II status and demographic data was collected. Fifty subjects were enrolled. The SonoSite MicroMaxx? with 38-mm broadband linear array, 13-6 MHz probe with color Doppler and image capturing capabilities was used for ultrasound measurements. With subject lying prone, the location of the sciatic nerve in relation to the popliteal crease and skin-to-nerve distance were assessed via ultrasound. Two independent investigators confirmed nerve location for measurements. Analyses were performed with SAS version 9.1 using Pearson Correlation Coefficients and regression analysis. Results: Gender stratification revealed that, while males were both taller and heavier, skin-nerve measurements for depth were consistently deeper in females (p-value 0.02). Independent of the right or left leg, male gender and increased height decreases the skin-nerve distance, while increased weight increases the distance. There was no correlation between patient characteristics and crease-nerve distance. In some subjects, variability of crease-nerve distance even existed between their right and left leg. Conclusion: We show that significant variability exists for actual sciatic nerve bifurcation location, or target injection site, with consistently deeper skin depth values for female patients when compared to male patients, accounting for height and weight. These findings suggest visualization techniques such as ultrasound may lead to better localization of ideal injection sites.
文摘目的评价股神经阻滞联合关节腔浸润麻醉在膝关节镜手术中的安全性和有效性。方法选择滨州医学院附属医院骨关节外科2022年1月至6月因半月板损伤、游离体、骨性关节炎计划行单侧膝关节镜手术患者120例,随机分为股神经阻滞联合关节腔浸润麻醉组(F/I组)和腰硬联合麻醉组(CSEA组),每组60例。F/I组中男32例,女28例,年龄(38.75±11.35)岁;CSEA组中男25例,女35例,年龄(37.80±10.85)岁。比较两组术中补救例数、术后视觉模拟评分法(VAS)评分、术后感觉恢复时间及首次下地活动时间、术后并发症、住院花费及住院天数等指标的差异。采用t检验、χ^(2)检验、Fisher确切概率法。结果F/I组术后6 h VAS评分低于CSEA组[(2.08±0.61)分比(2.54±0.64)分],差异有统计学意义(t=-2.484,P=0.018)。F/I组感觉恢复时间长于CSEA组[(6.25±0.40)h比(3.60±0.31)h,首次下地活动时间短于CESA组[(2.99±1.05)h比(8.14±1.88)h],差异均有统计学意义(t=14.095、-12.263,均P<0.001)。术后并发症:F/I组术中加用麻醉发生率3.3%(2/60)、尿潴留发生率0、下肢静脉血栓发生率1.7%(1/60)、恶心呕吐发生率3.3%(2/60),CSEA组术中加用麻醉发生率0、尿潴留发生率10.0%(6/60)、下肢静脉血栓发生率5.0%(3/60)、恶心呕吐发生率16.7%(10/60),两组尿潴留、恶心呕吐发生率比较差异均有统计学意义(均P<0.05)。F/I组住院时间为(3.90±0.63)d、住院费用为(9612.67±507.15)元,CESA组分别为(5.27±0.75)d、(11401.52±530.01)元,差异均有统计学意义(t=-8.862、-15.425,均P<0.001)。结论股神经阻滞联合关节腔浸润麻醉在膝关节镜手术中能够减少术后并发症、缩短住院时间、降低住院费用,并提供良好的麻醉效果。
