Objective:To explore the value of ultrasound-guided ilioinguinal and iliohypogastric nerve block(IINB)in tension-free inguinal hernia repair in elderly patients.Methods:A total of 70 elderly patients with tension-free...Objective:To explore the value of ultrasound-guided ilioinguinal and iliohypogastric nerve block(IINB)in tension-free inguinal hernia repair in elderly patients.Methods:A total of 70 elderly patients with tension-free inguinal hernia repair who treated in the hospital from April 2018 to November 2019 were selected and divided into two groups according to the random number table method,with 35 cases each.The control group underwent infiltration of local anesthesia(LA),and the study group added with IINB.The visual analogue scale(VAS)scores of the two groups of patients were compared.Results:The VAS score of the study group when pulling the hernia sac was lower than that of the control group,and the difference was statistically significant(P<0.05).Conclusion:IINB has good analgesic effect in tensionfree inguinal hernia repair in elderly patients,and it is worth promoting.展开更多
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
BACKGROUND: Ultrasound guided regional anesthesia is widely taught using task trainer models. Commercially available models are often used; however, they can be cost prohibitive. Therefore, alternative "homemade&...BACKGROUND: Ultrasound guided regional anesthesia is widely taught using task trainer models. Commercially available models are often used; however, they can be cost prohibitive. Therefore, alternative "homemade" models with similar fidelity are often used. We hypothesize that professional task trainers will be preferred over homemade models. The purpose of this study is to determine realism, durability and cleanliness of three different task trainers for ultrasound guided nerve blocks.METHODS: This was a prospective observational study using a convenience sample of medical student participants in an ultrasound guided nerve block training session on January 24 th, 2015. Participants were asked to perform simulated nerve blocks on three different task trainers including, 1 commercial and 2 homemade. A questionnaire was then given to all participants to rate their experiences both with and without the knowledge on the cost of the simulator device.RESULTS: Data was collected from 25 participants. The Blue Phantom model was found to have the highest fidelity. Initially, 10(40%) of the participants preferred the Blue Phantom model, while 10(40%) preferred the homemade gelatin model and 5(20%) preferred the homemade tofu model. After cost awareness, the majority, 18(72%) preferred the gelatin model.CONCLUSION: The Blue Phantom model was thought to have the highest fidelity, but after cost consideration the homemade gelatin model was preferred.展开更多
Aim: To study the features of local anesthetic solution spreading during sciatic nerve block in dependence on the anesthetic solution volume. Material and Methods: One hundred and sixty nine cases of sciatic nerve blo...Aim: To study the features of local anesthetic solution spreading during sciatic nerve block in dependence on the anesthetic solution volume. Material and Methods: One hundred and sixty nine cases of sciatic nerve blocks done under ultrasonic visualization control were analyzed. Sciatic nerve blocks were performed by lidocaine in volumes 30;25;20;15;12.5;10;7.5;6.5;5;4.5 ml. The cross-section area, equal to local anesthetic spreading, was determined;the extension of the anesthetic solution spreading along sciatic nerve was calculated. Results: The anesthetic agent solution spreads along sciatic nerve in proximal and distal direction, forming a kind of cylinder. The minimum volume of the local anesthetic, which covers sciatic nerve in the whole, is 5 ml. A rare (1.77%) variation of sciatic nerve structure was described, in which tibial and common peroneal nerves develop directly from the branches of sacral plexus. Conclusion: The decrease of the local anesthetic volume leads to reduction of its spreading distance and cross-section area. Ultrasonic visualization can provide for sciatic nerve anatomical peculiarities, which can have an effect on the block quality.展开更多
Breast cancer is the most prevalent cancer in women worldwide, and pain following mastectomy is a major post-surgical complication. This paper highlights the risk factors for chronic pain in breast surgery and evaluat...Breast cancer is the most prevalent cancer in women worldwide, and pain following mastectomy is a major post-surgical complication. This paper highlights the risk factors for chronic pain in breast surgery and evaluates various regional block techniques used to reduce post-operative pain, and minimize hospital stays in high-risk patients. Further research is needed to evaluate the effectiveness of novel regional anaesthesia techniques in an enhanced recovery context, and to assess their role in preventing or reducing chronic pain.展开更多
目的:观察超声引导下胸椎旁神经阻滞联合全身麻醉在腹腔镜胆囊切除术(LC)患者中的应用效果。方法:回顾性分析2022年2月至2023年3月于该院行LC的86例患者的临床资料,按照麻醉方案不同将其分为研究组和对照组各43例。对照组实施全身麻醉,...目的:观察超声引导下胸椎旁神经阻滞联合全身麻醉在腹腔镜胆囊切除术(LC)患者中的应用效果。方法:回顾性分析2022年2月至2023年3月于该院行LC的86例患者的临床资料,按照麻醉方案不同将其分为研究组和对照组各43例。对照组实施全身麻醉,研究组在对照组基础上联合超声引导下胸椎旁神经阻滞。比较两组镇痛泵按压次数,不同时间[麻醉前(T_(0))、麻醉后20 min(T_(1))、拔管时(T_(2))]血流动力学指标[心率、平均动脉压(MAP)]水平,术后不同时间疼痛[视觉模拟评分法(VAS)]评分,手术前后应激指标[皮质醇(Cor)、去甲肾上腺素(NE)]水平,以及不良反应发生率。结果:研究组镇痛泵按压次数少于对照组,差异有统计学意义(P<0.05);T_(1)、T_(2)时,研究组心率、MAP水平均高于对照组,差异有统计学意义(P<0.05);研究组术后1、3、6 h VAS评分均低于对照组,差异有统计学意义(P<0.05);术后1 d,研究组Cor、NE水平均低于对照组,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:超声引导下胸椎旁神经阻滞联合全身麻醉应用于LC患者可减少镇痛泵按压次数,稳定血流动力学指标水平,降低术后疼痛评分和应激指标水平,效果优于单纯全身麻醉。展开更多
目的:分析超声引导下腰丛坐骨神经阻滞麻醉在老年胫骨平台骨折患者中的应用。方法:选取2021年7月—2023年7月菏泽市定陶区人民医院诊治的80例胫骨平台骨折老年患者为研究对象,采用随机数表法将其分为对照组40例,观察组40例,对照组采用...目的:分析超声引导下腰丛坐骨神经阻滞麻醉在老年胫骨平台骨折患者中的应用。方法:选取2021年7月—2023年7月菏泽市定陶区人民医院诊治的80例胫骨平台骨折老年患者为研究对象,采用随机数表法将其分为对照组40例,观察组40例,对照组采用全身麻醉,观察组采用超声引导下腰丛坐骨神经阻滞麻醉。对比两组围手术期动脉血氧分压(PaO_(2))、舒张压(DBP)、收缩压(SBP)、心率(HR)、应激反应[皮质醇(Cor)、去甲肾上腺素(NE)、肾上腺素(E)]、认知功能及术后不良反应发生情况。结果:两组麻醉前PaO_(2)、DBP、SBP、HR比较,差异无统计学意义(P>0.05);麻醉后15 min、麻醉后45 min、手术结束即刻,观察组PaO_(2)、DBP、SBP、HR均较对照组高,差异有统计学意义(P<0.05)。两组手术结束即刻应激反应指标比较,差异无统计学意义(P>0.05);两组术后2 h Cor、NE、E较手术结束即刻下降,但观察组术后2 h Cor、NE、E较对照组低,差异有统计学意义(P<0.05)。观察组术后1 d认知功能评分优于对照组,差异有统计学意义(P<0.05);观察组术后不良反应发生率明显低于对照组,差异有统计学意义(P<0.05)。结论:超声引导下腰丛坐骨神经阻滞麻醉相较于全身麻醉,不仅能够为老年胫骨平台骨折患者提供更加稳定的手术条件,还能减轻生理应激反应,同时对老年患者的认知功能影响更小,能降低术后不良反应发生风险。展开更多
目的:观察超声引导下股神经阻滞联合复元活血汤对全膝关节置换术后患者疼痛程度及膝关节功能的影响。方法:选择2020年5月至2022年5月就诊于武汉市中医医院骨科收治的拟行全膝关节置换术的60例膝骨关节炎患者,按照随机数字表法分为试验...目的:观察超声引导下股神经阻滞联合复元活血汤对全膝关节置换术后患者疼痛程度及膝关节功能的影响。方法:选择2020年5月至2022年5月就诊于武汉市中医医院骨科收治的拟行全膝关节置换术的60例膝骨关节炎患者,按照随机数字表法分为试验组和对照组,每组各30例。两组患者均给予人工全膝关节置换术,对照组于术后即刻行超声引导下股神经阻滞镇痛,试验组在对照组治疗的基础上口服复原活血汤。记录两组患者手术后第3天、第5天、第7天静息及被动屈曲20°、50°、70°时视觉模拟评分法(visual analogue scale,VAS)评分、患膝关节周缘肿胀差值、关节主动屈伸活动度、美国特种外科医院膝关节功能(hospital for special surgery,HSS)评分。结果:静息0°状态下,术后第3天试验组VAS评分高于对照组(P<0.05),但术后第5天、第7天两组患者VAS评分比较,差异无统计学意义(P>0.05)。被动屈曲20°、45°、70°状态下,术后第3天、第5天、第7天试验组VAS评分高于对照组(P<0.05)。在同一测量点,术后第3天、第5天、第7天试验组患肢肿胀差值大对照组(P<0.05)。术后第3天、第5天、第7天试验组膝关节主动屈曲角度大于对照组(P<0.05)。术后第3天、第5天、第7天试验组膝关节HSS评分高于对照组(P<0.05)。结论:将超声引导下股神经阻滞联合复元活血汤运用于全膝关节置换术后,可降低术后各时间段的静息及主动屈伸时的疼痛程度,缓解患肢肿胀程度,从而增加患膝活动范围,促进膝关节功能恢复。展开更多
文摘Objective:To explore the value of ultrasound-guided ilioinguinal and iliohypogastric nerve block(IINB)in tension-free inguinal hernia repair in elderly patients.Methods:A total of 70 elderly patients with tension-free inguinal hernia repair who treated in the hospital from April 2018 to November 2019 were selected and divided into two groups according to the random number table method,with 35 cases each.The control group underwent infiltration of local anesthesia(LA),and the study group added with IINB.The visual analogue scale(VAS)scores of the two groups of patients were compared.Results:The VAS score of the study group when pulling the hernia sac was lower than that of the control group,and the difference was statistically significant(P<0.05).Conclusion:IINB has good analgesic effect in tensionfree inguinal hernia repair in elderly patients,and it is worth promoting.
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BACKGROUND: Ultrasound guided regional anesthesia is widely taught using task trainer models. Commercially available models are often used; however, they can be cost prohibitive. Therefore, alternative "homemade" models with similar fidelity are often used. We hypothesize that professional task trainers will be preferred over homemade models. The purpose of this study is to determine realism, durability and cleanliness of three different task trainers for ultrasound guided nerve blocks.METHODS: This was a prospective observational study using a convenience sample of medical student participants in an ultrasound guided nerve block training session on January 24 th, 2015. Participants were asked to perform simulated nerve blocks on three different task trainers including, 1 commercial and 2 homemade. A questionnaire was then given to all participants to rate their experiences both with and without the knowledge on the cost of the simulator device.RESULTS: Data was collected from 25 participants. The Blue Phantom model was found to have the highest fidelity. Initially, 10(40%) of the participants preferred the Blue Phantom model, while 10(40%) preferred the homemade gelatin model and 5(20%) preferred the homemade tofu model. After cost awareness, the majority, 18(72%) preferred the gelatin model.CONCLUSION: The Blue Phantom model was thought to have the highest fidelity, but after cost consideration the homemade gelatin model was preferred.
文摘Aim: To study the features of local anesthetic solution spreading during sciatic nerve block in dependence on the anesthetic solution volume. Material and Methods: One hundred and sixty nine cases of sciatic nerve blocks done under ultrasonic visualization control were analyzed. Sciatic nerve blocks were performed by lidocaine in volumes 30;25;20;15;12.5;10;7.5;6.5;5;4.5 ml. The cross-section area, equal to local anesthetic spreading, was determined;the extension of the anesthetic solution spreading along sciatic nerve was calculated. Results: The anesthetic agent solution spreads along sciatic nerve in proximal and distal direction, forming a kind of cylinder. The minimum volume of the local anesthetic, which covers sciatic nerve in the whole, is 5 ml. A rare (1.77%) variation of sciatic nerve structure was described, in which tibial and common peroneal nerves develop directly from the branches of sacral plexus. Conclusion: The decrease of the local anesthetic volume leads to reduction of its spreading distance and cross-section area. Ultrasonic visualization can provide for sciatic nerve anatomical peculiarities, which can have an effect on the block quality.
文摘Breast cancer is the most prevalent cancer in women worldwide, and pain following mastectomy is a major post-surgical complication. This paper highlights the risk factors for chronic pain in breast surgery and evaluates various regional block techniques used to reduce post-operative pain, and minimize hospital stays in high-risk patients. Further research is needed to evaluate the effectiveness of novel regional anaesthesia techniques in an enhanced recovery context, and to assess their role in preventing or reducing chronic pain.
文摘目的:观察超声引导下胸椎旁神经阻滞联合全身麻醉在腹腔镜胆囊切除术(LC)患者中的应用效果。方法:回顾性分析2022年2月至2023年3月于该院行LC的86例患者的临床资料,按照麻醉方案不同将其分为研究组和对照组各43例。对照组实施全身麻醉,研究组在对照组基础上联合超声引导下胸椎旁神经阻滞。比较两组镇痛泵按压次数,不同时间[麻醉前(T_(0))、麻醉后20 min(T_(1))、拔管时(T_(2))]血流动力学指标[心率、平均动脉压(MAP)]水平,术后不同时间疼痛[视觉模拟评分法(VAS)]评分,手术前后应激指标[皮质醇(Cor)、去甲肾上腺素(NE)]水平,以及不良反应发生率。结果:研究组镇痛泵按压次数少于对照组,差异有统计学意义(P<0.05);T_(1)、T_(2)时,研究组心率、MAP水平均高于对照组,差异有统计学意义(P<0.05);研究组术后1、3、6 h VAS评分均低于对照组,差异有统计学意义(P<0.05);术后1 d,研究组Cor、NE水平均低于对照组,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:超声引导下胸椎旁神经阻滞联合全身麻醉应用于LC患者可减少镇痛泵按压次数,稳定血流动力学指标水平,降低术后疼痛评分和应激指标水平,效果优于单纯全身麻醉。
文摘目的:分析超声引导下腰丛坐骨神经阻滞麻醉在老年胫骨平台骨折患者中的应用。方法:选取2021年7月—2023年7月菏泽市定陶区人民医院诊治的80例胫骨平台骨折老年患者为研究对象,采用随机数表法将其分为对照组40例,观察组40例,对照组采用全身麻醉,观察组采用超声引导下腰丛坐骨神经阻滞麻醉。对比两组围手术期动脉血氧分压(PaO_(2))、舒张压(DBP)、收缩压(SBP)、心率(HR)、应激反应[皮质醇(Cor)、去甲肾上腺素(NE)、肾上腺素(E)]、认知功能及术后不良反应发生情况。结果:两组麻醉前PaO_(2)、DBP、SBP、HR比较,差异无统计学意义(P>0.05);麻醉后15 min、麻醉后45 min、手术结束即刻,观察组PaO_(2)、DBP、SBP、HR均较对照组高,差异有统计学意义(P<0.05)。两组手术结束即刻应激反应指标比较,差异无统计学意义(P>0.05);两组术后2 h Cor、NE、E较手术结束即刻下降,但观察组术后2 h Cor、NE、E较对照组低,差异有统计学意义(P<0.05)。观察组术后1 d认知功能评分优于对照组,差异有统计学意义(P<0.05);观察组术后不良反应发生率明显低于对照组,差异有统计学意义(P<0.05)。结论:超声引导下腰丛坐骨神经阻滞麻醉相较于全身麻醉,不仅能够为老年胫骨平台骨折患者提供更加稳定的手术条件,还能减轻生理应激反应,同时对老年患者的认知功能影响更小,能降低术后不良反应发生风险。
文摘目的:观察超声引导下股神经阻滞联合复元活血汤对全膝关节置换术后患者疼痛程度及膝关节功能的影响。方法:选择2020年5月至2022年5月就诊于武汉市中医医院骨科收治的拟行全膝关节置换术的60例膝骨关节炎患者,按照随机数字表法分为试验组和对照组,每组各30例。两组患者均给予人工全膝关节置换术,对照组于术后即刻行超声引导下股神经阻滞镇痛,试验组在对照组治疗的基础上口服复原活血汤。记录两组患者手术后第3天、第5天、第7天静息及被动屈曲20°、50°、70°时视觉模拟评分法(visual analogue scale,VAS)评分、患膝关节周缘肿胀差值、关节主动屈伸活动度、美国特种外科医院膝关节功能(hospital for special surgery,HSS)评分。结果:静息0°状态下,术后第3天试验组VAS评分高于对照组(P<0.05),但术后第5天、第7天两组患者VAS评分比较,差异无统计学意义(P>0.05)。被动屈曲20°、45°、70°状态下,术后第3天、第5天、第7天试验组VAS评分高于对照组(P<0.05)。在同一测量点,术后第3天、第5天、第7天试验组患肢肿胀差值大对照组(P<0.05)。术后第3天、第5天、第7天试验组膝关节主动屈曲角度大于对照组(P<0.05)。术后第3天、第5天、第7天试验组膝关节HSS评分高于对照组(P<0.05)。结论:将超声引导下股神经阻滞联合复元活血汤运用于全膝关节置换术后,可降低术后各时间段的静息及主动屈伸时的疼痛程度,缓解患肢肿胀程度,从而增加患膝活动范围,促进膝关节功能恢复。
