Treatment of posterior interosseous nerve entrapment syndrome with ultrasound-guided hydrodissection:A case report

BACKGROUND Posterior interosseous nerve(PIN)entrapment syndrome is one of the causes of weakness and pain of the arm muscles,which is prone to missed diagnosis and misdiagnosis in clinic practice.This paper reports a case of PIN entrapment syndrome,with PIN injury indicated by electrophysiology.Musculoskeletal ultrasound was applied to identify that the entrapment point was located at the inlet of the Frohse arch and the outlet of the supinator muscle.Treatment with ultrasound-guided nerve hydrodissection was performed on the entrapment point,which significantly improved the symptoms.Ultrasound-guided nerve hydrodissection is an effective therapeutic method for PIN entrapment syndrome.CASE SUMMARY A male patient,35 years old,worked as an automobile mechanic.He felt slightly weak extension activity of his right fingers 2 years ago but sought no treatment.Later,the symptoms gradually became aggravated and led to finger drop,particularly severe in the right middle finger,accompanied by supination weakness of the right forearm.Neural electrophysiological examination showed that the patient had partial PIN injury of the right radius.Musculoskeletal ultrasound examination indicated PIN entrapment at the inlet of the Frohse arch and the outlet of the supinator muscle.Therefore,PIN entrapment syndrome was diagnosed.After treatment with ultrasound-guided nerve hydrodissection around the entrapment point,the dorsiflexion weakness of the right hand was significantly improved compared with before treatment.CONCLUSION Ultrasound-guided hydrodissection is efficacious for PIN entrapment syndrome,with high clinical value and great application prospects.

Ultrasound-guided paravertebral nerve block anesthesia on the stress response and hemodynamics among lung cancer patients

BACKGROUND Thoracic surgery for radical resection of lung tumor requires deep anesthesia which can lead to an adverse inflammatory response,loss of hemodynamic stability,and decreased immune function.Herein,we evaluated the feasibility and benefits of ultrasound-guided paravertebral nerve block anesthesia,in combination with general anesthesia,for thoracic surgery for lung cancer.The block was performed by diffusion of anesthetic drugs along the paravertebral space to achieve unilateral multi-segment intercostal nerve and dorsal branch nerve block.AIM To evaluate the application of ultrasound-guided paravertebral nerve block anesthesia for lung cancer surgery to inform practice.METHODS The analysis was based on 140 patients who underwent thoracic surgery for lung cancer at our hospital between January 2018 and May 2020.Patients were randomly allocated to the peripheral+general anesthesia(observation)group(n=74)or to the general anesthesia(control)group(n=66).Patients in the observation group received ultrasound-guided paravertebral nerve block anesthesia combined with general anesthesia,with those in the control group receiving an epidural block combined with general anesthesia.Measured outcomes included the operative and anesthesia times,as well as the mean arterial pressure(MAP),heart rate(HR),and blood oxygen saturation(SpO;)measured before surgery,15 min after anesthesia(T1),after intubation,5 min after skin incision,and before extubation(T4).RESULTS The dose of intra-operative use of remifentanil and propofol and the postoperative use of sufentanil was lower in the observation group(1.48±0.43 mg,760.50±92.28 mg,and 72.50±16.62 mg,respectively)than control group(P<0.05).At the four time points of measurement(T1 through T4),MAP and HR values were higher in the observation than control group(MAP,90.20±9.15 mmHg,85.50±7.22 mmHg,88.59±8.15 mmHg,and 90.02±10.02 mmHg,respectively;and HR,72.39±8.22 beats/min,69.03±9.03 beats/min,70.12±8.11 beats/min,and 71.24±9.01 beats/min,respectively;P<0.05).There was no difference in SpO;between the two groups(P>0.05).Postoperative levels of epinephrine,norepinephrine,and dopamine used were significantly lower in the observation than control group(210.20±40.41 pg/mL,230.30±65.58 pg/mL,and 54.49±13.32 pg/mL,respectively;P<0.05).Similarly,the postoperative tumor necrosis factor-αand interleukin-6 levels were lower in the observation(2.43±0.44 pg/mL and 170.03±35.54 pg/mL,respectively)than control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).CONCLUSION Ultrasound-guided paravertebral nerve block anesthesia improved the stress and hemodynamic response in patients undergoing thoracic surgery for lung cancer,with no increase in the rate of adverse events.

Ultrasound-guided needle release plus corticosteroid injection of superficial radial nerve:A case report

BACKGROUND The radial nerve(RN)splits into two main branches at the elbow:The superficial branch of RN(SBRN)and the deep branch of RN.The SBRN can be easily damaged in acute trauma due to its superficial feature.CASE SUMMARY A 55-year-old male patient injured his right wrist 10 mo ago.Debridement,suturing and bandaging were performed in the emergency room.Six months after the scar had healed,he felt numbness and tingling in the dorsal surface of the thumb of the right hand.So the surgery of resection and SBRN anastomosis were performed.The pathological findings showed it as traumatic neuroma.Four months after surgery,the patient felt numbness and tingling in the right dorsal surface of the thumb again.The tenderness was marked in the operated area.Ultrasound indicated that the SBRN was adhered to the surrounding tissue.The patient refused further surgical treatment and underwent ultrasound-guided needle release plus corticosteroid injection of the SBRN.Four weeks later,the tenderness in the surgical area was reduced by 70%,the numbness in the dorsal surface of the thumb of the right hand was reduced by 40%and the nerve swelling evaluated by ultrasound was reduced.Four months passed,he did not feel any numbness or tingling sensation of his right wrist.This is the first report of ultrasound-guided needle release plus corticosteroid injection of the SBRN.CONCLUSION Ultrasound can evaluate the condition of the RN,and the relationship with surrounding tissues.Ultrasound-guided needle release plus corticosteroid injection is an effective and safe treatment for SBRN adhesion.

Effects of dexmedetomidine combined with ultrasound-guided nerve block on hemodynamics, immune function and cortisol levels in patients undergoing inguinal surgery

Objective:To investigate the effect of dexmedetomidine combined with ultrasound guided nerve block on the hemodynamics, immune function and cortisol level in the patients undergoing inguinal surgery.Methods:A total of 120 patients who underwent unilateral inguinal surgery in our hospital were randomly divided into control group and observation group, 60 cases in each group. The control group was induced by intravenous anesthesia with sufentanil. The observation group was given dexmedetomidine combined with ultrasound guided ilioinguinal/iliac hypogastric nerve block. Hemodynamics, immune function and cortisol levels were compared between the two groups before and after anesthesia induction. Results:After anesthesia, in surgical incision and recovery time, the levels of HR in the two groups were significantly lower than that before the anesthesia, and the levels of HR in the observation group were significantly lower than that in the control group. After anesthesia, in surgical incision and recovery time, the levels of CD3+, CD4+ and CD4+/CD8+ in the control group were significantly lower than that of the group before anesthesia. After anesthesia, the levels of CD3+, CD4+ and CD4+/CD8+ in the observation group were significantly lower than that of the group before anesthesia. In surgical incision and recovery time, there was no significant difference in the levels of CD3+, CD4+ and CD4+/CD8+ in the observation group before anesthesia. After anesthesia, in surgical incision and recovery time, the levels of CD3+, CD4+ and CD4+/CD8+ in the observation group were significantly higher than that of the control group. The levels of serum PI3K, ET -1, CRP and cortisol of the two groups were significantly higher than those before anesthesia, and the levels of PI3K, ET -1, CRP and cortisol in the serum of the patients in the observation group were significantly lower than those in the control group.Conclusion: The effect of dexmedetomidin combined with ultrasound guided nerve block anesthesia on the patients with inguinal surgery can effectively maintain the hemodynamic stability of the patients and have less influence on the immune function and the stress response. The security is higher.

Analgesic, anti-inflammatory and antioxidant effects of ultrasound-guided lower extremity nerve block for elderly hip arthroplasty

Objective:To study the analgesic, anti-inflammatory and antioxidant effects of ultrasound-guided lower extremity nerve block for elderly hip arthroplasty.Methods: A total of 99 elderly patients with femoral neck fractures who underwent hip arthroplasty in our hospital between January 2017 and March 2018 were selected, and the anesthetic solutions were reviewed and used to divide the enrolled patients into the control group (n=51) who accepted conventional general anesthesia and the nerve block group (n=48) who accepted ultrasound-guided lower extremity nerve block anesthesia. The differences in the serum levels of pain mediators, inflammatory mediators and oxidative stress indexes were compared between the two groups immediately after surgery (T0), 12 h after surgery (T1) and 24 h after surgery (T2).Results: At T0, serum levels of pain mediators, inflammatory mediators and oxidative stress indexes were not significantly different between the two groups. At T1 and T2, serum pain mediators PGF2a, SP and NPY levels of nerve block group were lower than those of control group;serum inflammatory mediators IL-1β, TNF-α and hs-CRP levels were lower than those of control group;serum oxidative stress indexes T-AOC and SOD levels were higher than those of control group whereas MDA and LHP levels were lower than those of control group.Conclusion:Ultrasound-guided lower limb nerve block for elderly hip arthroplasty has exact analgesic, anti-inflammatory and antioxidant effects.

Chinese Association for the Study of Pain:Experts consensus on ultrasound-guided injections for the treatment of spinal pain in China(2020 edition)

Spinal pain(SP)is a common condition that has a major negative impact on a patient’s quality of life.Recent developments in ultrasound-guided injections for the treatment of SP are increasingly being used in clinical practice.This clinical expert consensus describes the purpose,significance,implementation methods,indications,contraindications,and techniques of ultrasound-guided injections.This consensus offers a practical reference point for physicians to implement successfully ultrasound-guided injections in the treatment of chronic SP.

Features and Principles the Spread of Local Anesthetic Blockade of the Sciatic Nerve at Depends on the Amount of Anesthetic

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.

Combined Sciatic, Femoral, and Obturator Nerve Blocks for Ankle Surgery in a Patient with Severe Pulmonary Hypertension—A Case Report

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.

Clinical effect of acupuncture along fascia,meridians,and nerves combined with ultrasound-guided paravertebral nerve block in the treatment of postherpetic neuralgia:a randomized parallel-controlled study

OBJECTIVE:To observe the clinical efficacy of acupuncture along fascia,meridians,and nerves combined with ultrasound-guided nerve blockage in the treatment of postherpetic neuralgia.METHODS:A total of 61 outpatients with post-chest and back herpes zoster neuralgia were recruited in the Department of Pain at the Xiyuan Hospital,China Academy of Chinese Medical Sciences from May 2019 to June 2021.They were randomly divided into two groups.Thirty-one patients in the control group were treated with ultrasound-guided thoracic paravertebral nerve block(PVB)alone,one patient declined to continue during treatment(n=30),and thirty patients in the observation group received the acupuncture along the fascia,meridians,and nerves combined with ultrasound-guided PVB treatment(n=30).Both control and observation group received treatment weekly for 4 weeks.The medical history data such as age,sex,presence or absence of comorbidities and disease course were analyzed.The visual analog scale(VAS)score was used to assess the pain degree of two groups at T0(before treatment),T1(1-time treatment ended),T2(2 times treatment ended),T3(3 times treatment ended),and T4(4 times treatment ended).The sleep state was examined by Pittsburgh Sleep Quality Index(PSQI)before and after the study.RESULTS:There was no significant difference in general conditions between the control group and the observation group(P>0.05).The VAS score in both control and observation group was decreased in a time-dependent manner after 1-4 weeks of treatment.There were no significant differences in VAS scores between the two groups after 1 or 2 weeks of treatment(P>0.05).After 3 and 4 weeks of treatment,the VAS score was significantly decreased in the observation group compared with that in the control group(P<0.001).In addition,the reduction in VAS score(after treatment-before treatment)between the two groups was statistically significant[D value:-1.53,95%CI(-2.32,0.74),P<0.001].Furthermore,the sleep state of patients in both groups markedly improved and much obvious in the observation group than that in the control group(P<0.05).CONCLUSION:These results suggest that a combination of acupuncture along fascia,meridians,and nerves with ultrasound-guided PVB treatment is more effective than ultrasound-guided PVB treatment alone.

Regional Block Anesthesia in Breast Surgery: What Do We Know So Far?

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.

温针灸治疗寒湿痹阻型腰椎间盘突出症的临床观察

【目的】观察温针灸治疗寒湿痹阻型腰椎间盘突出症的临床疗效。【方法】将96例寒湿痹阻型腰椎间盘突出症患者随机分为观察组和对照组,每组各48例,对照组给予康复疗法联合西药治疗,观察组在对照组治疗的基础上联合温针灸治疗。2组均治疗4周。治疗1个月后,评价2组临床疗效,观察2组患者治疗前后疼痛视觉模拟量表(VAS)评分和日本骨科协会评估治疗分数(JOA)评分的变化情况,以及血清前列腺素E2(PGE2)、转化生长因子β1(TGF-β1)以及血清肿瘤坏死因子α(TNF-α)、白细胞介素1β(IL-1β)、β-内啡肽(β-EP)的情况。比较2组患者治疗前后腓总神经传导速度(CPNMCV)、胫神经传导速度(NTMCV)的变化情况。并评价2组不良反应的发生情况。【结果】(1)治疗后,2组患者的IL-1β、TNF-α、β-EP水平明显改善(P<0.05),且观察组在改善IL-1β、TNF-α、β-EP水平方面明显优于对照组,差异有统计学意义(P<0.05)。(2)治疗后,2组患者的TGF-β1、PGE2水平明显改善(P<0.05),且观察组在改善TGF-β1、PGE2水平方面明显优于对照组,差异有统计学意义(P<0.05)。(3)治疗后,2组患者的VAS、JOA评分明显改善(P<0.05),且观察组在改善VAS、JOA评分方面明显优于对照组,差异有统计学意义(P<0.05)。(4)治疗后,2组患者的CPNMCV、NTMCV水平明显改善(P<0.05),且观察组在改善CPNMCV、NTMCV水平方面明显优于对照组,差异有统计学意义(P<0.05)。(5)观察组总有效率为93.75%(45/48),对照组为75.00%(36/48)。观察组疗效优于对照组,差异有统计学意义(P<0.05)。(6)观察组不良反应总发生率为14.58%(7/48),对照组为16.67%(8/48),2组患者的不良反应发生率比较,差异无统计学意义(P>0.05)。【结论】温针灸治疗寒湿痹阻型腰椎间盘突出症,能明显减轻患者的疼痛症状,改善患者的腰椎功能,疗效显著。

平乐筋骨并调疗法联合肌骨超声引导下颈神经根阻滞治疗神经根型颈椎病40例临床观察

目的:观察平乐筋骨并调疗法联合肌骨超声引导下颈神经根阻滞治疗神经根型颈椎病的临床疗效。方法:将80例神经根型颈椎病患者随机分为治疗组和对照组,每组40例。对照组采用肌骨超声引导下颈神经根阻滞治疗,治疗组采用平乐筋骨并调疗法联合肌骨超声引导下颈神经根阻滞治疗。观察2组患者治疗前后神经根型颈椎病症状体征积分及疼痛视觉模拟评分法(VAS)评分,并观察临床疗效。结果:治疗后、治疗后4周,2组患者症状体征积分较治疗前明显升高,VAS评分较治疗前明显降低,差异有统计学意义(P<0.05)。2组间比较,治疗组症状体征积分、VAS评分、疼痛改善程度明显优于对照组,差异有统计学意义(P<0.05)。2组患者治疗后及治疗后4周的疗效比较,治疗组均明显优于对照组,差异有统计学意义(P<0.05)。结论:平乐筋骨并调疗法联合肌骨超声引导下颈神经根阻滞治疗神经根型颈椎病疗效显著,标本兼治,值得临床推广应用。

电针四白穴对神经阻断大鼠胃肌电的影响

目的:探讨电针四白穴,对大鼠胃肌电兴奋途径．方法:大鼠32只,随机分为4组．选用ip抗胆碱能M受体阻断剂阿托品、交感神经节阻断剂六羟季胺和肾上腺素能神经阻断剂利血平,观察电针四白穴对神经阻断大鼠胃肌电的影响．结果:大鼠腹腔注射阿托品、六羟季胺后,慢波高活动相平均振幅、慢波高活动相时程／慢波周期比值以及快波平均峰簇数下降(P<0．01, P<0．05,P<0．01);注射利血平后,以上三种参数分别升高(P<0．01,P>0．05,P<0．01)．针刺四白穴能部分取消阿托品、六羟季胺对大鼠胃肌电的抑制效应(P<0．05或P>0．05)．结论:电针足阳明经四白穴对胃调控作用的外周通路既有胆碱能神经、交感神经系统的参与,又有肾上腺素能神经系统的参与．

枕神经阻滞在合并眼鼻症状颈源性头痛中的诊疗作用

目的观察枕神经阻滞在合并眼鼻症状颈源性头痛中的诊疗作用。方法对20例合并眼鼻症状的头痛(单侧枕、顶、额部疼痛为主)患者采用枕神经阻滞,评价治疗前及治疗后第1,3天后的视觉模拟评分(VAS)及眼鼻症状。结果与治疗前相比,枕神经阻滞后第1天VAS评分及眼鼻症状显著改善(P<0.01);与阻滞后第1天比较,第3天的VAS评分及眼鼻症状明显增加(P<0.01)。结论枕神经阻滞有利于确诊合并眼鼻症状的颈源性头痛。

平面内技术与平面外技术在超声引导下的斜角肌间隙臂丛神经阻滞中的临床效果

目的:探讨平面内穿刺技术和平面外穿刺技术在超声引导下的斜角肌间隙臂丛神经阻滞中的效果,便捷性及并发症的发生率。方法:选择上肢手术需要行臂丛麻醉的患者60例,随机分为超声平面内技术组(UI组)和超声平面外技术组(UO组)。观察两组患者臂丛神经阻滞图像定位时间、操作时间、臂丛神经主要分支阻滞程度(完全阻滞、部分阻滞、未阻滞)、麻醉效果(优、良、差)、并发症(局麻药中毒、血肿、声嘶、气胸、神经损伤、呼吸困难、Horner综合征)发生率。结果:两组患者图像定位时间无明显差异[(66.90±2.13s) vs(67.83±3.53s),P>0.05],与平面内组相比,平面外组穿刺操作时间更短[(137.66±18.95s) vs(191.19±15.60s),P<0.05];两组患者的臂丛神经主要分支阻滞程度、麻醉效果、并发症发生率无显著差异。结论:平面内及平面外技术都可以较好地用于超声引导的斜角肌间隙臂丛神经阻滞,平面外技术用时更短。

腰大池置管持续外引流术置管方向不同的比较研究

目的对比腰大池置管持续外引流术置管方向不同出现并发症的机率大小。方法将46例颅内感染患者平均分为A、B两组,利用Medtronic体外引流及监测系统进行腰大池置管持续外引流术。A组采用置管时引流管进入蛛网膜下腔后管头向头部放置;B组采用置管时引流管进入蛛网膜下腔后管头向骶部侧放置。比较两组出现堵管和神经根刺激症状的不同。结果 A组较B组术后出现堵管和神经根刺激症状的例数均较多,堵管及神经根刺激症状差异有统计学意义(P<0.05)。结论腰大池置管持续外引流术置管时导管向骶部侧放置引起堵管及神经根刺激症状的机率较导管向头部放置小,故推荐置管时采用管头向骶部放置。

连续股神经阻滞联合浸润麻醉在全膝关节置换术患者中的镇痛效果

目的探讨浸润麻醉与连续股神经阻滞麻醉联合应用的镇痛效果。方法选取接受全膝关节置换手术患者80例,随机分成2组。对照组术前给予连续股神经阻滞麻醉,试验组给予浸润麻醉与连续股神经阻滞麻醉,比较2组镇痛效果及恢复清醒时间。结果试验组患者8、12、24、48 h的静态、动态VAS评分显著低于对照组(P<0.05)。试验组自主呼吸恢复时间、监护室停留时间、出室时间显著短于对照组(P<0.05)。结论采用浸润麻醉联合连续股神经阻滞麻醉的镇痛效果显著。

CT引导下化学性腰交感神经阻滞治疗下肢缺血性疼痛的疗效观察

目的观察CT引导下腰交感神经阻滞对下肢缺血性疾病的疗效。方法全部病例均在CT引导下操作,在L2椎体下1/3的前外侧各注射5.0 mL显影剂,未见异常后,各注射等量的无水乙醇。结果所有患者于4周后随访,优显效10例,有效16例,显效率27%,有效率70.3%。结论CT引导下腰交感神经阻滞操作简单、时间短、损伤小、副作用少、费用合理、易于被患者所接受,值得推广。

星状神经节和局部神经阻滞治疗顽固性头痛疗效观察

目的探讨顽固性头痛治疗的新方法。方法总结2004年12月至2009年12月采用同时注射药物阻滞痛侧星状神经节和痛区局部神经治疗447例顽固性头痛的临床疗效。结果经1~3次治疗头痛消失且1年内无复发者161例（36.02%）;经4~5次治疗头痛消失且1年内无复发者183例（40.94%）;经6~7次治疗头痛消失且1年内无复发者98例（21.92%）;经7次治疗头痛次数明显减少或头痛程度明显减轻者5例（1.12%）。结论同时阻滞患侧星状神经节和痛区局部神经是顽固性头痛的一种有效治疗方法 。

全膝关节置换术后股神经阻滞与静脉镇痛泵早期镇痛效果比较

目的对比连续股神经阻滞和静脉镇痛泵在全膝关节置换术后早期镇痛效果。方法 2012年03月—2012年08月笔者所在科行单侧全膝关节置换患者60例,随机分为两组,术后超声引导下连续股神经阻滞镇痛30例,应用静脉泵镇痛30例;股神经阻滞组患者术后间断泵入0.25%布比卡因溶液,静脉镇痛泵组患者术后持续泵入舒芬太尼100μg+氟哌利多2.5 mg+生理盐水至100 ml,两组患者均持续镇痛3 d。记录静息、被动功能训练时的疼痛视觉模拟评分(VAS),术后72 h的镇痛并发症发生率。结果在静息及被动功能锻炼时股神经阻滞组的VAS显著低于静脉镇痛泵组(P<0.05),镇痛并发症的发生率股神经阻滞组显著低于静脉镇痛泵组(P<0.05)。结论超声引导下持续股神经阻滞操作简单、安全,镇痛效果良好,能够有效缓解膝关节置换术后的早期疼痛。