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.

Efficacy of fascia iliaca compartment nerve block as part of multimodal analgesia after surgery for femoral bone fracture

BACKGROUND: Fascia iliaca compartment nerve block(FICNB) has been an established technique for postoperative analgesia after surgery for femoral bone fracture. FICNB is technically easy, effective for postoperative pain control after operation for femoral bone fracture and decreases the complications induced by systemic analgesic drugs. The severity of postoperative pain is affected by genetics, cultural and social factors across the world. In this study we assessed the efficacy of fascia iliaca compartment nerve block when it is used as part of multimodal analgesia after surgery for femoral bone fracture.METHODS: An institution-based case control study was conducted from September, 2013 to May, 2014. All patients who had been operated on under spinal anesthesia for femoral bone fracture were included. The patients divided into a FICNB group(n=20) and a control group(n=20). The FICNB group was given 30 mL of 0.25% bupivacaine at the end of the operation. Postoperative pain was assessed within the f irst 24 hours, i.e. at 15 minutes, 2 hours, 6 hours, 12 hours and 24 hours using 100 mm visual analogue scale(VAS), total analgesic consumption, and the time for the f irst analgesic request.RESULTS: VAS pain scores were reduced within the f irst 24 hours after operation in the FICNB group compared wtih the control group. VAS scores at 2 hours were taken as median values(IQR) 0.00(0.00) vs.18.00(30.00), P=0.001; at 6 hours 0.00(0.00) vs. 34.00(20.75), P=0.000; at 24 hours 12.50(10.00) vs. 31.50(20.75), P=0.004; and at 12 hours(17.80±12.45) vs.(29.95±12.40), P=0.004, respectively. The total analgesic consumption of diclofenac at 12 and 24 hours was reduced in the FICNB group, and the time for the fi rst analgesic request was signifi cantly prolonged(417.50 vs. 139.25 minutes, P=0.000).CONCLUSIONS: A single injection for FICNB could lead to postoperative pain relief, reduction of total analgesic consumption and prolonged time for the fi rst analgesic request in the FICNB group after surgery for femoral bone fracture. We recommend FICNB for analgesia after surgery for femoral bone fracture and for patients with femoral bone fracture at the emergency department.

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.

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.

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.

Effect of Ketoprofenphonophoresis and Femoral Nerve Block in Knee Osteoarthritis

Objective:To evaluate the effect of ketoprofenphonophoresis and femoral nerve block in knee osteoarthritis.Methods:One hundred and fourteen patients with knee osteoarthritis were randomly divided into two groups.The control group consisted of 57 patients who were treated with only ketoprofenphonophoresis.The experimental group consisted of patients were treated with ketoprofenphonophoresis and femoral nerve block.The patients were followed for more than one month.The treatment effect assessed by observing their WOMAC index before and after therapy.Results:All the patients finished the follow-up.Their WOMAC indexes were reduced after therapy and one month after treatment,especially in the experimental group(P<0.05).The effective efficiency of ketoprofenphonophoresis and femoral nerve block were higher than that in the control group after treatment and after one month of follow-up(P<0.05).Conclusion:Compared with only ketoprofenphonophoresis,the combined treatment of ketoprofenphonophoresis and femoral nerve block was more appropriate in knee osteoarthritis.

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.

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.

髋关节囊周围神经阻滞与髂筋膜间隙阻滞对老年股骨粗隆间骨折患者镇痛效果的对比研究

目的 探讨髋关节囊周围神经(pericapsular nerve group, PENG)阻滞与髂筋膜间隙阻滞(fascia iliaca compartment block, FICB)对老年股骨粗隆间骨折(intertrochanteric femur fracture, IFF)患者股骨近端防旋髓内钉(proximal femoral nail anti-rotation, PFNA)内固定术的镇痛效果。方法 选取2022年1—12月首都医科大学附属北京积水潭医院老年IFF患者60例,随机分为P组和F组,每组各30例。P组采用PENG阻滞,F组采用FICB。两组患者均接受椎管内麻醉进行手术,术后均给予患者静脉自控镇痛(patient controlled intravenous analgesia, PCIA)。比较两组患者不同时点(T1,神经阻滞前;T2,神经阻滞后30 min;T3,术后6 h;T4,术后24 h;T5,术后48 h)静息和运动时的视觉模拟评分(visual analogue score, VAS)、术后补救镇痛率、镇痛满意度评分、住院时间、PCIA按压次数及不良反应发生率。结果 60例患者中,男23例,女37例,年龄65~85岁,平均(70.6±6.0)岁。两组T2~T5时点静息和运动时VAS均低于T1时点,差异均有统计学意义(P <0.05);两组静息和运动时所有时点VAS、术后补救镇痛率、镇痛满意度评分、住院时间、PCIA按压次数及不良反应发生率的比较,差异均无统计学意义(P>0.05)。结论 PENG阻滞与FICB均可缓解老年IFF患者PFNA内固定术的镇痛,且镇痛效果相当。

超声引导下股神经、坐骨神经阻滞在跟骨骨折手术麻醉中的应用效果

目的:探究超声引导下股神经、坐骨神经阻滞在跟骨骨折手术麻醉中的应用效果。方法:选取2020年2月—2023年2月菏泽医学专科学校附属医院收治的跟骨骨折患者80例,以随机数字表法将其均分为对照组(椎管内麻醉)及观察组(超声引导下股神经、坐骨神经阻滞)各40例,对比两组麻醉效果;对比两组麻醉前(T_(0))、麻醉后5 min(T_(1))、麻醉后10 min(T_(2))、麻醉后15 min(T_(3))、麻醉后30min(T_(4))时刻的心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO_(2));对比两组应激反应指标[肾上腺素(E)、皮质醇(Cor)]、凝血功能[凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)]、不良反应发生率。结果:观察组麻醉效果Ⅰ级率高于对照组,差异有统计学意义(P<0.05)。两组T_(0)、T_(1)时刻HR、MAP、SpO_(2)水平比较差异均无统计学意义(P>0.05);对照组T_(2)、T_(3)、T_(4)时刻HR、MAP均高于T_(0)时刻,SpO_(2)均低于T_(0)时刻,差异均有统计学意义(P<0.05);观察组T_(2)、T_(3)、T_(4)时刻HR、MAP、SpO_(2)较T_(0)时刻差异均无统计学意义(P>0.05);观察组T_(2)、T_(3)、T_(4)时刻HR、MAP均低于对照组,SpO_(2)均高于对照组,差异均有统计学意义(P<0.05)。术前,两组E、Cor水平相较差异均无统计学意义(P>0.05);术后1 h两组E、Cor水平均升高,但观察组均低于对照组,差异均有统计学意义(P<0.05)。术前,两组TT、PT、APTT水平相较差异均无统计学意义(P>0.05);术后1 h,两组TT、PT、APTT水平均升高,且观察组均高于对照组,差异均有统计学意义(P<0.05)。观察组不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论:对跟骨骨折患者实施超声引导下股神经、坐骨神经阻滞,麻醉效果显著,减轻应激反应,稳定术中血流动力学,改善血液高凝状态,降低并发症发生率。

神经刺激仪引导下腰丛联合骶丛神经阻滞麻醉在股骨颈骨折患者中的应用

目的:探讨在股骨颈骨折患者中应用神经刺激仪引导下腰丛联合骶丛神经阻滞麻醉的效果。方法:选取2020年1月—2023年6月桂林市中医医院收治的98例股骨颈骨折患者作为研究对象,按照随机数表法将其分为对照组和研究组,各49例。对照组采用传统的腰硬联合麻醉,研究组采用神经刺激仪引导下腰丛联合骶丛神经阻滞麻醉。比较两组麻醉效果、平均动脉压(MAP)、心率(HR)、皮质醇(Cor)和儿茶氨酚(CA)及不良反应。结果:两组麻醉效果比较,差异无统计学意义(P>0.05)。研究组麻醉后15 min(T_(2))、麻醉后30 min(T_(3))时MAP高于对照组,差异有统计学意义(P<0.05);研究组麻醉后5 min(T_(1))、T_(2)、T_(3)、手术结束后(T_(4))时HR高于对照组,差异有统计学意义(P<0.05)。研究组术中(Tb)时CA、Cor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:股骨颈骨折患者应用神经刺激仪引导下腰丛联合骶丛神经阻滞麻醉能稳定血流动力学,缓解应激反应,具有良好的麻醉效果和较高的安全性。

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疼痛及膝关节功能的影响

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。

超声引导下髂腰肌平面阻滞对髋关节置换术患者术后恢复质量的影响

目的观察超声引导下髂腰肌平面阻滞对髋关节置换术患者术后恢复质量的影响。方法选择择期行人工髋关节置换术的患者60例,男37例,女23例,年龄40~79岁,BMI 18~30 kg/m^(2),ASAⅠ—Ⅲ级。采用随机数字表法将患者分为两组:髂腰肌平面阻滞组(IPB组)和股神经阻滞组(FNB组),每组30例。麻醉诱导前,IPB组采用0.5%罗哌卡因10 ml行超声引导下IPB,后采用0.5%罗哌卡因5 ml行股外侧皮神经阻滞;FNB组采用0.5%罗哌卡因10 ml行超声引导下FNB,后采用0.5%罗哌卡因5 ml行股外侧皮神经阻滞。记录术中丙泊酚、瑞芬太尼和顺式阿曲库铵用量。采用15项恢复质量(QoR-15)量表评估术前、术后1、2、3 d的恢复质量。记录术后12、24、48 h最高VAS(VAS_(max))疼痛评分和股四头肌徒手肌力测试(MMT)评分。记录术后首次下床活动时间、阿片类药物用量、患者满意度评分。记录神经损伤、血管损伤、穿刺部位感染和局麻药中毒等神经阻滞相关并发症的发生情况。记录头晕、恶心呕吐、深静脉血栓和谵妄等术后并发症的发生情况。结果两组术中丙泊酚、瑞芬太尼和顺式阿曲库铵用量差异无统计学意义。与FNB组比较,IPB组术后1、2、3 d QoR-15量表评分明显升高(P<0.05)。与FNB组比较,IPB组术后12、24 h股四头肌MMT评分明显升高,术后首次下床活动时间明显缩短(P<0.05)。两组术后VAS_(max)疼痛评分、术后48 h股四头肌MMT评分、阿片类药物用量和患者满意度评分差异无统计学意义。两组均未见神经阻滞等相关并发症。两组术后并发症发生率差异无统计学意义。结论超声引导下髂腰肌平面阻滞可提高髋关节置换术患者术后恢复质量,加速患者康复,效果优于股神经阻滞。

股神经和髂筋膜阻滞联合针灸对老年股骨颈骨折患者镇痛效果观察

目的探索针灸联合股神经和髂筋膜阻滞在老年股骨颈骨折(femoral neck fracture,FNF)患者疼痛管理中的效果。方法研究纳入2021年2月1日—2023年6月30日在海安市人民医院行髋关节置换术的FNF老年患者106例,随机分为将患者分为观察组和对照组,每组53例。对照组患者接受超声引导下的股神经阻滞和髂筋膜阻滞,观察组患者在股神经和髂筋膜的基础上予以针灸镇痛。比较观察组和对照组患者视觉模拟评分法(visual analogue scale,VAS)评分、认知功能(空间认知能力、工作记忆能力、简单计算能力、图片识别能力)、阻滞起效时间(感觉阻滞起效时间、完全感觉阻滞时间、运动阻滞起效时间、完全运动阻滞时间)、术后髋关节屈曲角度和不良事件发生率。结果(1)VAS评分。观察组和对照组患者术前VAS评分比较差异无统计学意义(P>0.05)。术后即刻和术后24 h,观察组患者VAS评分低于对照组(P<0.05)。术后2 d和术后3 d,观察组患者在静息时和功能锻炼时的VAS评分均低于对照组(P<0.05)。(2)认知功能。观察组和对照组患者术前空间认知能力评分、工作记忆能力评分、简单计算能力评分、图片识别能力评分等方面比较差异无统计学意义(P>0.05)。两组患者术后空间认知能力评分、工作记忆能力评分、简单计算能力评分、图片识别能力评分均低于术前(P<0.05),且观察组患者评分均高于对照组(P<0.05)。(3)阻滞起效时间。观察组和对照组患者感觉阻滞起效时间、运动阻滞起效时间比较差异无统计学意义(P>0.05)。观察组患者达到完全感觉阻滞时间、完全运动阻滞时间少于对照组(P<0.05)。(4)术后髋关节屈曲角度。术后1 d,观察组和对照组患者关节屈曲角度比较差异无统计学意义(P>0.05)。术后2、3 d,观察组患者关节屈曲角度大于对照组(P<0.05)。(5)不良事件发生率。观察组患者补救镇痛、谵妄发生率低于对照组(P<0.05)。观察组和对照组患者头晕、呕吐、神经损伤等方面发生率比较差异无统计学意义(P>0.05)。结论针灸联合股神经和髂筋膜阻滞可以有效缓解FNF老年患者术后疼痛,促进髋关节功能恢复,保护患者认知功能,降低谵妄发生率。

神经阻滞复合全麻与喉罩全麻对老年股骨粗隆间骨折术的效果及对MMSE的影响

目的:观察在老年股骨粗隆间骨折术中应用喉罩全麻时应用不同神经阻滞的效果,并分析对患者术后认知情况的影响。方法:选取2020年9月—2022年3月安阳市人民医院收治的137例股骨粗隆间骨折的老年患者作为研究对象,采用随机数表法分为A组(n=45,单独予以喉罩全麻)、其余患者根据神经阻滞方式不同分为B组(n=46,腰丛-坐骨神经阻滞复合喉罩全麻)和C组(n=46,L1~L2椎旁神经阻滞复合喉罩全麻)。比较三组患者麻醉效果、手术效果及预后情况。结果:术后,B组患者血氧饱和度(SPO_(2))、动脉氧分压(PaO_(2))高于A组、C组,平均动脉压(MAP)、二氧化碳分压(PaCO_(2))低于A组、C组,差异有统计学意义(F=27.36、195.84、34.27、11.77,P<0.05);B组患者Harris、MMSE评分略高于A组、C组,差异有统计学意义(F=51.80、94.63,P<0.05);B组患者超氧化物歧化酶(SOD)、过氧化氢酶(CAT)、谷胱甘肽过氧化物酶(GSH-Px)高于A组、C组,丙二醛(MDA)低于A组、C组,差异有统计学意义(F=33.93、201.68、85.16、4.60,P<0.05);三组患者不良反应发生情况比较,差异无统计学意义(χ^(2)=1.099,P>0.05)。结论:在老年股骨粗隆间骨折患者术中应用喉罩全麻联合腰丛-坐骨神经阻滞对改善患者生命体征、减轻应激反应、避免认知障碍更具优势。

股神经阻滞联合关节腔浸润麻醉在膝关节镜手术中的应用效果

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。

右美托咪定辅助股神经及坐骨神经阻滞对老年下肢骨折患者免疫功能及麻醉效果的影响

目的探讨右美托咪定辅助股神经及坐骨神经阻滞对老年下肢骨折患者免疫功能及麻醉效果的影响。方法选取2020年8月至2022年12月抚州市中医医院实施下肢手术治疗的50例老年下肢骨折患者作为研究对象,随机分为观察组与对照组,每组25例。两组均于超声引导下对前路骨神经、后路坐骨神经实施联合阻滞麻醉,观察组在麻醉成功后予以右美托咪定微量泵入,对照组予以等剂量0.9%氯化钠注射液静脉注射。比较两组给药前(T0)、给药后15 min(T1)、手术开始后15 min(T2)、手术开始后30 min(T3)、手术完毕(T4)血流动力学状态及Ramsay评分;比较两组手术前后免疫功能指标及不良反应发生情况。结果T1时,观察组HR慢于对照组,Ramsay评分高于对照组,差异有统计学意义(P<0.05);T2~T4时,观察组HR均慢于对照组,Ramsay评分高于对照组,观察组T3时MAP低于对照组,差异有统计学意义(P<0.05)。术后,两组CD3+、CD4+水平及CD4+/CD8+均低于术前,但观察组高于对照组,差异有统计学意义(P<0.05)。观察组不良反应发生率为4.00%,低于对照组的32.00%,差异有统计学意义(P<0.05)。结论老年下肢骨折患者实施右美托咪定辅助股神经、坐骨神经阻滞麻醉可使麻醉过程中血流动力学维持在稳定状态,强化镇痛效果,且不会对免疫功能造成明显影响,不良反应发生风险较小,具有较高有效性、安全性,值得临床推广应用。

不同时间股神经-坐骨神经阻滞对胫腓骨骨折患者术后疼痛与谵妄的影响比较

目的:比较不同时间股神经-坐骨神经阻滞对胫腓骨骨折患者术后疼痛与谵妄的影响。方法:采取回顾性分析法,将2022年7月—2023年6月福州市第二医院麻醉科收治的100例胫腓骨骨折患者根据股神经-坐骨神经阻滞时间不同分成A组与B组,A组50例于气管插管后手术切皮前(术前)行股神经-坐骨神经阻滞,B组50例于手术缝合结束即刻(术后)行股神经-坐骨神经阻滞,两组其余麻醉方法相同。观察两组麻醉效果、术后疼痛程度、认知功能、术后谵妄及不良反应发生率。结果:A组神经阻滞镇痛持续时间长于B组,差异有统计学意义(P<0.05),A组术后苏醒时间早于B组,丙泊酚用量、瑞芬太尼用量均少于B组,差异均有统计学意义(P<0.05);A组术后2、6、12、24 h视觉模拟评分法(VAS)评分均低于B组,差异均有统计学意义(P<0.05);两组术后1、3 d的简易智力状态检查量表(MMSE)评分均低于术前,A组术后1、3 d的MMSE评分均高于B组,差异均有统计学意义(P<0.05);A组术后谵妄发生率低于B组,差异有统计学意义(P<0.05);A组不良反应发生率低于B组,差异有统计学意义(P<0.05)。结论:术前股神经-坐骨神经阻滞在胫腓骨骨折患者手术中的应用效果较好,与术后股神经-坐骨神经阻滞相比,能够延长神经阻滞镇痛持续时间,缩短术后苏醒时间,减少麻醉维持用药量,减轻术后疼痛及认知功能损伤,降低术后谵妄及不良反应发生率。

经股神经长轴髂筋膜阻滞在老年髋部骨折患者镇痛中的应用

目的探讨超声平面内经股神经长轴髂筋膜阻滞在老年髋部骨折患者疼痛管理中的应用效果。方法选取2023年3月至6月嘉兴学院附属第二医院收治的老年髋部骨折患者60例,根据随机数字表法将其分为S组和L组,每组各30例。S组患者行经股神经短轴髂筋膜阻滞,L组患者行经股神经长轴髂筋膜阻滞,比较神经阻滞前(T0)、神经阻滞后10min(T1)、2h(T2)、6h(T3)和12h(T4)两组患者的静态数字评分量表(numerical rating scale,NRS)评分、动态NRS评分,各神经分支阻滞有效例数和神经阻滞相关不良事件发生情况。结果两组患者的静态和动态NRS评分随着时间的延长,先降低后略有升高。L组患者T2、T3时点的静态和动态NRS评分均显著低于S组(P<0.05);L组患者的股外侧皮神经阻滞和闭孔神经阻滞有效例数均显著多于S组(P<0.05);两组患者均无局部麻醉药中毒、外周神经损伤、镇痛掩盖病情等不良事件发生。结论超声引导下经股神经长轴髂筋膜阻滞可有效减轻老年髋部骨折患者的早期疼痛,且安全性较高。