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.

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.

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.

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.

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。

超声引导下双侧闭孔神经阻滞联合咪达唑仑静脉麻醉对膀胱癌手术患者血流动力学及苏醒质量的影响

目的探讨超声引导下双侧闭孔神经阻滞联合咪达唑仑静脉麻醉对膀胱癌手术患者血流动力学及苏醒质量的影响。方法选取拟行手术治疗的98例膀胱癌患者进行前瞻性随机对照研究,通过随机数字表法将其分为对照组和研究组,各49例。对照组给予咪达唑仑静脉全麻,观察组在对照组基础上联用超声引导下双侧闭孔神经阻滞。对比两组麻醉前(T1)、麻醉后20 min(T2)、麻醉后40 min(T3)、术后拔管时(T4)血流动力学[心率(HR)、平均动脉压(MAP)]、苏醒质量[Steward苏醒评分、意识状态OAAS评分(OAAS)]及咪达唑仑使用剂量。结果随着T1、T2、T3、T4时点推移,两组HR、MAP水平均下降,且观察组T2、T3、T4时点HR、MAP水平均高于对照组(P<0.05)。观察组Steward苏醒评分、OAAS评分显著高于对照组(P<0.05)。对照组咪达唑仑剂量为5~10 mg,平均(7.64±1.23)mg;观察组咪达唑仑剂量为5~8 mg,平均(6.65±0.55)mg。观察组咪达唑仑剂量显著少于对照组,差异有统计学意义(t=5.143,P<0.001)。结论超声引导下双侧闭孔神经阻滞联合咪达唑仑静脉麻醉可提高膀胱癌手术患者苏醒质量,且对血流动力学影响较小,麻醉效果好。

两种麻醉方式对经尿道膀胱肿瘤电切术患者闭孔神经反射和术后恢复的影响

目的观察超声引导下改良闭孔神经阻滞(ONB)联合瑞马唑仑麻醉对经尿道膀胱肿瘤电切术(TURBT)患者闭孔神经反射(ONR)和术后恢复的影响。方法选取2019年6月至2021年6月秦皇岛医院收治的行TURBT术的膀胱肿瘤患者100例,根据ONB方式的不同将其分为常规组(椎管内麻醉+传统ONB麻醉)50例,超声组(椎管内麻醉+超声引导下改良ONB联合瑞马唑仑麻醉)50例。比较两组围术期指标、不同时间点血流动力学指标、术中ONR发生情况、并发症、麻醉不良反应。结果与常规组比较,超声组ONB时间、手术时间、尿管留置时间、住院时间均缩短,术中出血量减少(P<0.05)。给药后30 min(T1)、手术结束时(T2)时与常规组比较,超声组平均动脉压(MAP)、氧饱和度(SaO 2)升高(P<0.05)。与常规组比较,超声组术中ONR、膀胱出血发生率降低,术后心动过缓、恶心呕吐发生率降低(P<0.05)。结论超声引导下改良ONB联合瑞马唑仑麻醉可有效改善TURBT术围术期指标,减少术中ONR、膀胱出血,且对血流动力学影响小,术后麻醉不良反应少。

老年髋部骨折体位摆放前应用超声引导下FICB联合右美托咪定镇痛的效果

目的探究老年髋部骨折患者体位摆放前应用超声引导下髂筋膜间隙阻滞(FICB)联合右美托咪定(Dex)镇痛的效果。方法收集2020年8月—2022年4月收治的91例老年髋部骨折的临床资料,根据体位摆放前镇痛方法不同分为2组,ONB组45例采用超声引导下闭孔神经阻滞(ONB)联合Dex镇痛,FICB组46例采用超声引导下FICB联合Dex镇痛。比较2组阻滞操作时间、阻滞完善时间及入室时(T0)、摆放体位前(T1)、摆放体位时(T2)镇痛效果和心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO2),T1、T2时白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、超氧化物歧化酶(SOD)、丙二醛(MDA)水平,不良反应及阻滞后等待手术时间、术后住院时间。结果FICB组阻滞完善时间、阻滞后等待手术时间、术后住院时间均较ONB组短(P<0.05,P<0.01)。2组T1、T2时数字等级量表(NRS)分值均较T0时明显降低,改良警觉/镇静观察评分(OAA/S)均较T0时明显升高,且T2时FICB组NRS分值较ONB组低,OAA/S分值较ONB组高(P<0.05)。2组T1、T2时HR、MAP均较T0时明显降低,且T2时FICB组HR、MAP均较ONB组低(P<0.05)。2组T2时血清IL-6、TNF-α、MDA水平均较T1时升高,但FICB组均较ONB组低,2组T2时血清SOD水平均较T1时降低,但FICB组均较ONB组高(P<0.05,P<0.01)。2组不良反应发生率比较差异无统计学意义(P>0.05)。结论老年髋部骨折患者体位摆放前采用超声引导下FICB联合Dex镇痛效果较好,能有效稳定血流动力学,降低疼痛程度,且能缩短患者阻滞后等待手术时间,加速术后康复。

超声引导下闭孔神经阻滞在经尿道膀胱肿瘤电切术中预防闭孔神经反射的效果研究

目的比较超声联合神经刺激仪引导下经腹股沟远端入路闭孔神经阻滞(ONB)和传统体表标志定位联合神经刺激仪引导下ONB在经尿道膀胱肿瘤电切术(TURBT)中预防闭孔神经反射的效果差异。方法收集2019年3月至2021年12月在华润武钢总医院行TURBT的患者共32例,术前影像学或内镜检查评估膀胱肿瘤均位于膀胱侧壁单侧或双侧闭孔神经支配区域,将其随机分为超声引导组(U组)18例和体表标志定位组(S组)14例。对比两组患者每侧ONB的穿刺次数、操作时间、ONB成功率、术中ONB的效果及并发症发生情况等。结果U组患者均为1次穿刺成功;S组患者有8侧为1次穿刺成功,10侧为2次及以上穿刺成功,其中1例失败,两组穿刺成功率比较差异无统计学意义(P>0.05)。U组ONB操作时间显著低于S组(P<0.05)。U组有1例术中出现轻度闭孔神经反射;S组有8例术中出现轻度闭孔神经反射,两组比较差异有统计学意义(P<0.05)。所有患者均未出现局麻药中毒、术后闭孔神经支配区域痛性感觉异常及闭孔神经损伤等情况。结论与传统体表标志定位联合神经刺激仪引导下ONB比较,超声联合神经刺激仪引导下经腹股沟远端入路ONB定位更准确、穿刺次数少、操作时间短且阻滞效果好,值得临床推广使用。

股骨粗隆间骨折患者采用B超引导闭孔神经阻滞联合髂筋膜间隙阻滞的麻醉效果研究

目的 分析B超引导闭孔神经阻滞联合髂筋膜间隙阻滞用于股骨粗隆间骨折患者中的麻醉效果。方法 98例股骨粗隆间骨折患者,采用抽签法分为对照组及观察组,各49例。对照组予以全身麻醉,观察组在对照组基础上予以B超引导闭孔神经阻滞联合髂筋膜间隙阻滞。对比两组不同时间点[穿刺前(T0)、穿刺后10 min(T1)、手术切皮时(T2)、术后5 min(T3)]的血流动力学指标[心率(HR)、呼吸频率(RR)、平均动脉压(MAP)]水平,不同时间点[术前(t0)、进入手术室后(t1)、转侧卧位时(t2)、术后1 d(t3)]的疼痛[重症监护疼痛观察工具(CPOT)]评分、睡眠质量[匹茨堡睡眠质量指数量表(PSQI)]评分,麻醉前后的疼痛介质指标[5-羟色胺(5-HT)、前列腺素E_(2)(PGE_(2))、P物质(SP)]水平,并发症发生情况,麻醉效果。结果 两组T0时的HR、RR、MAP水平对比,差异无统计学意义(P>0.05);观察组T1、T2、T3时的HR、RR、MAP水平均高于对照组,差异具有统计学意义(P<0.05)。两组t0时的CPOT评分对比,差异无统计学意义(P>0.05);观察组t1、t2、t3时的CPOT评分均低于对照组,差异具有统计学意义(P<0.05)。观察组术后1 d的PSQI评分低于对照组,差异具有统计学意义(P<0.05)。麻醉前,两组的5-HT、PGE_(2)、SP水平对比,差异无统计学意义(P>0.05);麻醉后,观察组的5-HT、PGE_(2)、SP水平分别为(0.51±0.08)μmol/L、(26.53±2.19)ng/ml、(52.36±2.88)pg/ml,均低于对照组的(0.76±0.12)μmol/L、(50.29±3.27)ng/ml、(98.49±5.76)pg/ml,差异具有统计学意义(P<0.05)。观察组并发症发生率2.04%低于对照组的16.33%,差异具有统计学意义(P<0.05)。观察组麻醉优良率97.96%高于对照组的79.59%,差异具有统计学意义(P<0.05)。结论 B超引导闭孔神经阻滞联合髂筋膜间隙阻滞运用于股骨粗隆间骨折患者中,麻醉效果更确切,能稳定血流动力学,保障生命安全,值得推广。

Three Cases of Idiopathic Superior Laryngeal Neuralgia Treated by Superior Laryngeal Nerve Block under Ultrasound Guidance

In treating superior laryngeal neuralgia （SLN）, superior laryngeal nerve blocks （SLNBs） can provide immediate relief of persistent pain. Although SLNB was effective, the procedure can increase the risks due to the proximity to the carotid artery, external vein, and other vessels. To avoid complications such as advertent intravascular injection, local anesthetic toxicity from intravascular absorption, and intratracheal injection, we successfully blocked the superior laryngeal nerve under ultrasound guidance in three patients suffering from SLN. The written informed consent before treatment was obtained for each patient participating in this study.

超声引导下闭孔神经阻滞联合连续股神经阻滞在全膝关节置换术后镇痛中的应用效果

目的:观察超声引导下闭孔神经阻滞联合连续股神经阻滞在全膝关节置换术(TKA)后镇痛中的应用效果。方法:回顾性分析2019年9月至2022年9月于该院行TKA治疗的70例患者的临床资料,根据镇痛方式不同将其分为对照组和观察组各35例。两组均顺利完成TKA,对照组术后予以连续股神经阻滞镇痛,观察组在对照组基础上联合超声引导下闭孔神经阻滞镇痛。比较两组术后疼痛[视觉模拟评分法(VAS)]评分、镇痛满意度和不良反应发生率。结果:术后6、12、24 h,观察组静息、运动时VAS评分均低于对照组,差异有统计学意义(P<0.05);术后48 h,两组静息、运动时VAS评分比较,差异均无统计学意义(P>0.05);观察组镇痛满意度为97.14%(34/35),高于对照组的77.14%(27/35),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:超声引导下闭孔神经阻滞联合连续股神经阻滞可提高TKA术后镇痛效果和患者镇痛满意度,效果优于单纯连续股神经阻滞,且不会增加不良反应。

不同膀胱癌切除术的临床效果比较

目的比较双极和单极经尿道外侧壁膀胱癌切除术(TURBT)在闭孔神经阻滞(ONB)下治疗侧壁非肌层浸润性膀胱癌(NMIBC)的围手术期结果和并发症。方法选取我院收治的外侧壁原发膀胱癌患者200例,依据双盲法分为观察组和对照组,每组100例。观察组予以双极TUR(B-TURBT)治疗,对照组予以单极TUR(M-TURBT)治疗。对比两组围手术期结果(包括闭孔神经反射、肌肉组织取样和热组织损伤、血红蛋白减少、钠减少、手术时间、住院时间及导管插入时间)和术后并发症(切口感染、肠梗阻、心肺脑意外、吻合口狭窄、肾积水和活动性血尿)。结果治疗后两组患者的闭孔神经反射、肌肉组织取样率和热组织损伤率比较,P>0.05;两组血红蛋白减少、钠减少、手术时间、住院时间比较,P>0.05;观察组导管插入时间明显低于对照组(P<0.05)。观察组术后并发症发生率显著低于对照组(P<0.05)。结论在外侧壁原发膀胱癌患者的治疗中,M-TURBT和B-TURBT均可通过脊髓麻醉联合ONB安全有效地实施。但是,M-TURBT患者术后导管插入时间长,术后并发症发生率高,因此,在外侧壁原发膀胱癌患者的治疗中更推荐B-TURBT。

超声联合神经刺激仪引导下闭孔神经阻滞效果的临床研究

目的通过比较超声联合神经刺激仪引导及单纯神经刺激仪引导下闭孔神经阻滞（ONB）,探讨超声联合神经刺激仪引导 ONB 的可行性及先进性。方法需行 ONB 的经尿道膀胱肿瘤电切术（TURBT）患者60例,男女不限,年龄39-77岁,BMI 19-30 kg/m2,随机均分为神经刺激仪组（S 组）和超声联合神经刺激仪组（US 组）,S 组患者在神经刺激仪引导下经典入路行 ONB；US组患者在超声联合神经刺激仪引导下行 ONB。神经阻滞过程中记录两组患者穿刺中最高 VAS 评分、穿刺一针成功率、穿刺内收肌收缩时间间隔、穿刺次数、穿刺深度、阻滞后大腿内收肌力、成功率及并发症等指标。结果两组患者 ONB 成功率、阻滞后大腿内收肌力、并发症发生率差异无统计学意义；一针成功率 US 组明显高于 S 组（P 〈0.01）；US 组最高 VAS 评分明显低于,穿刺内收肌收缩时间间隔明显短于,诱发收缩穿刺次数明显少于,穿刺深度明显浅于 S 组（P 〈0.05）。结论与经典入路神经刺激仪引导下 ONB 比较,超声联合神经刺激仪引导下 ONB 定位更准,操作更快,患者痛苦更小。

连续股神经阻滞联合单次闭孔神经阻滞对膝关节置换术后镇痛的影响

目的评价超声引导连续股神经阻滞联合单次闭孔神经阻滞对膝关节置换术后镇痛的影响。方法 2015年6月至2016年10月期间在本院择期行单膝置换术患者80例,ASA分级Ⅰ~Ⅲ级。采用随机数表法将患者分为连续股神经阻滞联合闭孔神经阻滞组(A组)和连续股神经阻滞组(B组),每组40例。两组患者全麻诱导前均在超声引导下行股神经阻滞。随后A组采用超声引导下行闭孔神经后支与前支阻滞,分别注射0.5%罗哌卡因各7.5 m L。B组使用同样方法注射生理盐水各7.5 m L。分别记录两组患者麻醉前与注药后15 min阻滞侧大腿内收肌肌力,术后6 h、12 h、24 h、48 h静态与动态VAS评分,不良反应及患者满意度评分。结果 A组患者的闭孔神经阻滞成功率为90.0%,显著高于B组的30.0%,差异具有显著统计学意义(P<0.01);A组患者术后12 h、24 h静态VAS评分分别为(2.5±0.5)分和(2.8±0.9)分,明显低于B组相应时间点的(2.8±0.5)分和(3.3±0.5)分,两组比较差异均有统计学意义(P<0.05);A组患者术后12 h、24 h动态VAS评分分别为(3.1±0.8)分和(3.0±0.9)分,明显低于B组的(3.5±0.7)分和(3.7±0.7)分,差异具有统计学意义(P<0.05);两组患者术后恶心、头晕发生率比较差异无统计意义(P>0.05);术后满意度A组高于B组,两组比较差异有显著统计学意义(P<0.01)。结论与单纯连续股神经阻滞比较,连续股神经置管联合闭孔神经阻滞对膝关节置换术患者术后镇痛效果更好,且不增加并发症。

超声引导下肢多神经联合阻滞在腘窝囊肿切除术中的应用

目的:观察超声引导下闭孔神经、股神经、股外侧皮神经和坐骨神经联合阻滞在腘窝囊肿切除手术中的镇痛效果及安全性。方法:选择本院2014年1月至2016年2月期间行单侧腘窝囊肿切除手术的患者60例,通过随机数字表法随机分为两组:硬膜外麻醉组(epidural anesthesia,E组)30例和超声引导神经阻滞组(nerve blocking,N组)30例。于入室时、腘窝囊肿切除时、缝皮时分别监测患者平均动脉血压(mean arterial blood pressure,MAP)、心率(heart rate,HR),术中和术后2、4、6、10 h分别监测患者视觉模拟量表(visual analogue scale scores,VAS)评分,并监测两组术中血压下降及能够耐受止血带的病例数。结果:N组患者术中生命体征较E组更加平稳(P<0.05),N组能够耐受止血带的病例数明显多于E组(P<0.05),且N组术中没有患者发生低血压。术中及术后2 h两组患者VAS评分无明显差异(P>0.05),但术后4、6、10 h N组较E组明显降低(P<0.05)。结论:超声引导下多神经联合阻滞能够充分满足腘窝囊肿手术的麻醉要求,镇痛持续时间更长,更加安全有效。

超声联合神经刺激仪引导利多卡因闭孔神经阻滞的半数有效容量

目的测定超声联合神经刺激仪引导下1.5%利多卡因闭孔神经阻滞(ONB)抑制经尿道膀胱肿瘤电切术(TURBT)中闭孔神经反射的半数有效容量(EV50)。方法术前根据膀胱镜检或CT检查结果确定需行闭孔神经阻滞的择期经尿道膀胱肿瘤电切术患者27例,ASAⅠ或Ⅱ级,年龄18～80岁,BMI 19～30kg/m2,在超声及外周神经刺激仪引导下用1.5%利多卡因行ONB,以大腿内收肌力、术中腿动情况等判定阻滞效果。利多卡因容量根据序贯法确定,起始容量为10ml,相邻容量比为1.2。计算利多卡因EV50及95%CI。结果超声及外周神经刺激仪引导下闭孔神经阻滞1.5%利多卡因EV50为5.26ml,95%CI为4.99～5.54ml。结论超声及外周神经刺激仪引导下行闭孔神经阻滞抑制经尿道膀胱肿瘤电切术中闭孔神经反射的1.5%利多卡因半数有效容量为5.26ml。

电刺激定位闭孔神经阻滞复合硬膜外麻醉用于经尿道膀胱肿瘤电切术

目的:观察神经刺激仪引导定位闭孔神经阻滞复合低位硬膜外麻醉用于输尿管开口周围的膀胱肿瘤患者经尿道膀胱肿瘤电切术(TUR-BT)的麻醉效果。方法:膀胱肿瘤位于输尿管开口周围(0.5～2cm)患者1100例,随机分为A组(神经刺激仪引导定位下闭孔神经阻滞)和B组(传统解剖标志定位下闭孔神经阻滞)各550例。比较2组闭孔神经阻滞效果及注入局麻药剂量。结果:与B组比较,A组平均进针深度浅(P<0.05),局麻药用药量少(P<0.05),闭孔神经阻滞失败、出血和局麻药中毒等不良反应发生率均明显降低(P<0.05)。结论:神经刺激仪引导可精确定位闭孔神经位置,排除发育变异,使闭孔神经阻滞更加准确,效果更加完善,降低中继开腹手术率,利于患者早日康复。