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.

Peripheral Nerve Block Combined with Epidural Anesthesia for Incarcerated Inguinal Hernia Repair in a Patient with Severe Chronic Obstructive Pulmonary Disease: A Case Report

Background: Invasive mechanical ventilation worsens prognosis in patients with severe chronic obstructive pulmonary disease (COPD). To avoid complications in these patients, anesthesia should be carefully considered. Case presentation: A 78-year-old man with COPD presented with dyspnea and pain from the epigastric to the umbilical regions. He was diagnosed with left incarcerated inguinal hernia and underwent radical inguinal hernia repair and surgical ileus treatment. To avoid general anesthesia with tracheal intubation, epidural anesthesia was combined with peripheral nerve blocks. An epidural catheter was inserted from T12/L1, and ilioinguinal-iliohypogastric and genitofemoral nerve blocks were performed under ultrasound guidance. No post-surgery complications or pain symptoms were noted. Conclusions: General anesthesia would likely have been challenging due to the patient’s COPD;however, management of peritoneal traction pain is difficult using peripheral nerve block alone. By combining epidural anesthesia with peripheral nerve blocks, we safely performed a procedure in a patient with severe COPD while avoiding invasive positive pressure ventilation.

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.

Supplementary motor area deactivation impacts the recovery of hand function from severe peripheral nerve injury

Although some patients have successful peripheral nerve regeneration,a poor recovery of hand function often occurs after peripheral nerve injury.It is believed that the capability of brain plasticity is crucial for the recovery of hand function.The supplementary motor area may play a key role in brain remodeling after peripheral nerve injury.In this study,we explored the activation mode of the supplementary motor area during a motor imagery task.We investigated the plasticity of the central nervous system after brachial plexus injury,using the motor imagery task.Results from functional magnetic resonance imaging showed that after brachial plexus injury,the motor imagery task for the affected limbs of the patients triggered no obvious activation of bilateral supplementary motor areas.This result indicates that it is difficult to excite the supplementary motor areas of brachial plexus injury patients during a motor imagery task,thereby impacting brain remodeling.Deactivation of the supplementary motor area is likely to be a serious problem for brachial plexus injury patients in terms of preparing,initiating and executing certain movements,which may be partly responsible for the unsatisfactory clinical recovery of hand function.

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.

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.

Comparason of Peri-Articular Multimodal Drug Injection with Femoral and Sciatic Nerve Block after Total Knee Arthroplasty

Good perioperative analgesia following total knee arthroplasty facilitates rehabilitation and may reduce hospital stay. We present the patient analgesic requirements and rehabilitation of a prospective single surgeon series after the introduction of a multimodal drug injection during his total knee arthroplasty. Basic epidemiological data as well as analgesic, antiemetic requirements and time to straight leg raised was collected on 27 consecutive patients (group 1) whom received the multimodal drug injection, consisting of levobupivacaine, ketorolac and adrenaline at the time of their total knee arthroplasty under spinal anaesthesia. Their rehabilitation was compared to a retrospective review of patients who were case matched by age and sex (group 2n = 26), whom had received the unit standard of spinal anaesthetic and a femoral and sciatic block at the time of their operation. Patients in group 1 had significantly lower analgesic and antiemetic requirements than group 2. Group 1 also had a significantly shorter hospital stay. We have demonstrated that periarticular multimodal drug injection can improve perioperative analgesia and mobilisation following total knee arthroplasty as well as reducing opioid requirements and side effects.

Preoperative Pain Management of Patients with Hip Fractures: Blind Fascia Iliaca Compartment Block Compared to Ultrasound Guided Femoral Nerve Block—A Randomized Controlled Trial

Introduction: Blind fascia iliaca compartment block (FICB) and ultrasound guided femoral nerve block (FNB) are two types of peripheral nerve blocks, commonly used in preoperative pain management in patients with hip fractures in Danish emergency departments. The aim of this study was to compare the efficacy in pain management of these two types of peripheral nerve blocks in the preoperative period in patients with hip fractures. Method: We performed a randomized controlled study. The primary outcome was the proportion of patients with a numeric rating scale (NRS) pain score equal to three or less at rest and after passive leg raise test three hours after block administration. Results: A total of 88 patients were included in the study and 67 patients in the statistical analysis with 33 in the FICB group and 34 in the FNB group. The results showed a significant reduction in the proportion of patients with an NRS score higher than three, three hours after administration of either FICB or FNB compared to at inclusion. There was no significant difference in pain scores between patients receiving FICB versus patients receiving FNB at rest or after passive leg raise (p = 0.25 and p = 0.86, respectively). Conclusion: Blind FICB and ultrasound guided FNB were effective in preoperative pain management in patients with hip fractures. The results showed that the two types of peripheral nerve blocks were equally efficient in providing pain management in the preoperative period.

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.

Ultrasound Imaging of the Sciatic Nerve Division in the Popliteal Fossa: A Volunteer Study

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.

Ultrasound-Guided Peri-Lymphatic and Peri-Neural Corticosteroid Injection as an Adjuvant to Pain and Lymphedema Management in Terminal Cancer: Two Case Reports

We are reporting two patients presented with intractable cancer pain that was treated with a novel application of an ultrasound-guided peripheral nerve block using corticosteroid. This technique offered relief to both patients whom otherwise their cancer pain was difficult to manage. The first patient developed lymphedema to the right axilla from metastatic squamous cell carcinoma. After multiple injections were deposited around the brachial plexus, lymphedema on the right axilla decreased slightly in size;however, range of motion improved post-procedure prior to his discharge one week later. In the second patient with left inguinal lymphadenopathy from metastatic left ureteral transitional cell carcinoma, there was a dramatic reduction in lymphedema in the left groin and leg as well as a considerable decrease in pain score during a two week follow-up after the peri-neural and peri-lymphatic femoral block. A 75% improvement in patient satisfaction was reported in the office visit’s questionnaire form. Corticosteroids can be used as an adjuvant to peripheral nerve block to decrease the pain secondary to lymphedema caused by the inflammatory response from metastatic cancer. This application can provide an alternative way to manage severe cancer-related pain caused by lymphedema in both upper and lower limbs.

Predictive Reliability of the Phoenix Sign for the Outcome of Common Fibular (Peroneal) Nerve Decompression Surgery

A positive Phoenix sign occurs when a patient, with a suspected focal nerve entrapment of the Common Fibular (Peroneal) Nerve (CFN) at the level of the fibular neck, demonstrates an improvement in dorsifexion after an ultrasound guided infiltration of a sub-anesthetic dose of lidocaine. Less than 5 cc’s of 1% or 2% lidocaine is utilized and the effect is seen within minutes after the infiltration, but usually lasts only 10 minutes. This effect may be due to the vasodilatory action of lidocaine on the microcirculation in the area of infiltration. This nerve block has significant diagnostic utility as it is highly specific in the confirmation of true focal entrapment of the CFN, has high predictive value for a patient who may undergo surgical nerve decompression if they have demonstrated a positive Phoenix Sign, and may help in the surgical decision-making process in patients who have had a drop foot for many years but still may regain some motor function after decompression. In this retrospective review, 26 patients were tested, and 25 of this cohort demonstrated a Positive Phoenix Sign (an increase in dorsiflexion strength of the Extensor Hallucis Longus muscle (EHL)). One patient had no response to the peripheral nerve block. Of the 25 patients who demonstrated a positive “Phoenix Sign” and underwent nerve decompression of the CFN, and 25 (100%) showed an increase in dorsiflexion strength of the EHL after nerve decompression surgery of the CFN. The one patient in this cohort who did not demonstrate any improvement in dorsiflexion of the EHL after the nerve block did not have any improvement after surgery.

不同麻醉方式对老年全膝关节置换术早期预后的影响:一项单中心回顾性研究

目的 探讨不同麻醉方式对老年全膝关节置换术后早期预后的影响。方法 回顾性分析2018年10月至2021年9月在我院骨科行单侧全膝关节置换术病人的临床资料,根据麻醉方式分为全身麻醉组(GA组)、复合麻醉组(CA组)、外周神经阻滞组(PNB组)和腰麻组(SA组),与GA组和CA组比较,PNB组和SA组病人美国麻醉医师协会(ASA)分级,合并症比率更高,差异有统计学意义(P<0.05)。记录病人的一般资料、手术时间、麻醉时间、术后恢复室(PACU)观察时间和术后住院天数;记录低血压、血管活性药物泵注、术后24 h补救镇痛、舒芬太尼用量、术后炎性指标和48 h内并发症的发生率。结果 与GA组、CA组比较,PNB组和SA组病人低血压、低氧血症、血管活性药物泵注、急性心肌损伤、术后谵妄、术后恶心呕吐(PONV)、补救镇痛、入住ICU的发生率更低,舒芬太尼用量、炎性指标水平更低,术后PACU观察时间和住院时间缩短,差异均有统计学意义(P<0.05)。与GA组比较,CA组术中舒芬太尼用量、术中低血压、血管活性药物泵注和补救镇痛率显著降低,差异有统计学意义(P<0.05)。结论 与全身麻醉和复合麻醉相比,外周神经阻滞和腰麻是老年病人全膝关节置换术推荐的麻醉方式,可以改善早期预后。

不同局麻药佐剂在周围神经阻滞中的应用进展

超声引导下周围神经阻滞技术在临床麻醉和术后镇痛中的应用越来越广泛。目前,怎样缩短周围神经阻滞的起效时间、延长所用局麻药的作用时间、降低局麻药的毒性反应、增强周围神经阻滞效果是临床麻醉关注的热点问题。许多学者为了缩短周围神经阻滞麻醉的起效时间,增强阻滞效果,延长阻滞的作用时间,尝试了在局麻药中加入多种佐剂进行研究,对比了在周围神经阻滞中应用不同局麻药佐剂的作用效果。本文将对近年来在周围神经阻滞中应用不同局麻药佐剂的应用和研究进展做一综述,以期为临床麻醉医生进行周围神经阻滞提供指导。

Ultrasound guidance for brachial plexus block decreases the incidence of complete hemi-diaphragmatic paresis or vascular punctures and improves success rate of brachial plexus nerve block compared with peripheral nerve stimulator in adults

Background The use of traditional techniques （such as landmark techniques, paresthesia and peripheral nerve stimulator） for upper-limb anesthesia has often been restricted to the expert or enthusiast, which was blind. Recently, ultrasound （US） has been applied to differ blood vessel, pleura and nerve, thus may reduce the risk of complications while have a high rate of success. The aim of this study was to determine if the use of ultrasound guidance （vs. peripheral nerve stimulator, （PNS）） decreases risk of vascular puncture, risk of hemi-diaphragmatic paresis and risk of Homer syndrome and improves the success rate of nerve block. Methods A search strategy was developed to identify randomized control trials （RCTs） reporting on complications of US and PNS guidance for upper-extremity peripheral nerve blocks （brachial plexus） in adults available through PubMed databases, the Cochrane Central Register of Controlled Trials, Embase databases, SinoMed databases and Wanfang data （date up to 2011-12-20）. Two independent reviewers appraised eligible studies and extracted data. Risk ratios （OR） were calculated for each outcome and presented with 95% confidence intervals （CI） with the software of Review Manager 5.1.0 System （Cochrane Library）. Results Sixteen trials involving 1321 adults met our criteria were included for analysis. Blocks performed using US guidance were more likely to be successful （risk ratio （RR） for block success 0.36, 95% CI 0.23-0.56, P 〈0.00001）, decreased incidence of vascular puncture during block performance （RR 0.13, 95% CI 0.06-0.27, P 〈0.00001）, decreased the risk of complete hemi-diaphragmatic paresis （RR 0.09, 95% CI 0.03-0.52, P=-0.0001）. Conclusions US decreases risks of complete hemi-diaphragmatic paresis or vascular puncture and improves success rate of brachial plexus nerve block compared with techniques that utilize PNS for nerve localization. Larger studies are needed to determine whether or not the use of US can decrease risk of neurologic complications.

右美托咪定复合罗哌卡因收肌管阻滞辅助全身麻醉在全膝关节置换术中的应用效果

目的:探讨右美托咪定复合罗哌卡因收肌管阻滞辅助全身麻醉在全膝关节置换术(TKA)中的应用效果。方法:选取2019年3月至2020年3月于该院行TKA治疗的110例膝关节病患者进行前瞻性研究,按照随机数字表法将其分为观察组和对照组各55例。在全身麻醉基础上,对照组采用罗哌卡因行超声引导下收肌管阻滞,观察组采用右美托咪定复合罗哌卡因行收肌管阻滞。比较两组神经阻滞效果[感觉阻滞起效时间(OTSB)、运动阻滞起效时间(OTMB)、感觉阻滞持续时间(DSB)、运动阻滞持续时间(DMB)]、术中血流动力学指标[麻醉诱导完成后(T_(0))、切皮时(T_(1))、手术开始后30 min(T_(2))、术毕时(T_(3))的平均动脉压(MAP)和心率]水平、术后疼痛[视觉疼痛模拟评分法(VAS)]评分、麻醉药物用量、术后镇痛泵按压次数及不良反应发生率。结果:两组OTSB、OTMB比较,差异均无统计学意义(P>0.05);观察组DSB、DMB均长于对照组,差异有统计学意义(P<0.05);T_(1)、T_(2)、T_(3)时,观察组MAP、心率水平均低于对照组,差异有统计学意义(P<0.05);观察组术后12、24、48 h时的VAS评分均低于对照组,差异有统计学意义(P<0.05);观察组丙泊酚、舒芬太尼、瑞芬太尼用量及术后镇痛泵按压次数均少于对照组,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:右美托咪定复合罗哌卡因收肌管阻滞辅助全身麻醉用于TKA患者可缩短麻醉起效时间,延长神经阻滞持续时间,维持术中血流动力学稳定,提高术后疼痛效果,减少术中及术后麻醉药物用量,且不增加不良反应。

腰硬联合麻醉复合髋关节囊周围神经阻滞在老年髋部骨折患者中的应用效果

目的分析老年髋部骨折患者联合腰硬复合麻醉、髋关节囊周围神经阻滞的作用。方法非随机选取2021年1月—2023年1月新疆生产建设兵团第十三师红星医院收治的120例老年髋部骨折患者为研究对象,均予以外科手术治疗,按照不同麻醉方式分为两组,各60例。对照组采取腰硬联合麻醉,观察组采取腰硬联合麻醉复合髋关节囊周围神经阻滞,比较两组患者应用效果。结果观察组术后中枢神经特异蛋白、β-淀粉样蛋白1-40水平分别为(94.28±13.23)mg/L、(6.52±0.94)mg/L,均较对照组的(130.54±23.89)mg/L、(9.81±1.55)mg/L低,差异有统计学意义(t=9.044、7.837,P均<0.05);观察组术后2、4、6、12 h的VAS评分较对照组低,差异有统计学意义(P均<0.05)。结论联合腰硬复合麻醉、髋关节囊周围神经阻滞用于老年髋部骨折患者,能够减轻患者术后疼痛,并降低术后中枢神经系统的损伤。

周围神经阻滞后反弹性疼痛的研究进展

周围神经阻滞是一种不良反应少、安全性高的麻醉镇痛方法,已普遍应用于各类手术的麻醉和术后镇痛,神经阻滞后反弹性疼痛也逐渐被认识。本文就周围神经阻滞后反弹性疼痛的定义、发生机制和干预措施进行综述,旨在提高临床医师对周围神经阻滞后反弹性疼痛的重视,为周围神经阻滞后反弹性疼痛的综合管理提供参考。