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.

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.

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.

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.

前路腰方肌-阴部神经阻滞对PCNL患者痛敏反应、血流动力学的影响

目的观察前路腰方肌-阴部神经阻滞对经皮肾镜碎石术(PCNL)患者痛敏反应、血流动力学的影响。方法前瞻性选取2022年5月至2023年2月在四川大学华西医院行全身麻醉下PCNL手术治疗的80例患者,按照简单随机法将其分为两组,每组各40例。全麻组单纯行全身麻醉,神经阻滞组全麻诱导后在超声引导下行前路腰方肌-阴部神经阻滞。比较两组手术一般情况(两组麻醉时间、术中出血量、苏醒时间、丙泊酚用量、术中瑞芬太尼用量、术后补救镇痛率、术后艾司洛尔和阿托品使用率、住院时间),麻醉诱导前(T_(0))、建立工作通道(T_(1))、取石即刻(T_(2))、手术结束(T_(3))的血流动力学指标[心率、平均动脉压(MAP)],术后3、6、12、24、48 h的咳嗽和静息视觉模拟评分法(VAS)评分,检测两组术前、术后1 d应激指标[皮质醇、促肾上腺皮质激素(ACTH)、去甲肾上腺素(NE)、肾素]的差异,记录并比较两组术后24、48 h术后恢复质量(QoR40)评分。结果两组的麻醉时间、术中出血量、苏醒时间、术后艾司洛尔和阿托品使用率、住院时间比较,差异均无统计学意义(P>0.05);神经阻滞组的丙泊酚用量、术中瑞芬太尼用量均少于全麻组,术后补救镇痛率低于全麻组,差异均有统计学意义(P<0.05)。神经阻滞组T1时心率低于全麻组,差异有统计学意义(P<0.05);神经阻滞组T_(0)、T_(2)、T_(3)时的心率及T_(0)、T_(1)、T_(2)、T_(3)时的MAP与同时间点全麻组比较,差异均无统计学意义(P>0.05)。神经阻滞组术后3、6、12、24、48 h的咳嗽和静息VAS评分均低于全麻组,差异均有统计学意义(P<0.05)。术后1 d,两组的皮质醇、ACTH、NE、肾素水平均较术前升高,且神经阻滞组的皮质醇、ACTH、NE、肾素水平均低于全麻组,差异均有统计学意义(P<0.05)。神经阻滞组术后24 h的QoR40评分高于全麻组,差异有统计学意义(P<0.05);神经阻滞组术后48 h的QoR40评分与全麻组比较,差异无统计学意义(P>0.05)。结论前路腰方肌-阴部神经阻滞可降低PCNL患者痛敏反应,稳定血流动力学,术后应激反应较小。

阴部神经阻滞在第二产程中的应用及对产妇分娩的影响

目的:探讨采用阴部神经阻滞与椎管内镇痛对产妇分娩第二产程的影响。方法:本研究将南昌市第一医院2022年1月—2023年11月收治的108例产妇作为研究对象,将其随机分为观察组58例,对照组50例,对照组采用椎管内镇痛,观察组采用阴部神经阻滞。比较两组分娩情况、疼痛评分、新生儿情况、满意度。结果:两组中转剖宫产数、阴道裂伤数比较,差异均无统计学意义(P>0.05)。观察组阴道侧切数、缩宫素使用数、产钳助产数均比对照组少,差异均有统计学意义(P<0.05)。两组第一产程视觉模拟评分法(VAS)评分比较,差异无统计学意义(P>0.05);观察组第二产程VAS评分比对照组低,差异有统计学意义(P<0.05)。两组新生儿心率、Apgar评分比较,差异均无统计学意义(P>0.05)。观察组满意度评分比对照组高,差异有统计学意义(P<0.05)。结论:在第二产程中采用阴部神经阻滞具有减少会阴侧切、缩宫素使用、产钳助产的作用,并且能够在第二产程中减少产妇疼痛,对新生儿无影响,具有明显的镇痛优势,能够被产妇所接受。

穴位揿针联合超声引导下的低浓度罗哌卡因阴部神经阻滞用于混合痔切除术后镇痛的临床研究

目的探析混合痔切除术患者采用穴位揿针联合超声引导下的低浓度罗哌卡因阴部神经阻滞对术后镇痛效果的影响。方法选取2023年1月至10月九江市中医医院肛肠科收治的混合痔手术治疗的60例患者作为研究对象,采用信封法将其分为观察组、对照组,每组各30例。对照组采用手术治疗和镇痛泵镇痛,观察组采取穴位揿针联合超声引导下的低浓度罗哌卡因阴部神经阻滞。比较两组疼痛评分、不良反应发生率、并发症发生率。结果观察组术后6、24、48、72 h以及术后7 d的疼痛评分均低于对照组,差异均有统计学意义(P<0.05),观察组不良反应总发生率、并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论在混合痔切除患者术后镇痛中采用穴位揿针联合超声引导下的低浓度罗哌卡因阴部神经阻滞,患者疼痛感明显减轻,有效防止患者不良反应和并发症发生,临床上可借鉴及推广。

双侧阴部神经阻滞联合硬膜外麻醉对混合痔手术患者的效果分析

目的:探讨双侧阴部神经阻滞(PNB)联合硬膜外麻醉(CEB)应用于混合痔手术患者的效果。方法:选取2022年5月-2023年5月枣庄市峄城区人民医院收治的82例混合痔手术患者为研究对象,按照随机数字表法将患者分为对照组和试验组,各41例。对照组采用CEB,试验组采用CEB联合双侧PNB麻醉,比较两组麻醉优良率、麻醉阻滞效果、血流动力学、肛门内压、术后疼痛评分及不良事件发生情况。结果:试验组麻醉优良率为95.12%,高于对照组的80.49%,差异有统计学意义(P<0.05)。试验组感觉神经、运动神经阻滞起效时间均短于对照组,维持时间长于对照组,差异均有统计学意义(P<0.05)。T_(1)、T_(2)、T_(3)时,试验组心率、平均动脉压低于对照组,差异均有统计学意义(P<0.05)。手术10 min时,试验组肛门内压低于对照组,术后6、12、24 h时试验组疼痛视觉模拟评分均较对照组低,差异均有统计学意义(P<0.05)。两组不良事件发生率相比,差异无统计学意义(P>0.05)。结论:双侧PNB联合CEB在混合痔手术患者中应用效果好,有助于缩短麻醉起效时间,延长麻醉维持时间,保持术中血流动力学指标相对平稳,降低手术时的肛门内压,减少术后疼痛,安全可靠。

经皮穴位电刺激联合超声引导下阴部神经阻滞在分娩镇痛中的临床研究

目的:探讨经皮穴位电刺激(transcutaneous electrical acupoint stimulation,TEAS)联合超声引导下阴部神经阻滞对阴道分娩产妇镇痛效果及妊娠结局的影响。方法:选取2021年7月至2022年1月在重庆市妇幼保健院经阴道分娩的初产妇106例,采用随机数字表法分为2组(经皮穴位电刺激联合超声引导下阴部神经阻滞为TP组,单纯硬膜外镇痛为EP组),每组53例。观察产妇在干预前(T_(0))、宫口开至6 cm(T_(1))、胎头着冠时(T_(2))的VAS评分,检测各时点β-内啡肽(β-endorphin,β-EP)浓度,比较2组产程时长,新生儿1 min Apgar评分、会阴情况及分娩后并发症。结果:2组产妇VAS评分自镇痛开始后均明显降低(P<0.01),且在不同时点VAS评分降低程度不一样;EP组VAS评分在T_(1)时低于TP组,在T_(2)时高于TP组(P<0.05);与EP组相比,TP组β-内啡肽浓度在T_(1)、T_(2)时增高(P<0.05);TP组产妇的第一产程活跃期及第二产程时间短于EP组,产妇会阴侧切率明显低于EP组(P<0.05),2组器械助产率及新生儿Apgar评分比较差异无统计学意义(P>0.05)。结论:TEAS镇痛效果在第一产程不如硬膜外阻滞明显,但TEAS联合超声引导下阴部神经阻滞可减轻全产程产痛至产妇耐受的程度,具有缩短产程及会阴保护作用,对母婴无不良影响,尤其当产妇不适用椎管内镇痛时,可作为一种安全、有效的多模式镇痛方案应用于临床。

超声引导下阴部神经阻滞联合椎管内镇痛在自然分娩术中的应用

目的 评估超声引导下阴部神经阻滞在自然分娩术中的应用。方法 选取2021年3月至2022年10月在泉州市中医院自然分娩的初产妇80例,按随机数表法将入选者分为试验组40例和对照组40例。试验组采用超声引导下的阴部神经阻滞加硬膜外镇痛,对照组采用单纯硬膜外镇痛。比较两组产妇在宫口扩张3 cm前、椎管内镇痛后30 min、会阴侧切时和切口缝合时的视觉模拟评分法(VAS)评分,助产士追加会阴部局部浸润麻醉的产妇数,产妇自行按压镇痛次数,对两组产妇的满意度进行统计。结果 在第二产程中,试验组会阴侧切时和切口缝合时的VAS评分小于对照组,差异有统计学意义(P<0.05);试验组术中自行按压镇痛次数少于对照组,差异有统计学意义(P<0.05);试验组术中助产士追加会阴部局部浸润麻醉的产妇数少于对照组,差异有统计学意义(P<0.05);试验组产妇满意度高于对照组,差异有统计学意义(P<0.05)。结论 经超声引导下双侧阴部神经阻滞用于自然分娩术中镇痛效果好,优势明显,值得推广。

超声引导下改良阴部神经阻滞用于肛周脓肿镇痛的临床研究

目的分析超声引导下改良阴部神经阻滞用于肛周脓肿镇痛的临床研究。方法采取前瞻性随机对照研究方法,选择2020年1月至2022年12月在四川省第二中医医院行手术治疗的120例肛周脓肿患者作为研究对象,采用随机数字表法分为2组,每组60例。2组均实施腰硬联合麻醉,在此基础上,对照组术后给予阿司匹林镇痛,观察组术后给予超声引导下改良阴部神经阻滞镇痛,比较2组手术结束时、术后48 h、术后72 h疼痛程度[视觉模拟评分法(VAS)],比较2组术前、术后48 h、术后72 h的炎性因子水平[C-反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)],比较2组补救镇痛率及不良反应发生情况。结果观察组术后48 h、术后72 h VAS评分均低于对照组,组间、时点、组间·时点交互比较有差异(P<0.05);观察组术后48 h、术后72 h CRP、IL-6、TNF-α水平均低于对照组,组间、时点、组间·时点交互比较有差异(P<0.05);观察组术后48 h、术后72 h睡眠质量均高于对照组,组间、时点、组间·时点交互比较有差异(P<0.05);观察组补救镇痛率低于对照组,差异有统计学意义(P<0.05);2组不良反应发生情况比较无差异(P>0.05)。结论超声引导下改良阴部神经阻滞可有效减轻肛周脓肿患者术后疼痛程度,降低炎性因子水平,提高睡眠质量,减少术后补救镇痛次数,且安全性较好。

CT引导下高电压长时程脉冲射频与神经阻滞治疗阴部神经痛的疗效分析

目的评价CT引导下高电压长时程脉冲射频与神经阻滞治疗阴部神经痛的临床疗效。方法纳入91例确诊为阴部神经痛的患者并随机分为脉冲射频组(PRF组)和神经阻滞组(NB组)。PRF组采用CT引导下阴部神经的高电压长时程PRF治疗,NB组使用CT引导阴部神经阻滞治疗。分别于术后1 d、2周和术后1、3以及6个月对患者进行疼痛视觉模拟量表(VAS)评分、坐姿时间以及PHQ-9评分,并记录所有与手术相关的并发症。结果共87例患者完成6个月随访,其中PRF组45例,NB组42例。术后第1天,两组VAS评分均较术前显著降低(P<0.01),NB组的VAS评分显著低于PRF组(P=0.039)。术后1、3和6个月,PRF组的VAS评分明显低于NB组(P<0.05)。术后3个月和6个月PRF组患者坐姿时间以及PHQ-9评分显著优于NB组(P<0.01)。PRF组和NB组均未观察到与此次手术相关的严重不良反应。结论CT引导阴部神经高电压长时程PRF较NB可更有效的缓解阴部神经痛患者疼痛、延长坐姿时间、改善抑郁状态。

神经刺激仪联合超声引导下双侧阴部神经阻滞用于直肠癌腹腔镜手术患者效果观察

目的探讨直肠癌腹腔镜手术患者采用神经刺激仪联合超声引导下双侧阴部神经阻滞的临床应用效果。方法以2017年4月-2022年4月收治的100例直肠癌腹腔镜手术患者作为研究对象,并随机分对照组(单纯神经刺激仪,50例)和观察组(神经刺激仪联合超声引导下双侧阴部神经阻滞,50例)。比较两组阻滞完成、起效及镇痛持续时间,对比分析两组麻醉效果,统计两组不同麻醉阶段患者生命体征变化,记录两组术后临床康复指标水平。结果观察组阻滞完成、阻滞起效、苏醒、肛门排气、首次下床及住院时间均显著短于对照组,T_(1)时心率水平显著低于对照组,T_(1)、T_(2)时舒张压水平均显著高于同期对照组(P值均<0.05)。结论神经刺激仪联合超声引导下双侧阴部神经阻滞用于直肠癌腹腔镜手术患者阻滞完成时间更短,起效更快,对机体生命体征指标影响更小,更利于术后康复。

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.

前路腰方肌-阴部神经阻滞联合全麻在经阴道全子宫切除术中的应用价值

目的探讨前路腰方肌-阴部神经阻滞联合全麻在经阴道全子宫切除术中的应用价值。方法选取在我院行择期经阴道全子宫切除+阴道前后壁修补术患者100例,将患者分为前路腰方肌-阴部神经阻滞联合全麻组(QPG组,50例)和前路腰方肌阻滞联合全麻组(QG组,50例),观察比较2组麻醉情况、运动及静息下视觉模拟(visual analog scale,VAS)评分。结果QPG组阻滞起效时间为(6.40±1.13)min,短于QG组(P<0.05);QPG组瑞芬太尼、丙泊酚、顺式阿曲库铵的用量分别为(6.40±1.13)min、(810.12±97.55)mg、(660.74±51.21)mg和(17.80±2.21)mg,少于QG组(P<0.05)。QPG组术后48 h内静脉自控镇痛(patient controlled intravenous analgesia,PCIA)累计用量、术后48 h内PCIA有效按压次数和补救镇痛发生率分别为(38.87±8.12)mL、(6.80±1.22)次和4.00%,少于QG组(P<0.05);QPG组苏醒时间、自主呼气恢复时间和拔除喉罩时间分别为(4.20±0.97)min、(5.33±1.02)min和(5.80±1.21)min,短于QG组(P<0.05)。QPG组运动及静息下术后2 h、8 h、12 h和24 h时VAS评分低于QG组(P<0.05),在组间、时点间差异有统计学意义(P<0.05)。结论经阴道全子宫切除前路腰方肌-阴部神经阻滞联合全麻有助于减少麻醉药物用量,改善术后镇痛效果。

罗哌卡因阴部神经阻滞对盆底重建术后镇痛及应激反应的影响

目的分析罗哌卡因阴部神经阻滞(PNB)应用于盆底重建术患者对术后镇痛及应激反应的影响。方法选取80例盆底重建手术患者为研究对象,按照随机数字表法将其分为对照组和研究组,各40例。对照组给予自控静脉镇痛(PCIA),研究组在对照组基础上给予罗哌卡因PNB。比较两组的临床效果。结果静息状态下,研究组术后6、12 h的视觉模拟评分法(VAS)评分显著低于对照组(P<0.05);活动状态下,研究组术后2、6、12 h的VAS评分显著低于对照组(P<0.05)。两组术后2、6、12、24、48 h的Ramsay评分比较,差异无统计学意义(P>0.05)。术后48 h,研究组的皮质醇(Cor)、血糖(BG)、去甲肾上腺素(NE)水平低于对照组(P<0.05)。术后48 h,研究组的白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)水平低于对照组(P<0.05)。术后6、12、24 h,研究组的Bruggrmann舒适度量表(BCS)评分高于对照组(P<0.05)。研究组的不良反应总发生率略低于对照组,但差异无统计学意义(P>0.05)。结论罗哌卡因PNB应用于盆底重建术患者中,具有较好的镇痛效果,可有效减轻疼痛程度、炎性反应和应激反应,增加舒适度。

硬膜外镇痛联合超声引导下阴部神经阻滞在产妇分娩中的应用效果

目的探讨产妇分娩期间应用硬膜外镇痛联合超声引导下阴部神经阻滞对手术效果的影响。方法选取70例产妇,根据随机数字表法分为两组,每组35例。对照组应用硬膜外麻醉,试验组应用硬膜外镇痛联合超声引导下阴部神经阻滞麻醉。比较两组产妇不同时间疼痛评分、手术相关指标。结果试验组产妇在阴部神经阻滞后15min(T_(4))、胎头着冠(T_(5))、会阴缝合(T_(6))时的疼痛评分明显低于对照组(P<0.05)。试验组第二、三产程短于对照组,硬膜外罗哌卡因用量、自控镇痛泵按压次数均明显少于对照组(P<0.05)。结论硬膜外镇痛联合超声引导下阴部神经阻滞在产妇分娩中的应用效果确切,值得临床推广。