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.

Case Report of a Patient with Swyer-James-MacLeod Syndrome Undergoing Breast Surgery under Regional Anaesthesia and Review of Literature

Swyer-James-MacLeod Syndrome is a rare acquired pulmonary disorder that develops secondary to infectious etiologies in early childhood. Patients who are affected have the potential of developing perioperative respiratory complications. While regional anaesthetic techniques are often performed as adjuncts to general anaesthesia, there is less data on breast operations being done solely under regional anaesthesia. We herein describe a patient with Swyer-James-MacLeod Syndrome who underwent breast lesion wide excision under combined paravertebral and pectoral nerves block, supplemented with propofol infusion for sedation. Choice of blocks was decided upon based on knowledge on the anatomy. Sole regional anaesthetic techniques have been the safest approach in some circumstances and should always be considered in patients who are of high risk under general anaesthesia.

Comparison of Three Methods of Regional Anesthesia of Peripheral Nerves and Plexuses

Aim: There were acquitted 1105 nerve blocks on 762 patients by means of three methods of peripheral nerves and plexuses identification to compare the safety and efficiency of the methods of regional anesthesia. Methods: Depending on the technique of carrying out the peripheral nerve blocks, patients were divided into 3 groups. 1st group: the identification of the correct placement of the injection needle was done by eliciting paresthesia (572 blocks were performed on 395 patients);2nd group: an electrical nerve stimulator was used to locate the nerve (164 blocks on 110 patients);3rd group: the location of the nerve was identified using ultrasonic visual guidance (369 blocks on 257 patients). Results and Conclusion: In 1st group 8 (1.4%) accidental intravascular injections of local anesthetic, 1 case of Horner syndrome (0.17%), 1 case of phrenical nerve were registered. In 17 cases there were performed other methods of anesthesia by reason of inefficiency of the block. In 2nd group 1 case (0.61%) of intravascular injection was noticed. The block was ineffective in single case. There was no complication received in the 3rd group. All the blocks were effective.

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.

模拟课程在住培医生超声引导下区域麻醉教学中的应用

超声引导下区域麻醉(ultrasound-guided regional anesthesia,UGRA)已成为不可或缺的局部麻醉方式之一。熟练掌握UGRA需要从业人员具备相关专业知识和技能。然而,目前针对住院医师的UGRA教学并没有标准化的课程,导致住院医师的UGRA熟练程度存在明显差异。研究表明,模拟课程可以显著提高住院医师的UGRA熟练程度,并帮助缺乏相关基础的麻醉医师建立必要的知识和技能储备。本文综述了在UGRA课程中实施的基于模拟的培训方法,以提高住院医师的UGRA熟练程度。

Drugs used for pain management in gastrointestinal surgery and their implications

Pain is the predominant symptom troubling patients.Pain management is one of the most important aspects in the management of surgical patients leading to early recovery from surgical procedures or in patients with chronic diseases or malignancy.Various groups of drugs are used for dealing with this;however,they have their own implications in the form of adverse effects and dependence.In this article,we review the concerns of different pain-relieving medicines used postoperatively in gastrointestinal surgery and for malignant and chronic diseases.

Thoracic Unilateral Spinal Cord Syndrome Following Neuraxial Anaesthesia for Periprosthetic Knee Fracture: A Case Report

Neuraxial anaesthesia is widely used in surgical procedures;overall, epidural and intrathecal techniques. Nevertheless, several outcomes should be considered. The incidence of neurologic complications after neuraxial anaesthesia is not perfectly clear (0% - 0.08%), although there are several described cases of spinal cord ischemia. We present a case of thoracic unilateral spinal cord syndrome following lumbar spinal anaesthesia for periprosthetic knee fracture. Our patient suffered monoparesis in her left lower limb as well as decreasing of muscle strength and loss of tendon reflexes. The MNR showed left hyperintense intra-cord images from T7 to T12 attributed to spinal cord oedema and a lineal hypointensity related to minimal haematic component. What made this case surprising was the fact that spinal anaesthesia was performed between L3 and L4 and the patient did not suffer paraesthesia associated with local anaesthetic injection. She was treated with glucocorticoids, gabapentin and amitriptyline. She also was checked by physical rehabilitators, neurologists and Pain Unit physicians. We have found another case reported in the literature about thoracic cord injury after lumbar spinal puncture. In this paper, we report possible aetiologies according to a review and neurological evolution of the patient seven months later.

经皮穴位电刺激辅助超声引导下胸椎旁神经阻滞用于乳腺癌根治术的麻醉效果

目的研究经皮穴位点刺激辅助超声引导下胸椎旁神经阻滞用于乳腺癌根治术的麻醉效果。方法选取2021年1月-2022年1月唐山市协和医院收治的120例行乳腺癌改良根治术患者为研究对象,根据麻醉方式的不同分为对照组和观察组,每组60例。对照组患者术前行单纯超声引导下胸椎旁神经阻滞,观察组患者术前行经皮穴位电刺激辅助出超声引导下胸椎旁神经阻滞,比较两组患者入室时(T-0)、麻醉时(T_(1))、插管时(T_(2))、切皮时(T_(3))、腋窝清扫时(T_(4))、拔管时(T_(5))、出室时(T-6)的心率(Heart rate,HR)和平均动脉压(Mean arterial pressure,MAP)和脑电双频指数(Bispectral index,BIS)血流动力学指标,术中舒芬太尼和丙泊酚用量,术后镇痛泵按压次数,术后不同时间点疼痛视觉模拟评分、不良反应发生情况。结果与对照组比较,观察组T_(3)、T_(4)时刻HR降低,T_(2)、T_(3)、T_(4)、T_(5)时刻BIS指数降低;术中舒芬太尼和丙泊酚用量、术后镇痛泵按压次数均降低;术后2、4、8、12、24 h VAS评分均降低,术后不良反应发生率降低,差异均有统计学意义(P<0.05)。结论经皮穴位电刺激辅助超声引导下胸椎旁神经阻滞用于乳腺癌根治术可提升麻醉效果,缓解患者疼痛,安全性良好,促进患者术后转归。

Awake laparoscopic cholecystectomy:A case report and review of literature

BACKGROUND Laparoscopic cholecystectomy(LC)is one of the most widely practiced surgical procedures in abdominal surgery.Patients undergo LC during general anaesthesia;however,in recent years,several studies have suggested the ability to perform LC in patients who are awake.We report a case of awake LC and a literature review.CASE SUMMARY A 69-year-old patient with severe pulmonary disease affected by cholelithiasis was scheduled for LC under regional anaesthesia.We first performed peridural anaesthesia at the T8-T9 level and then spinal anaesthesia at the T12-L1 level.The procedure was managed in total comfort for both the patient and the surgeon.The intra-abdominal pressure was 8 mmHg.The patient remained stable throughout the procedure,and the postoperative course was uneventful.CONCLUSION Evidence has warranted the safe use of spinal and epidural anaesthesia,with minimal side effects easily managed with medications.Regional anaesthesia in selected patients may provide some advantages over general anaesthesia,such as no airway manipulation,maintenance of spontaneous breathing,effective postoperative analgesia,less nausea and vomiting,and early recovery.However,this technique for LC is not widely used in Europe;this is the first case reported in Italy in the literature.Regional anaesthesia is feasible and safe in performing some types of laparoscopic procedures.Further studies should be carried out to introduce this type of anaesthesia in routine clinical practice.

经腹横筋膜平面阻滞时使用不同浓度罗哌卡因对剖宫产术后镇痛效果的影响

目的 观察经腹横筋膜平面（TAP）阻滞时使用不同浓度罗哌卡因对剖宫产术后镇痛效果的差异。方法 本研究采用随机、对照、双盲的试验方法,选取66例行剖宫产手术患者。所有患者均接受腰硬联合麻醉。手术结束后行超声引导下双侧TAP阻滞,分别给予0.4%罗哌卡因40 m L（A组）、0.5%罗哌卡因40 m L（B组）及0.6%罗哌卡因40 m L（C组）,各22例。所有患者术后每6小时口服双氯芬酸钾50 mg至术后48 h。若服药间期最高疼痛数字评价量表（NRS）评分〉4分,静脉给予曲马多或肌注杜冷丁镇痛。患者术后48 h内评估静息及运动NRS评分,阿片类药物使用量;记录首次下地及首次排气时间;记录恶心、呕吐、过度镇静的发生情况及患者对术后镇痛方式的满意度。结果 A组患者术后24 h及36 h静息NRS评分明显较其他两组升高,且A组患者术后36 h时测得运动NRS评分明显高于其他两组,差异均有统计学意义（均P〈0.05）。A组患者在术后〉24~36 h曲马多使用量较其他两组明显增加（P〈0.05）。B、C组患者比较,NRS评分及阿片类药物使用量差异均无统计学意义（P〉0.05）。三组患者首次下地时间、首次排气时间及患者对镇痛方式满意程度、恶心、呕吐发生率及镇静评分比较,差异均无统计学意义（P〉0.05）。结论 与使用0.4%及0.6%罗哌卡因比较,使用0.5%罗哌卡因40 m L进行超声引导下双侧TAP阻滞更适用于剖宫产术后镇痛。

超声引导颈神经通路阻滞和颈浅丛阻滞对甲状腺切除术镇痛效果的比较

目的比较超声引导下颈神经通路阻滞和颈浅丛阻滞对全麻下行甲状腺切除术患者的镇痛效果。方法本研究采用随机、对照、双盲的试验方法 ,选择年龄18~65岁、美国麻醉医师协会麻醉（ASA）分级Ⅰ~Ⅱ级、全麻下行择期甲状腺切除术的患者42例,随机分为颈浅丛阻滞组（S组,n=21）和颈神经通路阻滞组（P组,n=21）。全麻诱导后手术开始前,S组和P组分别行超声引导下双侧颈浅丛阻滞和超声引导下双侧颈神经通路阻滞,每侧均给予0.4%罗哌卡因20 mL,总计40 mL。术后使用舒芬太尼静脉自控镇痛至术后48 h。观察手术切皮时心率血压的变化,记录手术时间及术中阿片类药物的消耗量;记录术后拔管时间和恢复室停留时间;记录术后1、4、8、12、24、36、48 h静息及运动（吞咽）的视觉模拟评分（VAS）;记录术后阿片类药物消耗量及恶心、呕吐、过度镇静、呼吸困难、声嘶等不良反应的发生率。结果切皮前后收缩压（SBP）变化[M（Q）][3.0（3.0）mm Hg比4.0（5.3）mm Hg,Z=-0.547,P〉0.05]、舒张压（DBP）变化[4.0（3.0）mm Hg比2.0（6.5）mm Hg,Z=-1.050,P〉0.05]及心率（HR）变化[3.0（2.0）次/min比2.0（4.0）次/min,Z=-1.408,P〉0.05]、术中芬太尼用量[（155.9±43.4）μg比（169.0±40.0）μg,t=1.007,P〉0.05]、首次觅求舒芬太尼时间[（1157.8±99.2）min比（1275.5±119.4）min,t=0.523,P〉0.05）]两组差异无统计学意义。术后0~12 h两组均未使用舒芬太尼。术后12~24 h舒芬太尼使用量、24~36 h舒芬太尼使用量及36~48 h舒芬太尼使用量两组差异无统计学意义。术后1 h运动VAS评分[2.0（1.0）比4.0（2.0）,Z=-0.304,P=0.001]、4 h运动VAS评分[（3.0（2.0）比4.0（2.0）,Z=-3.082,P〈0.01]、8 h运动VAS评分[2.0（0.0）比2.0（2.0）,Z=-2.992,P〈0.01]、12 h运动VAS评分[3.0（1.0）比4.0（1.0）,Z=-5.410,P〈0.001]P组低于S组,术后4、8、12、24、36、48 h静息VAS及24、36、48 h运动VAS评分两组差异无统计学意义（P〉0.05）。两组均无呼吸困难和声嘶的发生,拔管时间、恢复室停留时间、术后恶心呕吐的发生、镇静评分两组差异均无统计学意义（P〉0.05）。结论使用0.4%罗哌卡因行超声引导下双侧颈浅丛阻滞和颈神经通路阻滞均可为甲状腺切除术提供安全有效的术中及术后早期镇痛,颈神经通路阻滞效果更优。

唤醒麻醉下直接电刺激语言区定位在切除语言区胶质瘤中的作用

目的探讨皮质直接电刺激(DES)在语言区胶质瘤切除术中的应用价值。方法回顾性分析91例大脑语言区胶质瘤病例的临床资料,均在唤醒麻醉下以皮质DES测定脑功能区,并最大程度切除肿瘤。结果直接电刺激结果:88例(125个阳性刺激点)病人出现运动发作(面部或手),91例(112个阳性点)出现语言障碍(包括数数中断、命名错误或不能命名)。肿瘤全切除53例(58.2%),次全切除31例(34.1%),部分切除7例(7.7%)。术后无神经功能障碍42例(46.2%),短暂神经功能障碍并恢复48例(52.7%),出现永久性神经功能障碍1例(1.1%)。结论皮质DES是一种可靠、精确、安全的脑功能区定位方法,可在保留术后语言功能的前提下,最大程度切除语言区胶质瘤。

术中实时超声在脑功能区胶质瘤手术中的应用价值

目的探讨实时超声在功能区胶质瘤术中的应用价值。方法对45例大脑功能区胶质瘤,采用术中实时超声定位肿瘤的解剖边界,在唤醒麻醉下结合皮质电刺激确定功能边界,根据解剖-功能边界切除肿瘤,同时采用实时超声监测病灶切除程度。结果本组肿瘤均定位准确。低级别胶质瘤病灶回声均匀,周围无明显水肿带;高级别胶质瘤病灶形态不规则,边界欠清。肿瘤全切除27例,近全切除7例,大部分切除11例。结论唤醒麻醉下结合术中皮质电刺激定位肿瘤切除边界,同时采用术中超声辅助切除功能区胶质瘤,疗效较好。

剖宫产术中低血压的原因和处理

椎管内神经阻滞下剖宫产手术中低血压是最常见的并发症。发生低血压时的处理包括改变子宫位置、下肢加压促使静脉血回流、预先静脉输液及血管活性药物的应用等。发生仰卧位低血压综合征时普遍采取使子宫左偏,下肢加压有效但是应用并不普遍。静脉内输入大量晶体液升压效果也不明显,输注胶体液有效但是价格昂贵而且有潜在的并发症。血管活性药物如麻黄素不减少子宫的血流,去氧肾上腺素抗低血压效果好,浓度容易滴定,而且对胎儿的血液pH值和碱剩余影响较小。

乳化异氟醚对大鼠不同脑区nAChRs表达的影响

为探讨乳化异氟醚对大鼠不同脑区nAChRs表达的影响,采用18只Wistar大鼠随机分为对照组、麻醉组和恢复组,应用乳化异氟醚通过尾静脉途径给药,对大鼠进行麻醉,采用免疫组织化学的方法,观察鉴别不同脑区中nAChRs表达的阳性细胞,并作阳性细胞计数。结果显示,大鼠注射乳化异氟醚后大脑皮层和海马的nAChRs的阳性细胞数显著下降,而小脑和脑干的nAChRs阳性细胞数显著增加,提示乳化异氟醚能够抑制大脑皮层和海马nAChRs的表达,诱导小脑和脑干nAChRs的表达,nAChRs可能是乳化异氟醚产生全麻作用的靶位之一。

区域阻滞麻醉中辅助应用咪达唑仑剂量探讨

目的:通过观察三种不同剂量咪达唑仑的镇静效果和副作用,探讨区域阻滞麻醉中辅助应用咪达唑仑的合适剂量。方法:选择在区域阻滞麻醉下行择期手术的患者40例,分为A,B,C,D四组。在阻滞平面固定后,对B,C,D组患者分别静脉注射0.03,0.05和0.07 mg/kg咪达唑仑,A(对照)组患者不用咪达唑仑。观察镇静作用起效时间、镇静程度、遗忘作用,监测Bp,HR和SpO2。结果:镇静作用起效时间D组最短,B组最长,三组间差异显著。镇静程度C组和D组显著强于B组,C,D组间差异不显著;B,C,D组发生遗忘的例数分别为2,5和7例,其中B组和D组之间差异有统计学意义。C组5 m in和10m in时以及D组5,10和15 m in时MAP和SpO2显著降低。结论:静脉注射0.05 mg/kg的咪达唑仑镇静效果较好,副作用较少,可作为临床辅助麻醉的参考剂量。

4mmolK^+对利多卡因臂丛麻醉效果的影响

在58只家兔臂丛安放刺激电极,用JD—2型肌电图机记录桡侧腕伸肌的肌电图,分别观察0.5％利多卡因,0.5％利多卡因+4mmolKCL,0.7％利多卡因、0.7％利多卡因+4mmolKCL和1％利多卡因臂丛注射的麻醉效果,同时记录血压、心电图、呼吸和唇肌电并测定血钾浓度。结果表明:(1)利多卡因中加入4mmolK^+可以明显地缩短麻醉潜伏期和延长麻醉持续时间,即明显地提高麻醉效果;(2)4mmolK^+无增加利多卡因毒性反应的倾向。

Preeclampsia and eclampsia: Etiopathogenesis and perioperative management

Preeclampsia is a pregnancy specific syndrome of elusive etiology, developing in 2nd trimester and associated with high maternal and perinatal morbidity and mortality. The spectrum ranges from mild preeclampsia with no systemic involvement to multi-system involvement. The course is unpredictable and delivery is the only curative treatment. Elevated blood pressure(> 160/110 mm Hg) should be reduced gradually to a safe level(140/90) using antihypertensive drugs. Prophylaxis and treatment of convulsions using Mg SO4 is indicated for severe preeclampsia. Fluid therapy is controversial due to potential delicate balance between constricted plasma volume and risk of fluid overload and pulmonary oedema secondary to increased capillary permeability and reduced colloid osmotic pressure. Single shot spinal anaesthesia is the technique of choice for caesarean delivery unless contraindicated. General anaesthesia is indicated in patients with coagulopathy or eclampsia but is associated with risk of difficult airway and exaggerated sympathetic response during laryngoscopy. Epidural analgesia and anaesthesia is safe in absence of coagulopathy.

超声引导下坐骨神经阻滞

超声引导下坐骨神经阻滞目前越来越受到关注。阻滞的质量与患者的手术效果直接相关。许多研究认为超声引导下坐骨神经阻滞是一种简单、有效的手段,并且逐渐在临床上运用。它的主要优点是提供了一种无创而有效的方法在穿刺前观察目标区域的解剖结构,另一大优点是能实时的观察进针行径和掌握好给药过程,假如在这一过程中出现问题,能及时的加以调整。

MAC技术在部位麻醉中的应用研究进展

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