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.

The Efficacy and Safety of Continuous Popliteal Sciatic Nerve Block for the Relief of Pain Associated with Critical Limb Ischemia: A Retrospective Study

Background: Patients with critical limb ischemia (CLI) often suffer from severe pain. A continuous peripheral nerve block has been shown to provide effective analgesia for patients having lower limb surgery. We have been administering continuous sciatic nerve block (CSNB) for patients with CLI whose pain could not be relieved by other analgesic tools. The aim of this retrospective study was to investigate the efficacy and safety of CSNB for patients with CLI. Method: We retrospectively investigated 99 patients who received CSNB for the relief of severe pain in the lower limb associated with CLI. Patient demographics, neurological history, complications, and subjective evaluation of the effectiveness of CSNB were investigated from their clinical records. The distal tips of 108 catheters were cultured. Result: One hundred and seventy-two catheters were placed in 99 patients. More than 90% of the patients enjoyed considerable relief of severe pain. The analgesic effect of CSNB was greater in patients with older age and hemodialysis. Thirty-one catheters had positive bacterial colonization. However, no severe infectious complication was found. There was no relationship between the co-existence of diabetes and positive bacterial colonization. We encountered a patient with ASO and diabetes who suffered from persistent motor weakness and hypesthesia even after 3 months of CSNB placement. Conclusions: CSNB provided good pain control for patients with severe pain caused by CLI. Although catheters were frequently found to be colonized, infection at the catheter site was self-limiting even in patients with diabetes.

PECS Block Provides Effective Postoperative Pain Management for Breast Cancer Surgery—A Retrospective Study

We investigated the efficacy of ultrasound-guided pectoral nerves (PECS) block for modified radical mastectomy surgery retrospectively. Methods: We measured that pain scores and the use of additional analgesic drugs were recorded in the postoperative care unit within 24 hours after the operation. Postoperative complications (i.e., nausea and vomiting) were noted. Results: Patients who received the PECS block under general anesthesia (PECS group) reported lower visual analog scale pain scores at 0, 1, 2, 4, 6, 12, 24 hours after the operation than patients who did not receive PECS block under general anesthesia (control group). Moreover, the use of additional analgesic drugs during the first 24 hours after surgery was lower in the PECS group than in the control group. While in the postoperative care unit, the PECS group had less nausea and vomiting than the control group. Conclusion: The PECS block provides effective postoperative analgesia within the first 24 hours after breast cancer surgery.

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.

Neural Modulation of Hemiparetic Shoulder Pain by Repetitive Ultrasound-Guided Suprascapularis Nerve Block

Background: Neural blockade is widely used in clinical practice to alleviate acute or chronic pain, including pain during rehabilitation. To date there is little controlled evidence to confirm the efficacy of nerve blocks in hemiparetic shoulder pain after stroke. Design: This study is a prospective, open label, cohort trial reporting result from a cohort of stroke patients affected by shoulder pain. Aim: As a cohort study report, in which it is often firstly reported the possibility of an association between an observed effect and a specific environmental based on detailed clinical evaluations and histories, we aim to firstly provide clues in identifying Suprascapularis Nerve blockade as further valuable approach for shoulder pain after stroke. Population: We studied a cohort of patients affected by hemiparetic shoulder pain after Stroke. Methods: Our protocol foresees nerve blocks to be performed each 3 out of 4 days (treatment lasting 30 days) in conjunction with a rehabilitation program with the first aim to provide the window of opportunity to proceed with effective rehabilitation. 47 potential study subjects fulfilled the study criteria and were enrolled. Twenty-four subjects were randomised to the study Group to receive SSNB for the pain of their hemiparetic shoulder while 23 subjects randomized to the control Group whose member did not receive SSNB. They received serial blocks each 3 out of 4 days during rehabilitation.Results: Both treatment reported a reduction in the intensity of their shoulder pain, according to data collected from day 1 through day 42 (6 weeks). Study Group patients, receiving SSNBs, reported significant improvement from entry through the whole follow-up period. The efficiency data were higher for SSNB Group after 2 weeks and again for SSNb group at the end of treatment. Conclusion: Excellent pain relief was achieved in SSNB without clinically relevant complications, these patients having a better improvement on pain during rehabilitation, than the control subjects. Great efficacy has been achieved by combining a nerve block and rehabilitation. About Clinical Rehabilitation Impact, we believe that Suprascapularis nerve blocks can help the stroke survivors maintain an ambulatory or outpatient treatment status, maintain participation in a physical therapy or rehabilitation program, decrease the need for analgesics and in some cases lead to a complete pain relief.

Management of Post-Operative Pain after Gyneco-Obstetrical Surgery: Practice of Transversus Abdominis Plane Bloc (Tap Block) Echoguide at the Ignace Deen National Hospital

Objectives: To describe the practice of ultrasound-guided TAP in the management of postoperative pain after gyneco-obstetric surgery. Methods: This was a descriptive prospective study carried out at the Gynecology-Obstetrics department of the Ignace Deen National Hospital over a period of three (03) months from February 01, 2020 to April 31, 2020. Results: In total, we collected 95 patients. These patients had a mean age of 30 ± 9.5 years. The ASA I class was the most represented with 76% of the cases and the cesarean was the most performed intervention. Regarding the assessment of the pain score by the simple verbal scale (SVE) postoperatively at rest, the mean SLE scores at H6 were 0.17 ± 0.38;at H12 of 1.15 ± 0.62;at H24 of 0.84 ± 0.51;at H36 0.45 ± 0.52 and at H48 0.09 ± 0.29. On mobilization, the mean pain scores were 0.77 ± 0.51 at H6, at H12 1.89 ± 0.61;at H24 of 1.53 ± 0.56;at H36 of 1 ± 0.29 and at H48 of 0.82 ± 0.44. The majority of our patients (66.3%) had a mobilization time of less than 24 hours. The mean length of stay was 3.1 ± 1.3 days and most patients (82%) were satisfied with the management of their pain by ultrasound-guided TAP block. Conclusion: Ultrasound-guided TAP is an effective technique for the management of postoperative pain in gyneco-obstetrics surgery. Its integration in a context of multimodal analgesia could improve the management of postoperative pain in gynecological obstetrics.

Review of Coeliac Plexus Blockade for the Management of Chronic Pancreatitis Pain at Tallaght University Hospital (TUH)

Background: Pain is a major problem for patients suffering from chronic pancreatitis. Unfortunately, medical therapy often fails to adequately control pain. Coeliac plexus block (CPB) is sometimes performed to treat intractable pain in patients with chronic pancreatitis. Aims: Our primary objective was to determine the effect of CPB for pain management in a cohort of patients with chronic pancreatitis. We also sought to quantify opioid use in patients with chronic pancreatitis. Methods: We reviewed the database of pain referrals for chronic pancreatitis and recorded opioid use for each patient. We interviewed all patients who underwent CPB for chronic pancreatitis at TUH from January 2018-December 2020. Effect of the block, duration of pain relief, analgesia requirements, complications and patient satisfaction were recorded. Results: 62 inpatient referrals were made to the pain service over a 3-year period regarding pain management in chronic pancreatitis. 76% of patients referred for chronic pancreatitis pain management require regular long-term opioids. Mean daily oxycodone requirement in this group was 52 mg. 11 of these patients underwent CPB over a 3-year period. Mean age of patients who underwent CPB was 44 years. Effective reduction in pain scores (>50% improvement) was achieved in 7 of 11 patients. The mean NRS pain score decreased from 9.2 (±0.9) to 4.4 (±3.1). Mean duration of pain relief experienced was 69 days. Transient diarrhoea was reported by 1 patient. 4 patients reported a temporary decrease in oral analgesia requirement, while 3 patients reported a sustained decrease in analgesia requirement post CPB. For those who had further CPBs, the effect of repeated interventions was comparable to the initial procedure. Conclusion: High regular opioid consumption is common in patients with chronic pancreatitis. CPB can provide significant improvement in pain control and quality of life in appropriately selected patients. CPB can assist with opioid reduction and containment. It is not effective in all cases and there is high inter-patient variability. The procedure has a good safety profile.

Effectiveness of the Suprainguinal Ultrasound-Guided Block for the Management of Postoperative Pain after Application of a Total Hip Prosthesis

Objective: To assess the effectiveness of ultrasound-guided supraginguinal block (SIB) in the management of pain after total hip replacement. Material and Methods: This was a prospective, randomized, single-blind controlled study carried out in the anesthesia-intensive care unit of the Donka National Hospital in Conakry, over a period of 06 months (01/01/2020 to 30/06/2020). It concerned 32 patients: 16 patients in the “ultrasound-guided SIB” group and 16 patients in the “standard analgesia” group. Results: The pain scores assessed by the simple verbal scale and collected at the different time intervals (6H, 12H, 24H, 36H, 48H) showed mean scores < 1 in the ultrasound-guided SIB group while the mean scores were ≤3 in the standard analgesia group (P < 0.001). On movement, the mean pain scores were ≤1 for the ultrasound-guided SIB group versus mean scores > 3 in the standard analgesia group (P < 0.001). The time to mobilization was greater than 48 hours in all patients in the standard analgesia group while it was less than 48 hours in the majority of patients (75%) in the ultrasound-guided SIB group. Nausea and vomiting were the most observed side effects. We did not observe any respiratory distress. The length of day hospitalization of patients in the ultrasound-guided SIB group was on average 5.50 ± 0.52 compared with 13.44 ± 1.55 in the group of standard analgesia patients (P = 0.001). The vast majority of patients in the ultrasound-guided SIB group were satisfied and unhappy in the standard analgesia group. Conclusion: Our study demonstrated that echo-guided SIB provided better analgesia compared to standard analgesia for the management of postoperative pain after total hip replacement.

Clinical Observation on 100 Cases of Postoperative Pain of Anal-Intestinal Diseases Treated with Vitamine K Blocking at Changqiang Point

Since the latter half of 1996, we have used vitamine K blocking at Changqiang (GV 1) for relieving the postoperative pain of anal fissure with satisfactory results. A report follows.……

Effect of Transverse Abdominis Plane Block on Chronic Post-Operative Pain—A Review

Chronic post-operative pain is a recognized adverse consequence of surgery;managing and preventing it are always a better choice. Proper choice of Anesthetic technique, use of combined anesthesia and pre-emptive analgesia may prevent and decrease the incidence of chronic post-operative pain. Transverse abdominis plane block (TAP Block) is a regional anesthesia technique following abdominal surgeries which involve injection of a large amount of local anesthetics in TAP, an anatomical space between the internal oblique and transverse abdominis muscle. The aim of this review is to show the effect and uses of TAP block as a combined anesthesia and multimodal analgesia in preventing chronic post-operative pain.

Therapeutic Approaches to Post-Mastectomy Pain Syndrome

Background: Breast cancer is increasingly common in society and post-mastectomy pain is a striking condition associated with surgery, both intra and postoperatively. The post-mastectomy syndrome is characterized by the persistence of pain for more than 3 months after the procedure. It is mostly of neuropathic origin and is highly refractory to treatments, which vary from clinical to surgical measures and alternative techniques. In this context, it is essential to understand the possible approaches to these patients. Objective: Understand alternatives for pain management in patients undergoing mastectomy, especially in those in whom pain persists for more than 3 months. Methods: Systematic literature review, conducted in the Virtual Health Library databases includes: Lilacs, SciELO, Medline, PubMed and Cochrane between 2018 and 2023, restricted to articles in English with the descriptors: Mastectomy, chronic Pain, Nerve Blocks and Breast Cancer. 317 articles were found involving the descriptors presented, all in English. After reading the abstracts, 28 articles were selected. Results: This review analyzed 28 scientific studies that rigorously met the previously established characteristics in the sample selection. The synthesis included the following aspects: author/year of publication, article title, objective, type of study and database. Conclusion: It was concluded that, according to the analyzed studies, post-mastectomy pain is a problem that has increased its incidence and that needs the attention of health professionals. The use of antineuropathic medications, nerve blocks, fat grafting, lymph node transplantation, therapy, physical activity and acupuncture are some examples of therapeutic approaches for these women. Therefore, the team must assist the patients, seeking to provide a better prognosis, quality of life and comfort.

超声引导下RISS平面阻滞对胸腹部手术患者血清Cor、SP、PGE2、IL-6的影响

目的 探究超声引导下菱形肌-肋间肌-低位前锯肌(RISS)平面阻滞对胸腹部手术患者血清Cor、SP、PGE2、IL-6的影响。方法 选取2021年1月至2022年7月入住秦皇岛市第一医院接受胸腹部手术的患者126例,按照随机掷硬币法分为观察组和对照组,各63例,两组进行常规麻醉诱导,气管插管后观察组行超声引导下RISS平面阻滞,对照组不行神经阻滞。比较两组术后疼痛视觉模拟(VAS)评分及镇静Ramsay评分、手术麻醉药物用量、围术期血流动力学指标(收缩压、舒张压、心率)及炎症应激指标[皮质醇(Cor)、P物质(SP)、前列腺素E2(PGE2)、白细胞介素-6(IL-6)]水平、不良反应发生情况。结果 手术结束后2 h、12 h、24 h,观察组VAS评分和Ramsay评分均显著低于对照组,差异均有统计学意义(P<0.05);术中及术后24 h,观察组舒芬太尼使用量显著低于对照组,差异有统计学意义(P<0.05);插管后两组收缩压、舒张压和心率均低于插管前,差异有统计学意义(P<0.05),插管后10 min和停药后10 min,观察组收缩压、舒张压心率显著低于对照组,差异有统计学意义(P<0.05);术后两组外周血中Cor、SP、PGE2、IL-6水平均低于术前,差异有统计学意义(P<0.05);术后12 h、24 h,观察组Cor、SP、PGE2、IL-6水平均低于对照组,差异有统计学意义(P<0.05);观察组麻醉不良反应总发生率低于对照组,差异有统计学意义(P<0.05)。结论 超声引导下RISS平面阻滞具有良好镇痛镇静效果,能减轻胸腹部手术患者应激及炎症反应,安全性较高,值得临床应用推广。

超声引导下不同入路腰方肌阻滞在股骨头坏死患者术后镇痛中的效果研究

目的:比较超声引导下3种不同入路腰方肌阻滞(QLB)在股骨头坏死患者术后镇痛中的效果。方法:选取2019年5月至2021年5月唐山市第二医院收治的120例股骨头坏死患者,采用动态随机化分组法将其按3种不同入路QLB镇痛方法分为腰方肌外侧组、腰方肌后路组和腰方肌前路组,每组40例。所有患者均行髋关节置管术治疗,于术后行腰方肌外侧路、后路和前路QLB镇痛方法。比较3组镇痛前,镇痛后1、6和12 h视觉模拟量表(VAS)评分,及用药后不良反应发生率。结果:采用广义估计方程分析,3组VAS评分在镇痛后1 h时[3.83(3.51,4.01)分、3.15(2.99,3.43)分、3.25(3.08,3.53)分]至镇痛后12 h时[3.18(3.03,3.50)分、2.80(2.65,2.95)分、2.80(2.55,2.97)分]处于降低趋势,组内不同时点VAS评分比较,差异有统计学意义(Wald x^(2)=2778.131,P<0.05);后路组、前路组镇痛后不同时点VAS评分均低于侧路组(Wald x^(2)=102.935,P<0.05);后路组、前路组镇痛后VAS评分的降低趋势大于侧路组,即腰方肌前路、腰方肌后路的镇痛效果强于腰方肌外侧路(Wald x^(2)=25.245,P<0.05)。结论:超声引导下采用腰方肌前路、腰方肌后路行QLB用于股骨头坏死患者术后镇痛效果显著高于腰方肌外侧路,3种不同入路下行QLB镇痛的不良反应差异不显著。

Liposomal Bupivacaine in Erector Spinae Plane Block and Interscalene Block for Scapular and Proximal Humerus Resections

Erector spinae plane block (ESPB) is a novel fascial plane block that was first described in 2016. It is considered an alternative for brachial plexus blocks in shoulder surgeries as the erector spinae muscle extends to the cervical level. Herein, we present a successful multilevel ESPB plus an interscalene block using liposomal bupivacaine in a 45-year-old female patient with metastatic sarcoma who presented for scapula and proximal humerus resection. The post-operative course was smooth, and the patient was discharged home on post-operative day 2 with minimal narcotic requirements.

超声引导下连续股神经阻滞对膝关节置换术后炎症及氧化应激反应的影响

目的旨在分析超声引导股神经阻滞用于膝关节置换术后患者的效果。方法纳入自2019年1月至2022年12月在本院接受全膝关节置换手术的60例患者,随机分为观察组(n=30)和对照组(n=30),分别接受连续股神经阻滞镇痛和静脉自控镇痛。在术后6 h、24 h、48 h时评估视觉模拟评分(VAS)。在术后即刻、24 h、72 h检测血清白介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)、超氧化物歧化酶(SOD)、丙二醛(MDA)和脂质过氧化氢(LHP)水平。记录术后72 h内出现的不良反应。结果两组患者的基础资料具有可比性,术后24 h、48 h观察组患者的VAS评分均低于对照组(P<0.05)。术后24 h和术后72 h,观察组血清CRP、IL-6、TNF-α、MDA和LHP水平均显著低于对照组(P<0.05),SOD水平显著高于对照组(P<0.05)。术后72 h内,观察组的不良反应率为3.3%,明显低于对照组的10%。结论超声连续股神经阻滞能有效降低患者术后疼痛,抑制炎症及氧化应激反应。

右美托咪定复合罗哌卡因胸椎旁神经阻滞对冠状动脉搭桥术后心肌再灌注损伤及恢复质量的影响

目的研究右美托咪定复合罗哌卡因胸椎旁神经阻滞对冠状动脉搭桥术后心肌再灌注损伤及恢复质量的影响。方法前瞻性选取2021年3月至2023年2月邯郸市中心医院收治的97例行冠状动脉搭桥术的患者作为研究对象,采用掷硬币法将其分为观察组(n=49)和对照组(n=48)。两组患者均在全身麻醉下手术,对照组采用0.5%罗哌卡因20 mL进行胸椎旁神经阻滞,观察组采用0.75μg/kg右美托咪定+0.5%罗哌卡因20 mL进行胸椎旁神经阻滞。比较两组患者麻醉前、气管插管即刻、切皮后5 min、术毕的平均动脉压(MAP)、心率;记录两组患者的手术时间、术后机械通气时间、拔管时间、苏醒时间、ICU滞留时间及住院时间;比较两组患者手术后12、24 h的疼痛视觉模拟评分法(VAS)评分、Ramsay镇静评分,手术前、手术后24 h的肌钙蛋白(cTnI)、肌酸激酶同工酶(CK-MB)、天冬氨酸转移酶(AST)水平,以及补救镇痛及并发症发生情况。结果麻醉前及气管插管即刻,两组MAP、心率比较,差异均无统计学意义(P>0.05);切皮后5 min及术毕,观察组MAP、心率均低于对照组,差异均有统计学意义(P<0.05)。两组手术时间、术后机械通气时间及苏醒时间比较,差异均无统计学意义(P>0.05);观察组ICU滞留时间、拔管时间及住院时间分别为(16.58±4.03)h、(5.47±1.23)h、(11.24±2.10)d,均短于对照组[(18.33±4.52)h、(6.02±1.39)h、(12.17±2.38)d],差异均有统计学意义(P<0.05)。手术后12、24 h,观察组VAS评分分别为(2.65±0.45)、(2.56±0.59)分,均低于对照组[(2.87±0.53)、(2.92±0.61)分],Ramsay镇静评分分别为(2.15±0.95)、(2.20±0.91)分,均高于对照组(1.63±0.72)、(1.60±0.68)分,差异均有统计学意义(P<0.05)。手术后24 h,两组cTnI、CK-MB及AST水平均较手术前升高,但观察组cTnI、CK-MB及AST水平分别为(0.96±0.31)ng/mL、(4.91±1.06)ng/mL、(39.08±7.26)U/L,均低于对照组[(1.16±0.34)ng/mL、(5.61±1.17)ng/mL、(43.14±8.34)U/L],差异均有统计学意义(P<0.05)。两组术后补救镇痛发生率与总并发症发生率比较,差异均无统计学意义(P>0.05)。结论右美托咪定复合罗哌卡因胸椎旁神经阻滞应用于冠状动脉搭桥术,患者术后恢复更快,镇静效果更好,可显著减轻患者术后疼痛,对患者心肌再灌注损伤更小。

超声引导腰方肌阻滞技术在腹腔镜全子宫切除术中的应用

目的 探讨超声引导腰方肌阻滞技术在腹腔镜全子宫切除术中的应用效果。方法 选择2022年1月至2023年6月在寿光市人民医院实施全身麻醉气管插管下腹腔镜全子宫切除术的80例患者,按照随机数字表法分为两组,各40例。对照组采取气管插管全身麻醉,观察组在对照组基础上于全身麻醉诱导前实施超声引导腰方肌阻滞术。比较两组术后12h疼痛评分及血清P物质水平、并发症发生情况、镇痛泵按压次数、单次追加镇痛药物次数。结果 观察组术后12h疼痛评分、血清P物质水平低于对照组(P<0.05);观察组麻醉复苏阶段并发症总发生率低于对照组(P<0.05);观察组镇痛泵按压次数及单次追加镇痛药物次数少于对照组(P <0.05)。结论 超声引导腰方肌阻滞技术在腹腔镜全子宫切除术中的应用效果较好,能够减轻术后疼痛,降低并发症发生率,减少镇痛泵按压次数及单次追加镇痛药物次数。

伐昔洛韦联合神经阻滞对急性期带状疱疹性神经痛临床疗效的影响

目的:探讨伐昔洛韦联合神经阻滞对急性期带状疱疹性神经痛患者睡眠质量及血清疼痛介质指标、炎症因子表达的影响。方法:前瞻性选取2020年5月—2023年5月广州医科大学附属第六医院收治的60例急性期带状疱疹性神经痛患者作为本次研究对象,按照随机数字表法分为治疗A组和治疗B组,各30例。治疗A组予以伐昔洛韦治疗,治疗B组则在治疗A组基础上加用神经阻滞治疗。评估两组临床疗效、匹兹堡睡眠质量指数(PSQI)评分、血清疼痛介质指标、炎症因子表达水平及不良反应发生情况。结果:治疗B组临床治疗总有效率为93.33%,显著高于治疗A组的63.33%,差异有统计学意义(P<0.05)。干预后,两组PSQI评分较干预前均显著改善,且治疗B组PSQI评分显著优于治疗A组,差异均有统计学意义(P<0.05)。干预后,治疗B组血清疼痛介质指标较干预前均明显改善,且治疗B组β-内啡肽(β-EP)指标明显高于治疗A组,血浆P物质(SP)及一氧化氮(NO)指标则明显低于治疗A组,差异均有统计学意义(P<0.05)。干预后,治疗B组炎症因子表达水平较干预前均明显改善,且治疗B组γ干扰素(IFN-γ)水平明显高于治疗A组,而白细胞介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)水平则明显低于治疗A组,差异均有统计学意义(P<0.05)。治疗B组发生的头晕、胃肠不适及皮肤瘙痒总发生率显著低于治疗A组,差异有统计学意义(P<0.05)。结论:伐昔洛韦联合神经阻滞治疗急性期带状疱疹性神经痛患者,其临床疗效更为显著,可有效改善患者的睡眠质量、血清疼痛介质指标及炎症因子表达水平,减少不良反应的发生率。

不同浓度罗哌卡因用于超声引导下TAP阻滞在妇科手术中的镇痛效果及安全性

目的:探讨不同浓度罗哌卡因用于超声引导下腹横肌平面(TAP)阻滞在妇科手术中的临床效果。方法:将2021年4月-2023年4月于本院行全身麻醉下腹腔镜子宫全切术患者105例,依据双盲法分为3组,分别给予0.25%、0.30%、0.375%罗哌卡因。对比各组手术相关指标,不同时间点患者疼痛和舒适度评分变化,麻醉前后患者炎症因子水平,术后24h不良反应。结果:3组麻醉时间、术中出血量、手术时间均无差异(P>0.05);与术后1h对比,术后24h各组视觉模拟评分(VAS)均下降,Bruggrmann舒适度评分(BCS)均提升,但0.375%组VAS评分(1.56±0.51分)低于0.25%组(2.69±1.02分)、0.30%组(2.35±0.68分),BCS评分(3.24±0.54分)高于0.25%组(2.23±0.39分)、0.30%组(2.59±0.41分)(P<0.05);麻醉后各组C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)水平均提升,但0.375%组CRP(21.36±4.26 mg/L)、TNF-α(70.13±7.16 pg/ml)水平低于0.25%组(28.98±5.62 mg/L、96.54±8.97 pg/ml)、0.30%组(24.69±4.87 mg/L、84.33±7.62 pg/ml),不良反应发生率0.375%组(8.6%)低于0.25%组(40.0%)、0.30%组(31.4%)(均P<0.05)。结论:0.375%浓度罗哌卡因在超声引导下妇科TAP阻滞术中应用,改善患者疼痛效果显著,提升患者术后舒适度,有助于降低术后不良反应发生风险,提高用药安全性。