A nerve stimulation-guided lumbar plexus block is a well-established technique.It is not clear whether ultrasound guidance has additional value for this deep block technique.This study aimed to examine whether ultraso...A nerve stimulation-guided lumbar plexus block is a well-established technique.It is not clear whether ultrasound guidance has additional value for this deep block technique.This study aimed to examine whether ultrasound guidance using a paramedian transverse scan through the intertransverse space(PMTS-ITS)approach in combination with nerve stimulation reduces the onset time of a complete sensory block.Forty-four patients who were scheduled to undergo arthroscopic knee surgery with an ultrasound visibility score(UVS)of≥10 for the lumbar plexus were enrolled and randomly allocated to the ultrasound guidance with nerve stimulation group(group U-N)or nerve stimulation group(group N)in this prospective,randomized,parallel-group,active-controlled study.The primary outcome was the onset time of a complete sensory block.The results showed that the onset time of a complete sensory block to pinprick and cold was 10(10–40)min and 10(10–40)min in group U-N,respectively,and 30(10–40)min and 20(10–40)min in group N(P=0.005,P=0.004),respectively.The performance time was 658±87 s in group U-N and 528±97 s in group N(P<0.001).There was no(0%)patient who required 5 or more needle passes in group U-N and 6(27.3%)in group N(P=0.028).The block failure rate was 9.1%in group U-N and 31.8%in group N(P>0.05).In conclusion,ultrasound guidance using the PMTS-ITS approach in combination with nerve stimulation led to a faster onset of a complete sensory block than nerve stimulation alone for a lumbar plexus block in patients with a UVS≥10.Ultrasound guidance with nerve stimulation significantly decreased the number of patients who required 5 or more needle passes.展开更多
Background: Pneumatic arterial tourniquet is a utilized strategy in limb surgeries to provide bloodless field to facilitate surgical procedure. Be that as it may, arterial tourniquet has numerous injurious impacts inc...Background: Pneumatic arterial tourniquet is a utilized strategy in limb surgeries to provide bloodless field to facilitate surgical procedure. Be that as it may, arterial tourniquet has numerous injurious impacts including hemodynamic changes and tourniquet-induced pain which sometimes can be severe and intolerable. Objectives: Our primary aim was to assess the impact of performing “Lumbar Plexus Block and sciatic nerve block” with General Anesthesia (GA) on the degree of arterial tourniquet-induced hemodynamic effects. On the other hand, our secondary aims were: amount of postoperative analgesic prerequisites, patient satisfactory score and documented side effects. Settings and Design: Ain Shams University, Orthopedic operating theatre;a prospective, randomized, double-blind study. Methods and Material: The physical status of 50 patients (both sexes) including I and II patients from American Society of Anesthesiologists, whose ages are from 20 - 40 years, is not so ideal when they are undergoing elective knee Arthroscopy. The duration lasts no more than ninety minutes under GA with application of tourniquet. Patients were allotted haphazardly to one of two groups. In Group C (Control group): Only GA. In Group B: LPB and sciatic nerve block were performed just before GA administration. Intraoperative hemodynamics was recorded at specific timings. Results: Incidence of tourniquet induced hypertension (TIH) was markedly less with Group B at: forty five, sixty, seventy five mins after tourniquet inflation and just before tourniquet deflation. Also, the total ketorolac consumption during first 24 hours of postoperative period was significantly less with Group B (p Conclusions: Combined Sciatic-Lumbar plexus blocks when combined with general anesthesia were very effective in attenuating TIH.展开更多
目的:探讨超声引导下腰骶丛神经阻滞联合全麻对行髋关节置换术老年病人术后谵妄(POD)的影响。方法:选取髋关节置换术老年病人80例,随机分为腰骶丛神经阻滞联合全麻组(h组)和全麻组(q组),各40例。2组病人均采用喉罩通气,维持脑电双频指数...目的:探讨超声引导下腰骶丛神经阻滞联合全麻对行髋关节置换术老年病人术后谵妄(POD)的影响。方法:选取髋关节置换术老年病人80例,随机分为腰骶丛神经阻滞联合全麻组(h组)和全麻组(q组),各40例。2组病人均采用喉罩通气,维持脑电双频指数40~60,术后静脉自控镇痛(PCA)。比较2组病人术中麻醉药物用量、手术相关指标;采用视觉模拟量表(VAS)评估病人术后疼痛情况;于术前(D0)、术后第1(D1)、3(D3)、7(D7)天分别测定病人意识模糊评估量表(CAM)评分,并抽取静脉血检测白细胞介素(IL)-1β、IL-6、肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)和S100β蛋白水平。结果:与q组相比,h组病人术中麻醉药物用量、术后拔管时间、术后24 h PCA次数、术后各时间点VAS评分、首次下床时间及出院时间均明显减少(P<0.01);h组术后IL-1β、IL-6、TNF-α、CRP、S100β蛋白水平、CAM评分及POD发生率均明显低于q组(P<0.01)。结论:超声引导下腰骶丛神经阻滞联合全麻较单纯全麻,可减少行髋关节置换术的老年病人麻醉药用量,完善镇痛,降低炎性反应和POD发生率,有助于病人术后快速康复。展开更多
文摘A nerve stimulation-guided lumbar plexus block is a well-established technique.It is not clear whether ultrasound guidance has additional value for this deep block technique.This study aimed to examine whether ultrasound guidance using a paramedian transverse scan through the intertransverse space(PMTS-ITS)approach in combination with nerve stimulation reduces the onset time of a complete sensory block.Forty-four patients who were scheduled to undergo arthroscopic knee surgery with an ultrasound visibility score(UVS)of≥10 for the lumbar plexus were enrolled and randomly allocated to the ultrasound guidance with nerve stimulation group(group U-N)or nerve stimulation group(group N)in this prospective,randomized,parallel-group,active-controlled study.The primary outcome was the onset time of a complete sensory block.The results showed that the onset time of a complete sensory block to pinprick and cold was 10(10–40)min and 10(10–40)min in group U-N,respectively,and 30(10–40)min and 20(10–40)min in group N(P=0.005,P=0.004),respectively.The performance time was 658±87 s in group U-N and 528±97 s in group N(P<0.001).There was no(0%)patient who required 5 or more needle passes in group U-N and 6(27.3%)in group N(P=0.028).The block failure rate was 9.1%in group U-N and 31.8%in group N(P>0.05).In conclusion,ultrasound guidance using the PMTS-ITS approach in combination with nerve stimulation led to a faster onset of a complete sensory block than nerve stimulation alone for a lumbar plexus block in patients with a UVS≥10.Ultrasound guidance with nerve stimulation significantly decreased the number of patients who required 5 or more needle passes.
文摘Background: Pneumatic arterial tourniquet is a utilized strategy in limb surgeries to provide bloodless field to facilitate surgical procedure. Be that as it may, arterial tourniquet has numerous injurious impacts including hemodynamic changes and tourniquet-induced pain which sometimes can be severe and intolerable. Objectives: Our primary aim was to assess the impact of performing “Lumbar Plexus Block and sciatic nerve block” with General Anesthesia (GA) on the degree of arterial tourniquet-induced hemodynamic effects. On the other hand, our secondary aims were: amount of postoperative analgesic prerequisites, patient satisfactory score and documented side effects. Settings and Design: Ain Shams University, Orthopedic operating theatre;a prospective, randomized, double-blind study. Methods and Material: The physical status of 50 patients (both sexes) including I and II patients from American Society of Anesthesiologists, whose ages are from 20 - 40 years, is not so ideal when they are undergoing elective knee Arthroscopy. The duration lasts no more than ninety minutes under GA with application of tourniquet. Patients were allotted haphazardly to one of two groups. In Group C (Control group): Only GA. In Group B: LPB and sciatic nerve block were performed just before GA administration. Intraoperative hemodynamics was recorded at specific timings. Results: Incidence of tourniquet induced hypertension (TIH) was markedly less with Group B at: forty five, sixty, seventy five mins after tourniquet inflation and just before tourniquet deflation. Also, the total ketorolac consumption during first 24 hours of postoperative period was significantly less with Group B (p Conclusions: Combined Sciatic-Lumbar plexus blocks when combined with general anesthesia were very effective in attenuating TIH.
文摘目的:探讨超声引导下腰骶丛神经阻滞联合全麻对行髋关节置换术老年病人术后谵妄(POD)的影响。方法:选取髋关节置换术老年病人80例,随机分为腰骶丛神经阻滞联合全麻组(h组)和全麻组(q组),各40例。2组病人均采用喉罩通气,维持脑电双频指数40~60,术后静脉自控镇痛(PCA)。比较2组病人术中麻醉药物用量、手术相关指标;采用视觉模拟量表(VAS)评估病人术后疼痛情况;于术前(D0)、术后第1(D1)、3(D3)、7(D7)天分别测定病人意识模糊评估量表(CAM)评分,并抽取静脉血检测白细胞介素(IL)-1β、IL-6、肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)和S100β蛋白水平。结果:与q组相比,h组病人术中麻醉药物用量、术后拔管时间、术后24 h PCA次数、术后各时间点VAS评分、首次下床时间及出院时间均明显减少(P<0.01);h组术后IL-1β、IL-6、TNF-α、CRP、S100β蛋白水平、CAM评分及POD发生率均明显低于q组(P<0.01)。结论:超声引导下腰骶丛神经阻滞联合全麻较单纯全麻,可减少行髋关节置换术的老年病人麻醉药用量,完善镇痛,降低炎性反应和POD发生率,有助于病人术后快速康复。
