超声引导下髂筋膜阻滞用于小儿骨科手术的临床效果评价

目的评价超声引导下髂筋膜间隙阻滞在小儿下肢骨科手术中的应用效果。方法选取本院2015年3月至2018年2月于全身麻醉下行髋、膝关节手术或股骨手术的患儿共计60例。ASA分级I级,年龄6～10岁,性别不限。纳入患儿采用计算机随机软件随机分为超声引导下髂筋膜间隙阻滞组(fascia iliaca block group,F组)和空白对照组(control group,C组),每组患者各30例。F组患儿于超声引导下行髂筋膜间隙阻滞;C组患儿不实施干预。记录两组患儿麻醉诱导前(T_0)、切皮即刻(T_1)、手术开始后10分钟(T_2)、手术结束即刻(T_3)平均动脉压(MAP)和心率(HR)。记录患儿拔管时间并使用PAED评分评价患儿苏醒期躁动情况。使用FLACC量表评价患儿出室即刻、术后2小时、术后4小时、术后12小时疼痛情况。结果两组患儿T_0时点MAP、HR差异无统计学意义(P0.05)。C组患者T_1、T_2、T_3时点MAP、HR显著高于F组患儿,差异有统计学意义(P0.05);F组患儿术后各时点FLACC评分显著低于C组患儿,差异有统计学意义(P0.05);F组共计2名患儿发生苏醒期躁动,而C组则有9名患儿发生苏醒期躁动,差异有统计意义(P0.05)。F组患儿未见神经损伤、局麻药中毒、局部血肿等严重并发症的发生。结论超声引导下髂筋膜间隙阻滞有助于维持行髋、膝关节手术或股骨手术的患儿术中血流动力学稳定,有效抑制术后疼痛并降低苏醒期躁动发生率,值得在临床中推广使用。     

超声引导髂筋膜腔隙与髂腹下/髂腹股沟神经复合阻滞在老年患者髋关节置换术术后镇痛中的作用

目的 观察超声引导下髂筋膜腔隙与髂腹下/髂腹股沟神经联合阻滞在老年患者全髋关节置换术术后镇痛的作用. 方法 选择2015年1月～2015年11月全身麻醉下行单侧前外侧入路全髋关节置换术的患者50例,年龄61～75岁,ASA分级Ⅱ、Ⅲ级,采用随机数字表法将患者分为两组(每组25例):单纯髂筋膜间隙阻滞组(单纯组)和髂筋膜腔隙与髂腹下/髂腹股沟神经复合阻滞组(复合组).手术结束后即刻行患侧超声引导下神经阻滞.单纯组于髂筋膜腔隙注射0.3％罗哌卡因30 ml;复合组分别于髂筋膜腔隙与髂腹下/髂腹股沟注射0.3％罗哌卡因15 ml.记录患者一般情况,术后6、12、18、24 h患者静息及运动VAS评分,超声成像时间,穿刺注药时间,患者自控镇痛(patient controlled analgesia,PCA)芬太尼累计用量及术后镇痛相关副作用的发生情况. 结果 两组患者一般情况差异无统计学意义(P＞0.05).两组患者术后各时点静息VAS评分差异均无统计学意义(P＞0.05).复合组运动VAS评分在术后6 h [(3.8±0.9)分]和12 h[(3.6±1.3)分]时点较单纯组[(5.5±11)分和(5.3±1.0)分]降低(P＜0.05);在术后18h和24 h时点,2组运动VAS评分差异均无统计学意义(P＞0.05).两组患者超声成像时间和穿刺注药时间差异均无统计学意义(P＞0.05).复合组PCA芬太尼累计用量[(0.54±0.03) mg]较单纯组[(0.69±0.05) mg]降低(P＜0.05).两组患者术后镇痛相关副作用发生率差异无统计学意义(P＞0.05). 结论 在老年患者髋关节置换术后,超声引导髂筋膜腔隙与髂腹下/髂腹股沟神经复合阻滞可安全、有效地用于术后镇痛,显著缓解患者甲早期的运动疼痛同时减少芬太尼用量.     

髂腹下/髂腹股沟神经阻滞用于患儿围术期镇痛的研究进展

正神经阻滞复合全身麻醉是目前患儿腹股沟区手术中应用较广的麻醉模式,神经阻滞用于术后镇痛的研究与之衔尾相随。本文拟对近年来髂腹下/髂腹股沟神经阻滞(iliohypogastric/ilioinguinal nerve block,IINB)用于患儿围术期镇痛的研究进展作简要综述。IINB用于围术期镇痛现状髂腹下神经(iliohypogastric nerve,IHN)源于T12—L1,皮支分布于臀外侧、腹股沟区及下腹部皮肤;髂腹股沟     

超声引导下髂腰肌平面阻滞与髂筋膜间隙阻滞在髋关节置换围术期镇痛效果的比较

目的 比较超声引导下髂腰肌平面阻滞与髂筋膜间隙阻滞在髋关节置换围术期镇痛效果。方法 选择择期行单侧髋关节置换术患者50例,男28例,女22例,年龄18～95岁,BMI 17～35 kg/m²,ASAⅠ—Ⅲ级。采用随机数字表法将患者分为两组：髂腰肌平面阻滞组(Ⅰ组)和髂筋膜间隙阻滞组(S组),每组25例。Ⅰ组在髂股韧带和髂腰肌之间注射0.3%罗哌卡因10 ml, S组在腹股沟韧带上髂筋膜间隙注射0.3%罗哌卡因40 ml。术后采用舒芬太尼行患者自控静脉镇痛,VAS疼痛评分≥4分时,静脉注射氟比洛芬酯50 mg补救镇痛。记录神经阻滞操作时间、起效时间。记录术中丙泊酚、瑞芬太尼用量和舒芬太尼追加次数、术后2、6、8、12和24 h静息和活动(抬髋15°)时VAS疼痛评分、术后24 h镇痛泵有效按压次数和总按压次数、术后24 h舒芬太尼用量和补救镇痛情况。记录术后恶心呕吐、谵妄、感染、局麻药中毒和股四头肌无力发生情况。结果 与S组比较,Ⅰ组神经阻滞操作时间和起效时间明显缩短,术中舒芬太尼追加率、术后8 h活动时VAS疼痛评分、术后股四头肌无力发生率明显降低(P<0....     

超声引导下以旋髂深动脉为标记的髂腹股沟-髂腹下神经阻滞在老年斜疝手术中的应用

目的探讨超声引导下以旋髂深动脉为标记的髂腹股沟-髂腹下神经阻滞在老年斜疝手术中的临床应用效果。方法选择择期行斜疝手术的老年患者40例,男33例,女7例,年龄65~90岁,ASAⅠ~Ⅲ级,随机分为两组,每组20例。T组采用传统髂腹股沟-髂腹下神经阻滞解剖定位方法;V组采用超声引导下以旋髂深动脉为标记的髂腹股沟-髂腹下神经阻滞。记录神经阻滞起效时间,术中、术后6h VAS评分,麻醉满意度以及尿潴留、误入血管等并发症的发生情况。结果 V组神经阻滞起效时间明显短于T组[(6.1±1.8)min vs(12.1±2.0)min,P0.05];T组术中VAS评分明显高于V组[(4.5±1.1)分vs(2.1±0.9)分,P0.05]。术后6h两组VAS评分差异无统计学意义;V组麻醉满意度明显高于T组(P0.05)。两组均未出现尿潴留,T组有1例误入血管。结论超声引导下以旋髂深动脉为标记的髂腹股沟-髂腹下神经阻滞能为老年斜疝手术患者提供安全、有效、可靠的麻醉。     

超声引导腹横肌平面阻滞用于患儿疝囊高位结扎术后镇痛

目的 观察超声引导下腹横肌平面阻滞用于患儿腹股沟斜疝疝囊高位结扎术后镇痛的临床效果.方法 择期行单侧腹股沟斜疝的患儿50例,年龄1～3岁,ASA Ⅰ级,采用随机数字表法,将患儿均分为超声引导下腹横肌平面阻滞组(TAP组)和对照组.TAP组术前在超声引导下行腹横肌平面阻滞,注入0.25％左旋布比卡因0.3 ml/kg,对照组给予等容量生理盐水.记录术后拔除喉罩时间、麻醉后恢复室(PACU)停留时间;PACU期间记录躁动发生情况,采用患儿麻醉苏醒期躁动量化评分表(PAED)评价躁动程度.记录术后1、4、8、12、16和24 h患儿FLACC评分,记录腹横肌平面阻滞相关不良反应的发生情况.结果 与对照组比较,TAP组患儿躁动发生率、PAED评分均明显降低(P＜0.05);TAP组患儿术后1、4、8和12 h的FLACC评分均明显降低(P＜0.05).两组患儿术后16h和24 h FLACC评分、拔除喉罩时间和PACU停留时间差异无统计学意义.两组患儿均未见TAP阻滞相关不良反应.结论 患儿腹横肌平面阻滞给予0.25％左旋布比卡因0.3 ml/kg,能提供至少12 h的术后镇痛效果,有效预防七氟醚麻醉苏醒期躁动的发生.     

髂筋膜阻滞复合全身麻醉用于小儿髋脱位手术的观察

小儿发育性髋脱位(development dislocation of the hip,DDH)手术包括内收肌切断,股骨粗隆下截骨以及髋部截骨.术中手术刺激强,术后疼痛剧烈.本研究将髂筋膜间隙阻滞(fascia.illiaca compartment block,FICB)复合全身麻醉用于患儿DDH手术,观察其效果及安全性.     

罗哌卡因髂腹下/髂腹股沟神经阻滞在儿童腹股沟疝围手术期的效果

目的探讨罗哌卡因髂腹下/髂腹股沟神经阻滞在儿童腹股沟疝围手术期中的应用效果。 方法将2018年8月至2019年7月仙桃市第一人民医院收治的108例腹股沟疝患儿以抽签法分为对照组（54例）和观察组（54例）,均行腹股沟疝手术,对照组常规全身麻醉,观察组在常规全麻基础上于超声引导下行罗哌卡因髂腹下/髂腹股沟神经阻滞,观察2组不同时间点血流动力学指标,包括心率（HR）、收缩压（SBP）、舒张压（DBP）,记录其术中全麻药物（舒芬太尼和丙泊酚）用量、术后拔管时间、苏醒时间、麻醉复苏室（PACU）留观时间、术后特殊患者疼痛评估量表（FLACC）评分、麻醉不良反应,并采用躁动评分（PAED）评估2组患儿躁动发生及严重程度。 结果观察组入室后（T₀）HR、SBP、DBP与对照组均无显著差异（P>0.05）;切皮时（T₁）、术毕时（T₂）HR、SBP、DBP均低于对照组（P<0.05）。观察组舒芬太尼和丙泊酚使用剂量均少于对照组（P<0.05）,术后拔管时间、苏醒时间、PACU留观时间均短于对照组（P<0.05）,术后30 min、术后2、6、12和24 h FLACC评分均低于对照组（P<0.05）,恶心呕吐及躁动发生率、PAED评分均低于对照组（P<0.05）。 结论罗哌卡因髂腹下/髂腹股沟神经阻滞有利于维持儿童腹股沟疝围手术期血流动力学稳定,减轻术后疼痛。     

超声引导下腹股沟上髂筋膜阻滞对游离股前外侧皮瓣修复术后早期恢复质量的影响

目的 探讨术前超声引导下腹股沟上髂筋膜阻滞对四肢毁损伤患者游离股前外侧皮瓣修复术后早期疼痛及恢复质量的影响。方法 选择因四肢毁损伤择期行游离股前外侧皮瓣修复术的患者79例,男47例,女32例,年龄18～60岁,BMI 16～28 kg/m²,ASAⅠ—Ⅲ级。采用随机数字表法将患者分为两组：超声引导下腹股沟上髂筋膜阻滞组(F组,n=39)和对照组(C组,n=40)。F组在麻醉诱导前行超声引导下腹股沟上髂筋膜阻滞,注射0.375%罗哌卡因和地塞米松5 mg混合液共30 ml; C组不行神经阻滞,所有患者全麻用药方案相同。记录术中丙泊酚、瑞芬太尼、舒芬太尼、血管活性药物用量、拔管时间、PACU停留时间;出PACU时、术后2、6、12、24、48 h静息时NRS疼痛评分;术后第1、2天镇痛泵有效按压次数及补救镇痛情况;术前、术后第1、2天15项恢复质量量表(QoR-15)评分;术后48 h内不良反应(头晕、恶心呕吐、皮肤瘙痒、呼吸抑制、低氧血症等)发生情况;出院时皮瓣供区伤口愈合、受区存活情况及住院时间。结果 与C组比较,F组术中瑞芬太尼、舒芬太尼用量及使用血管活性药的例...     

超声引导下髂前上棘水平髂筋膜间隙阻滞在发育性髋关节脱位手术患儿中的应用

目的 探讨超声引导下髂前上棘水平髂筋膜间隙阻滞用于发育性髋关节脱位手术患儿的有效性和安全性。
方法 选择发育性髋关节脱位拟行髋臼成形及股骨截骨手术患儿59例,男14例,女45例,年龄1～5岁,体重9.5～21.0 kg,ASA Ⅰ或Ⅱ级,随机分为两组：超声引导下髂前上棘水平髂筋膜间隙阻滞组（UF组,n=30）和单纯全麻组（GA组,n=29）。UF组插管后行超声引导下患侧髂前上棘水平髂筋膜间隙阻滞,0.2%罗哌卡因0.8～1.0 ml/kg,最大用量小于20 ml,30 min后开始手术。GA组不行阻滞直接开始手术。记录麻醉诱导前1 min、手术开始后1、10、30、60 min、手术结束时的MAP、HR和呼出气七氟醚浓度（C_ETSev）以及术中芬太尼、瑞芬太尼和丙泊酚使用量、拔管时间、苏醒时间,拔管后10、20、30 min、出室时的苏醒期躁动（PAED）评分,术后4、8、12、24、48 h的FLACC疼痛评分和曲马多补救镇痛及不良反应情况。
结果 手术开始后1 min至手术结束时,UF组C_ETSev明显低于GA组（P＜0.05）。UF组术中芬太尼、瑞芬太尼和丙泊酚用量均明显少于GA组（P＜0.05）,拔管时间和苏醒时间明显短于GA组（P＜0.05）。拔管后10、20、30 min时UF组PAED评分均明显低于GA组（P＜0.05）。术后4、8、12 h,UF组FLACC评分明显低于GA组（P＜0.05）。GA组有6例（21%）需曲马多补救镇痛,UF组无一例补救镇痛（P＜0.05）。两组不良反应发生率差异无统计学意义。
结论 超声引导下髂前上棘水平髂筋膜间隙阻滞可为发育性髋关节脱位手术患儿提供较为完善的镇痛,减少全麻药和阿片类药物用量,促进术后早期恢复。     

Modification of the penile block

Summary Penile block is a recommended technique for circumcision in adults. The classic technique for performing this block fails to produce satisfactory analgesia in many cases, and pain sensation in the region of the prepuce persists. We propose a modified technique of penile block with the addition of infiltration of local anesthetic along the raphe of the penis up to the prepuce. In 30 patients (group 1), circumcision was performed with the classic technique of penile block, and in 100 patients (group 2) the modified technique was used. The frequency and intensity of pain during the operation were significantly higher in group 1, whereas patients in group 2 were practically pain-free. The discomfort experienced during performance of the block and in the postoperative period was equal in the two groups. We recommend this modified technique of penile block for circumcision in adults.     

Lighting of the operating block

The technology of operating lighting has developed. The performances are concerning both the quality of the light provided and mechanical performances of the lighting. In order to judge the qualities of a lighting, the following keypoints have to be understood: the light itself; optics and geometry of light beams; mechanical and ergonomic performances; available options.     

Examination of the anesthesia on transperineal prostate biopsy--saddle block versus caudal block

We examined the anesthesia of transperineal prostate biopsy under saddle block or caudal block. Between July 2003 and September 2004, we performed transperineal prostate biopsy under saddle block and caudal block, in 59 and 78 patients, respectively. We evaluated the pain score with the FACES Pain Rating Scale (0-5) and examined side effects on each anesthesia. There was no significant difference in the pain score of anesthesia prick between saddle block and caudal block (1.51 +/- 1.03 versus 1.39 +/- 0.98 respectively, P = 0.629), but the biopsy prick under saddle block revealed significantly (P < 0.0001) lower pain score (0.05 +/- 0.22) than caudal block (1.18 +/- 1.22). Saddle block caused post-operative retention more frequently than caudal block and required the patient to rest in bed for several hours after prostate biopsy. Saddle block was useful for relieving the pain of biopsy. In future, we need to consider using a method with fewer side effects.     

Cubital nerve block vs haematoma block for the manipulation of Colles' fracture

Blocking efficacy and acute toxicity of prilocaine (15 ml of 10 mg/ml prilocaine) was examined in 35 (16 + 19) patients by using blocks of the radial, ulnar and median nerves in the elbow region (Group 1), or the haematoma block method (Group 2) for the manipulation of Colles' fracture. In Group 1 vs Group 2, the reposition was painless in 44% (7/16) vs 68% (13/19), moderate pain occurred in 38% (6/16) vs 21% (4/19), and severe pain in 19% (3/16) vs 11% (2/19). At 15 minutes there was a higher degree of block, on average, at the median and ulnar nerve innervation areas in Group 1. Complete motor block at peripheral innervation regions of all three nerves was achieved in only one patient in Group 1 and in no case in Group 2. Despite this, the surgeons assessed the relaxation at the wrist satisfactory for reposition of the fracture in all but one patient (Group 2). The highest individual prilocaine plasma concentration in Group 1 was 0.68 microgram/ml at ten minutes, whereas the highest individual value in Group 2 was 0.77 microgram/ml at ten minutes. Systemic toxicity from the local anaesthetic did not occur.     

Infraclavicular brachial plexus block effects on respiratory function and extent of the block

Background and Objectives. Axillary block is devoid of severe respiratory complications. However, incomplete anesthesia of the upper limb is the main disadvantage of the technique. Theoretically, the more proximal infraclavicular approach would produce a more extensive block without the risk of pneumothorax. However, neither its effects on respiratory function nor a detailed characterization of the extent of neural block has been assessed. The goal of this study was to evaluate the possible changes in respiratory function and also the extent of the block after infraclavicular block. Methods. We performed an infraclavicular block with a mixture of 40 mL 1.5% plain mepivacaine and 4 mL 8.4% sodium bicarbonate in 20 patients. Forced expiratory volumes were measured before and 15 minutes after the injection of local anesthetic, and sensory and motor block were evaluated at 10 and 20 minutes. Results. We did not find significant differences from baseline in the forced expiratory volumes in any of the patients. Axillary and musculocutaneous nerve distributions had the lowest rate of sensory block at 20 minutes. Conclusions. Infraclavicular block does not produce a reduction in respiratory function.     

Depolarization block and phase II block at the neuromuscular junction.

The effects of repeated doses of decamethonium or succinylcholine in muscles of the cat, dog, and rabbit have been examined. In particular, the relation of degree of neuromuscular block to intensity of the electrical change at the end-plate region has been found to be more consistent when the peak spatial gradient of depolarization is used as a measure of electrical effect than when the peak depolarization is used; the reason for this difference is discussed. A plot of twitch height against electrical change provides a convenient frame of reference for following the development of phase II block quantiatively. Examples presented show that the extent and kinetics of phase II block can vary considerably among species or among muscles in a given species.