老年患者全髋关节置换术的腰丛-骶丛神经阻滞麻醉方法

目的 探讨改良的老年患者人工髋关节置换术的神经阻滞麻醉方法.方法 选取2015年3~6月于我院行全髋关节置换手术的14例老年患者,予腰丛-骶丛神经阻滞麻醉,术前运用针刺法测试麻醉平面,记录术中血流动力学变化、不良反应,评估麻醉效果.结果 臀上神经支配的阔筋膜张肌区域、臀下神经支配的臀大肌区域、股神经支配的股四头肌区域及坐骨神经支配的大腿后肌群区域皮肤痛觉消失.患者麻醉前即刻和切皮时收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、心率(heart rate,HR)值比较,差异均无统计学意义(均P>0.05).术中SBP、DBP和HR最大变化率分别为13.9%±6.2%、15.8%±7.8%和14.1%±4.8%,均在20%以内.所有患者均在单纯神经阻滞麻醉下顺利完成手术,术中均未追加阿片类药物.术中未出现局部麻醉药物中毒、血流动力学大幅波动、呼吸抑制等并发症.术者满意度评分均为10分.结论 本研究显示腰丛-骶丛神经阻滞麻醉可安全有效运用于老年患者人工髋关节置换术.受限于样本量,我们仍将在以后的临床工作中更进一步研究.     

不同麻醉方法在老年髋关节术中的应用

目的探讨神经阻滞麻醉联合小剂量全麻和腰硬联合麻醉在老年髋关节手术中的应用效果。方法将本院2017年11月至2020年11月收治的拟行髋关节手术的老年患者50例,随机分为观察组和对照组,每组25例。观察组给予腰骶丛神经阻滞+胸12～腰1椎旁阻滞联合全身麻醉,对照组予以腰硬联合麻醉,比较两组患者麻醉相关指标、术后24小时疼痛(VAS)、围术期匹兹堡睡眠质量指数(PSQI)以及术后认知功能障碍发生情况。结果观察组麻醉起效时间、麻醉时长、术毕拔管时间均短于对照组(P0.05);观察组患者24小时VAS(5.23±1.04)分较对照组(7.51±2.17)分低(P0.05);术后5天两组PSQI均较术前5天显著降低,且观察组低于对照组(P0.05);观察组术后认知功能发生率低于对照组(8%vs36%)(P0.05)。结论腰骶丛神经阻滞联合小剂量全身麻醉可以提高手术效率,改善患者睡眠质量,降低术后认知功能障碍发生率,有利于促进患者康复。     

超声引导下腰骶丛联合T12/L1椎旁神经阻滞在全髋关节置换术中的临床应用

目的评估超声引导下腰骶丛联合T12/L1椎旁神经阻滞在全髋关节置换术中的临床应用价值。方法择期行单侧全髋关节置换术病人61例,所有病人均采用超声引导下腰骶丛联合T12/L1椎旁神经阻滞,记录病人围术期情况、注药后30分钟感觉阻滞平面、阻滞前后血流动力学变化、手术麻醉效果及神经阻滞相关并发症发生情况。结果注药后30分钟,T12~S3支配皮区针刺感觉阻滞成功率为87.0%~100%。阻滞后平均动脉压及心率与阻滞前比较,差异无统计学意义(P0.05)。总体手术麻醉优良率为97.0%,61例病人发生1例双侧阻滞。结论超声引导下腰骶丛联合T12/L1椎旁神经阻滞用于全髋关节置换手术,血流动力学平稳,镇痛效果确切,阻滞效果更优。     

《临床麻醉学杂志》2003年（第19卷）1～12期文题索引

概论历史新年献辞 (1)∶5门诊手术麻醉进展 (2 )∶12 7麻醉前处理咪唑安定麻醉前用药与遗忘作用 (9)∶5 78部位麻醉颅神经阻滞透视下半月神经节阻滞治疗特发性三叉神经痛 (5 )∶2 86颈丛神经阻滞B超介导双侧颈丛阻滞技术在甲状腺手术中的　应用 (4 )∶2 38可乐定复合局麻药用于颈丛阻滞的临床观察 (6 )∶376臂丛神经阻滞臂丛神经阻滞肱中法的可行性评估 (3)∶177肌间沟臂丛神经扇形阻滞法的临床观察 (4 )∶2 4 5椎旁神经阻滞选择性腰骶神经后根切断治疗小儿脑瘫下肢　痉挛的麻醉体会 (9)∶5 6 2腰丛神经阻滞在膝关节骨性关节炎治疗中的　应…     

髋关节囊周神经阻滞的研究进展

髋关节囊周神经（PENG）阻滞是一种新型的神经阻滞区域麻醉方法。它最早在髋关节手术麻醉和围术期镇痛方面应用,现在已逐渐应用于下肢截肢手术、大隐静脉曲张结扎剥离术以及大腿内侧肿物切除术等下肢手术。由于PENG阻滞能操作简单且几乎完善地将闭孔神经阻滞,产生良好的围术期镇痛,减少阿片类药物需求和相关不良反应,且不影响下肢肌力,使得近几年国内外不少专家对其研究热度日益高涨。该文针对PENG阻滞的解剖基础、B超引导下麻醉技术分析及其应用于下肢手术中的效果临床研究进展予以综述。     

老年患者全髋关节置换术的神经阻滞方法

【】 目的 介绍一种改良的老年患者人工髋关节置换术的神经阻滞方法。方法 选取2015年3月-2015年6月在我院择期行全髋关节置换手术的14例老年患者,予腰丛+骶丛神经阻滞麻醉,术前运用针刺法测试麻醉平面,记录术中血流动力学变化,记录围术期不良反应,评估麻醉效果。结果 臀上神经支配的阔筋膜张肌区域、臀下神经支配的臀大肌区域、股神经支配的股四头肌区域及坐骨神经支配的大腿后肌群区域皮肤痛觉消失。患者麻醉前即刻与切皮时收缩压、舒张压、心率比较,差异无统计学意义(P>0.05)。术中收缩压、 舒张压和心率最大变化率分别为13.9±6.2%、15.8±7.8%和14.1±4.8％,均在20%以内。所有患者均在单纯神经阻滞下顺利完成手术,术中均未追加阿片类药物。围术期未出现局麻药中毒、循环大幅波动、呼吸抑制等并发症。术者满意度评分均为10分。结论 腰丛+骶丛神经阻滞可安全有效运用于老年患者人工髋关节置换术。     

腰丛-坐骨神经联合臀上皮神经阻滞麻醉与腰麻硬膜外联合麻醉用于髋关节置换术的临床效果观察

目的分析腰丛-坐骨神经联合臀上皮神经阻滞麻醉与腰麻硬膜外联合麻醉用于髋关节置换术的临床疗效。方法髋关节置换患者50例,将50例患者随机分为腰麻硬膜外联合麻醉组(A组)和腰丛-坐骨神经联合臀上皮神经阻滞麻醉组(B组)。结果患者在麻醉前心率(HR)、收缩压(SBP)、舒张压(DBP)、血氧饱和度(SpO_2)值比较,差异无统计学意义(P0.05),A组麻醉后、手术开始10、20、30分钟的HR、SBP、DBP低于麻醉前(P0.05)),A组患者HR与B组比较,有明显变化,B组患者麻醉后、手术开始10、20、30分钟的HR、SBP、DBP、SpO_2与麻醉前比较,差异无统计学意义(P0.05)。B组与A组同时点HR、SBP、DBP比较,差异有统计学意义(P0.05)。B组麻醉优良率高于A组,差异有统计学意义(P0.05)。结论腰丛-坐骨神经联合臀上皮神经阻滞麻醉对循环、呼吸系统影响小,可用于髋关节置换术。     

胫骨骨折术中超声引导区域神经阻滞麻醉、腰硬联合麻醉的临床效果

目的分析在胫骨骨折手术中采用超声引导的区域神经阻滞麻醉+腰硬联合麻醉的临床价值。方法抽取2017年6月至2019年6月本院80例胫骨骨折手术患者,并依据术中麻醉方案差异分组,对照组采取腰硬联合麻醉,观察组患者则改为应用超声引导的区域神经阻滞麻醉+腰硬联合麻醉,对比两组的麻醉效果与安全性。结果观察组的麻醉完善时间、术后睁眼时间以及完全清醒时间均短于对照组,VAS疼痛度评分低于对照组,且P0.05;两组麻醉前10分钟心率(HR)、收缩压(SBP)、舒张压(DBP)对比中P0.05;麻醉后10、20分钟观察组的HR低于对照组,SBP、DBP高于对照组,且P0.05;两组术后的恶心呕吐、寒颤、呼吸抑制、躁动发生率对比中P0.05。结论在胫骨骨折手术中通过运用超声引导区域神经阻滞麻醉+腰硬联合麻醉可取得更优的麻醉效果,且能够降低对患者的机体内环境影响,值得临床应用及推广。     

联合阻滞麻醉在高龄高危患者PFNA手术中的临床观察

目的 评价神经刺激仪定位腰丛一坐骨神经联合阻滞麻醉在高龄高危患者应用AO股骨近端髓内钉-抗螺旋刀片(PFNA)手术中的麻醉效果.方法 对30例合并多种严重内科疾病行PFNA手术的高龄患者,采用神经刺激仪定位下行腰丛-坐骨神经联合阻滞麻醉,术中辅助镇静,常规管理呼吸和循环,并记录血流动力学变化和不良反应的发生率.结果 30例PFNA手术患者麻醉效果满意,术中血流动力学较平稳,无神经阻滞不全,无局麻药中毒、恶心、呕吐,尿潴留及术后低血压等并发症发生.结论 对高龄高危PFNA手术患者采用神经刺激仪定位下腰丛-坐骨神经联合阻滞麻醉是比较理想的麻醉方法.     

超声引导下不同浓度罗哌卡因腰丛神经阻滞在老年患者髋关节置换术中的应用

目的 探索超声引导下不同浓度罗哌卡因腰丛神经阻滞在老年髋关节置换术中的应用效果及安全性.方法 2018年1月至2020年7月,90例髋关节置换术的老年患者采用随机数字表法分为A组、B组及C组,每组各30例,分别采用0.25％、0.30％、0.35％罗哌卡因腰丛神经阻滞联合全身麻醉方案,且均在超声引导下实施麻醉.分别于插...     

Bloqueo bilateral del grupo de nervios pericapsulares (PENG) como analgesia en cirugía de cadera infantil

Effective management and control of peri- and postoperative pain in hip surgery is essential in order to minimize the use of opioids and their adverse effects. Effective regional analgesia for hip pain is made particularly challenging by the complex innervation of the hip joint. Standard regional techniques can be associated with complications, including incomplete anesthesia, hypotension, or lower limb weakness. We present the case of a 5-year-old girl with a history of infantile cerebral palsy who underwent bilateral varus derotation osteotomy and adductor tenotomy due to paralytic dislocation. She received bilateral PENG block and femoral cutaneous nerve block - a simple technique that covers all the nerves involved in the sensory innervation of the joint capsule without the need for multiple injections.     

Differential epidural block for definitive diagnosis of snapping hip joint

Snapping hip joint syndrome is defined as snapping phenomenon accompanied by motion of the hip joint. It occurs from various causes, and its diagnosis and treatment are often difficult. We gave anesthesia for surgery against snapping hip joint under patient's active motion for definitive regional diagnosis. Differential epidural block, which precludes pain while maintaining motor function, was performed by 0.25% bupivacaine, 0.5% lidocaine, and additional administration of fentanyl by 25 micrograms. Although the mechanism of differential nerve block remains to be unknown, the case suggests that effective pain block preserving motor function may be achieved by differential epidural block in combination with low concentration of local anesthetics and small dose of opioid.     

Why patients choose regional anesthesia for orthopedic and trauma surgery

BACKGROUND: While both surgeons' and anesthesiologists' preference of regional over general anesthesia is increasing, the patients' preference remains limited. Little is known about why patients choose regional anesthesia. The aim of our study was to answer this question with regard to orthopedic and trauma surgery. METHODS: The study was carried out prospectively from 1999 to 2001 and included 238 patients scheduled for arthroscopy of the lower limb or other orthopedic or trauma surgery. All patients were informed about regional and general anesthesia in a pre-anesthesia interview and subsequently chose the method they preferred. RESULTS: Curiosity was the main reason why patients chose regional anesthesia for arthroscopy ( n=155, p<0.0001). For all other types of orthopedic or trauma surgery ( n=83), patients chose regional anesthesia to avoid postoperative pain ( p<0.01) and/or the side-effects of general anesthesia ( p<0.0001). Younger ( n=128) and low-risk ( n=184) patients chose regional anesthesia because they were curious ( p<0.01 and p<0.001, respectively), while older ( n=110) and unhealthier patients ( n=56) did so for safety ( p<0.01 and p<0.001, respectively). CONCLUSIONS: Patients choose different types of regional anesthesia for different reasons. While spinal anesthesia and femoral and sciatic block were chosen for curiosity reasons, brachial plexus block was chosen to avoid the side effects of general anesthesia. The patients' choice of regional anesthesia for orthopedic and trauma surgery is significantly influenced by the type of surgery, age, and health.     

Editorial Commentary: Neuraxial Anesthesia Improves Pain After Hip Arthroscopy but Risks Ambulatory Discharge Delay

Hip arthroscopy continues to be one of the fastest-growing orthopaedic procedures nationally, and pain control following these procedures can be challenging. As regional anesthesia techniques for this population have shown to have limited benefits, pain management for hip arthroscopy focused on multimodal analgesia and preventive analgesia, interventions that reduce postoperative hyperalgesia. The use of neuraxial anesthesia such as spinal and epidural anesthesia, established preventive analgesic anesthetic techniques, has demonstrated to improve postoperative pain in orthopaedic surgery when compared with general anesthesia. This promising finding highlights that despite potential disadvantages of neuraxial anesthesia, such as a small risk for complications or delayed resolution of the neuraxial block that could delay discharge, neuraxial anesthesia could be a suitable anesthetic technique for ambulatory orthopaedic surgery.     

A comparison of regional versus general anesthesia for ambulatory anesthesia: a meta-analysis of randomized controlled trials

Both regional anesthesia and general anesthesia have been proposed to provide optimal ambulatory anesthesia. We searched MEDLINE and other databases for randomized controlled trials comparing regional anesthesia and general anesthesia in ambulatory surgery patients for meta-analysis. Only major conduction blocks were considered to be regional anesthesia. Regional anesthesia was further separated into central neuraxial block and peripheral nerve block. Fifteen (1003 patients) and 7 (359 patients) trials for central neuraxial block and peripheral nerve block were included in the meta-analysis. Both central neuraxial block and peripheral nerve block were associated with increased induction time, reduced pain scores, and decreased need for postanesthesia care unit analgesics. However, central neuraxial block was not associated with decreased postanesthesia care unit bypass or time or reduced nausea despite reduced analgesics, and it was associated with a 35-min increase in total ambulatory surgery unit time. In contrast, peripheral nerve block was associated with decreased postanesthesia care unit need and decreased nausea but, again, not with decreased ambulatory surgery unit time. This meta-analysis indicates potential advantages for regional anesthesia, such as decreased postanesthesia care unit use, nausea, and postoperative pain. Although these factors have been proposed to reduce ambulatory surgery unit stay, neither central neuraxial block nor peripheral nerve block were associated with reduced ambulatory surgery unit time. Other factors, such as unsuitable discharge criteria and limitations of meta-analysis, may explain this discrepancy.     

Regional anesthesia for orthopedic procedures: What orthopedic surgeons need to know

Regional anesthesia is an integral component of successful orthopedic surgery. Neuraxial anesthesia is commonly used for surgical anesthesia while peripheral nerve blocks are often used for postoperative analgesia. Patient evaluation for regional anesthesia should include neurological, pulmonary, cardiovascular, and hematological assessments. Neuraxial blocks include spinal, epidural, and combined spinal epidural. Upper extremity peripheral nerve blocks include interscalene, supraclavicular, infraclavicular, and axillary. Lower extremity peripheral nerve blocks include femoral nerve block, saphenous nerve block, sciatic nerve block, iPACK block, ankle block and lumbar plexus block. The choice of regional anesthesia is a unanimous decision made by the surgeon, the anesthesiologist, and the patient based on a risk-benefit assessment. The choice of the regional block depends on patient cooperation, patient positing, operative structures, operative manipulation, tourniquet use and the impact of post-operative motor blockade on initiation of physical therapy. Regional anesthesia is safe but has an inherent risk of failure and a relatively low incidence of complications such as local anesthetic systemic toxicity (LAST), nerve injury, falls, hematoma, infection and allergic reactions. Ultrasound should be used for regional anesthesia procedures to improve the efficacy and minimize complications. LAST treatment guidelines and rescue medications (intralipid) should be readily available during the regional anesthesia administration.     

Interscalene regional anesthesia for shoulder surgery

BACKGROUND: Despite a trend toward the use of regional anesthesia for orthopaedic procedures, there has been resistance to the use of interscalene regional block for shoulder surgery because of concerns about failed blocks and potential complications. METHODS: We retrospectively reviewed the cases of 568 consecutive patients who had shoulder surgery under interscalene regional block in a tertiary-care, university-based practice with an anesthesiology residency program. The blocks were performed by a group of anesthesiologists who were dedicated to the concept of regional anesthesia in their practice. Complete anesthetic and orthopaedic records were available for 547 patients. The surgical procedure, planned type of anesthesia, occurrence of block failure, and the presence of complications were noted. RESULTS: Of the 547 patients, 295 underwent an arthroscopic procedure and 252 (including eighty who had an arthroplasty) underwent an open procedure. General anesthesia was the initial planned choice for sixty-nine patients because of the complexity or duration of the procedure, the anatomic location, or patient insistence. Thirty-four of the sixty-nine patients also received an interscalene regional block. Interscalene regional block alone was planned for 478 patients. A total of 462 patients (97%) had a successful block whereas sixteen required general anesthesia because the block was inadequate. The success of the block was independent of the type or length of the surgery. No patient had a seizure, pneumothorax, cardiac event, or other major complication. Twelve (2.3%) of the 512 patients who had a block had minor complications, which included sensory neuropathy in eleven patients and a complex regional pain syndrome that resolved at three months in one patient. For ten of the eleven patients, the neuropathy had resolved by six months. CONCLUSIONS: Interscalene regional block provides effective anesthesia for most types of shoulder surgery, including arthroplasty and fracture fixation. When administered by an anesthesiologist committed to and skilled in the technique, the block has an excellent rate of success and is associated with a relatively low complication rate.     

General anesthesia versus regional anesthesia

No distinct advantage is apparent between regional and general anesthesia when considering perioperative cardiac morbidity and mortality in peripheral vascular surgery. However, there is some evidence to support regional anesthesia over general anesthesia in an effort to optimize graft patency if the regional technique is extended into the postoperative period to provide neuraxial analgesia. An inadequate number of randomized, controlled trials have been conducted to determine whether regional or general anesthesia should be performed for carotid endarterectomy. The nonrandomized trials do support regional anesthesia by virtue of reductions in stroke, myocardial infarction, and death. A randomized, prospective trial is needed to verify these outcomes. The choice of technique does not appear to affect mortality in patients requiring hip fracture surgery, although Urwin et al. (29) reported less 1-month mortality in patients receiving regional anesthesia. General anesthesia has been associated with increased blood loss and thromboembolic complications in patients undergoing hip fracture repair. Epidural anesthesia has been shown to promote quicker return of bowel function postoperatively when the catheter has been sited at T12 or higher. Anastomotic breakdown in patients with epidural anesthesia/analgesia has rarely been reported. Most studies tend to show quicker return of bowel function when local anesthetics alone are administered epidurally.