艾司氯胺酮复合罗哌卡因对上肢骨折患者臂丛神经阻滞后反跳痛的影响

目的探讨艾司氯胺酮复合罗哌卡因对上肢骨折患者臂丛神经阻滞后反跳痛的影响。方法选取2021年11月至2022年8月于徐州市肿瘤医院在臂丛神经阻滞麻醉下行单侧上肢骨折切开复位内固定的患者, 按随机数字表法分为艾司氯胺酮组(RNK组, 75例)和罗哌卡因组(R组, 74例)。两组患者均实施超声引导下锁骨上臂丛神经阻滞, RNK组使用药物为0.375%罗哌卡因+0.5 mg/kg艾司氯胺酮30 ml, R组使用药物为0.375%罗哌卡因30 ml, 术后均采用舒芬太尼患者自控静脉镇痛(patient controlled intravenous analgesia, PCIA)。记录两组患者术后48 h内反跳痛的发生率;记录患者入室, 麻醉后5、10、20、30 min, 切皮及手术结束时的MAP和心率;记录感觉阻滞起效时间、运动阻滞起效时间、感觉阻滞持续时间和运动阻滞持续时间;记录术前及术后8、12、24、48 h静息和运动数字分级评分法(Numerical Rating Scale, NRS)疼痛评分;记录术后24、48 h PCIA舒芬太尼用量、总按压次数及有效按压次数;记录其他不良反应...     

神经刺激定位器在外周神经阻滞中的应用

随着微创手术的发展,临床麻醉也发生了明显的变革.从减少手术应激反应和镇痛机制的角度而言,区域麻醉特别是外周神经阻滞(peripheral nerve block, PNB)在临床麻醉和术后镇痛方面得到充分重视.为提高外周神经阻滞的成功率,减少并发症,2001年9月～2002年10月,我科使用神经刺激定位器行外周神经阻滞60例,取得良好效果,现报道如下.     

上肢手术患者不同腋路臂丛神经阻滞的效果

腋路臂丛神经阻滞定位简单,能为前臂和手部手术提供完善的神经阻滞,但麻醉后发生的神经功能暂时性障碍在临床上不容忽视。不同的神经阻滞技术与阻滞效果及并发症发生率有关。外周神经刺激器定位已广泛用于腋路臂丛神经阻滞中,然而其阻滞效果尚需进一步探讨。本研究拟比较上肢手术患者三种腋路臂丛神经阻滞的效果,为临床提供参考。     

神经刺激器在外周神经阻滞中的应用

外周神经阻滞是常用的临床麻醉及疼痛治疗方法,利用周围神经刺激器可使神经阻滞定位更加准确,提高阻滞 的成功率。本文介绍神经刺激器的工作原理、临床应用及评价。     

高龄患者下肢手术行外周神经阻滞效果分析

目的：在老年患者下肢手术过程中分别采用硬膜外麻醉与外周神经阻滞两种方法,并观察这两种麻醉方法的麻醉效果和安全性。方法选取2013年1月~2014年1月因下肢外伤就诊于我院的老年患者24例。按随机分组的方法分为外周神经阻滞组和硬膜外麻醉组,每组12例。外周神经阻滞组：在神经刺激器引导下行后路腰丛及坐骨神经阻滞。硬膜外麻醉组常规硬膜外麻醉。结果两组手术麻醉效果无显著差异（P＞0.05）。血流动力学改变：外周神经阻滞组患者阻滞前后及术毕均无明显波动,麻醉后15,30min两组心率、收缩压、舒张压及平均动脉压均有显著差异（P＜0.05）。镇痛时间：外周神经阻滞组明显长于硬膜外阻滞组。外周神经阻滞组起效时间明显短于硬膜外阻滞组,差异有统计学意义（P＜0.05）。外周神经阻滞组维持时间长于硬膜外阻滞组,差异有统计学意义（P＜0.05）。运动神经阻滞：外周神经阻滞组起效时间、维持时间均短于硬膜外阻滞,差异有统计学意义（P＜0.05）。结论外周神经阻滞可安全有效地应用于80岁以上高龄老人下肢手术。     

外周区域阻滞与术后镇痛的新观点和新方法

如何提高围术期病人的生活质量是麻醉医生应始终思考的问题之一 ,研究表明手术后疼痛是围术期病人的主要痛苦所在。因此 ,临床麻醉和术后镇痛是一个不可分隔的整体 ,术后镇痛是提高围术期病人生活质量的重要环节 ,理应予以重视 !近 10年来 ,随着临床麻醉条件的改善 ,国内临床麻醉中全身麻醉的比例明显提高 ,区域阻滞麻醉的比例有所下降 ,而国外在临床上全身麻醉十分普及的同时 ,却出现了重视外周区域阻滞的趋势。外周神经阻滞技术通常用于围术期麻醉和镇痛 ,外周神经置管和连续给药技术将外周神经阻滞演变为术后镇痛的有效方法。外周神经阻…     

神经刺激器在外周神经阻滞中的应用

外周神经阻滞是常用的临床麻醉及疼痛治疗方法，利用周围神经刺激器可使神经阻滞定位更加准确，提高阻滞的成功率。本文介绍神经刺激器的工作原理、临床应用及评价。     

外周神经阻滞并发症防治专家共识

随着超声可视化技术的普及,外周神经阻滞技术应用日益广泛,而与之相关的各类并发症也随之增加。这些并发症的早期预防、及时发现和有效处置,可大大改善临床预后;而其中对神经损伤原因科学而准确的鉴别,也是外周神经阻滞技术得以广泛推广的关键所在。为规范此类并发症的诊疗流程,降低其发生率,优化患者预后,中华医学会麻醉学分会特制定《外周神经阻滞并发症防治专家共识》。     

神经刺激仪引导下胫神经阻滞用于小儿马蹄足畸形纠正术

外周神经阻滞采用神经刺激仪定位技术在临床应用广泛.但小儿麻醉中使用多限于臂丛神经阻滞.本研究在小儿马蹄足畸形纠正术中采用神经刺激仪引导胫神经阻滞,取得了良好的麻醉效果,并且术后镇痛完善.     

外周神经阻滞在单侧大隐静脉曲张手术中的应用

下肢外周神经阻滞适用于髋关节以下的下肢手术,安全性高,并发症少,操作简便,麻醉效果确切,术后镇痛效果好.近年来,神经刺激仪定位技术的临床应用,提高了外周神经阻滞的准确性和阻滞效果.较之传统的椎管内麻醉,具有术中患者生命体征平稳、对胃肠道功能无影响、无脊麻后头痛、术后恶心呕吐,不需术后禁食等优点.我院于2004年9月起,对54例单侧大隐静脉手术分别采用神经刺激仪引导下的外周神经阻滞与硬膜外麻醉方法,观察并比较其麻醉效果.     

Bloqueio de nervos periféricos e dor rebote: revisão de literatura

Background and objectivesTo investigate, describe, and assess the phenomenon of “rebound pain” as a clinically relevant problem in anesthetic practice.ContentThe phenomenon of “rebound pain” has been demonstrated and described as a very severe pain, which occurs after a peripheral nerve block resolution with the recovery of sensitivity. The incidence of rebound pain is unknown. Usually, it occurs between 12 to 24 hours after surgery and adversely affecting sleep quality. It is not yet possible to establish a mechanism as a definitive cause or trigger factor of rebound pain. Studies suggest that rebound pain is a side effect of peripheral nerve blocks, despite their effectiveness in pain control. Currently, the extent and clinical significance of rebound pain cannot be well determined due to the lack of large prospective studies.ConclusionRebound pain assessment should always be considered in clinical practice, as it is not a rare side effect of peripheral nerve blocks. There are still many challenging questions to be answered about rebound pain, so large prospective studies are needed to address the issue. For prevention, the use of peripheral nerve block techniques that avoid nerve damage and adequate perioperative analgesia associated with patient education on the early administration of analgesics, even during the period of analgesia provided by peripheral nerve block, is recommended. A better understanding of the “rebound pain” phenomenon, its pathophysiology, associated risk factors, and long‐term consequences may help in developing more effective preventive strategies.     

周围神经阻滞后爆发痛的研究进展

周围神经阻滞是围术期控制疼痛和减少阿片类药物使用的重要手段。然而，以周围神经阻滞后痛觉过敏为特征的术后爆发痛可能会减少这种方式的总体获益，它会对镇痛药物总用量、患者整体满意度和术后恢复产生明显影响，也可能引起心血管和肺部并发症，对患者的预后产生负面影响。了解周围神经阻滞后爆发痛的特征、危险因素和防治策略对于有效利用周围神经阻滞起到重要作用。     

Continuous peripheral nerve blocks at home for treatment of recurrent complex regional pain syndrome I in children

BACKGROUND: Recurrent complex regional pain syndrome I is not rare in the pediatric population. The authors conducted this study to evaluate the efficacy of continuous peripheral nerve blocks with elastomeric disposable pumps associated with initial Bier blocks for the treatment of recurrent complex regional pain syndrome I in children. METHODS: After parental informed consent, 13 children who did not respond to conventional complex regional pain syndrome treatment were included (mean age, 13 yr; range, 9-16 yr). After general anesthesia, peripheral nerve block was performed using 0.5 ml/kg lidocaine, 1%, with epinephrine and 0.5% ropivacaine injected in the peripheral nerve block catheter. Then, a 20-min Bier block was performed using a tourniquet and 0.2 ml/kg lidocaine, 1%; 3 ml/kg hydroxyethyl starch 130/06; and 5 mg/kg buflomedil injected intravenously. A solution of 0.1 ml . kg . h continuous ropivacaine, 0.2%, was infused through the catheter using an elastomeric pump for 96 h. Need for rescue analgesia, occurrence of side effects, and status of motor and sensory block were recorded at hours 1, 6, 12, 24, 48, 72, and 96. Children and parents completed a satisfaction assessment. All of the children had follow-up visits after 2 months. RESULTS: Postoperative analgesia was excellent. The median pain score was 0 for each period studied. Motor blockade was minimal before 12 h (median, 1) and absent thereafter. One child needed rescue analgesia. All children were able to walk easily after the initial 24-h period (walking score, > 4). Children and parents were all satisfied. Children returned home under parental surveillance beginning in the 24th hour. Neither peripheral nerve block nor Bier block caused side effects. After 2 months, none of the children exhibited any clinical symptom of recurrent complex regional pain syndrome. CONCLUSION: Ambulatory continuous peripheral nerve block associated with an initial Bier block seems to be a significant and novel contribution to treat recurrent pediatric complex regional pain syndrome I. It allows complete pain relief, early mobilization, and rapid return home, representing a psychological advantage for these children.     

Sciatic nerve palsy following uneventful sciatic nerve block

We describe the loss of function in the sciatic nerve after an uneventful sciatic nerve block using 25 ml of lignocaine 1% with adrenaline 1 in 200 000 in a patient receiving β blocker drugs. Lack of pain on injection and complete regeneration of the nerve after 12 months in a patient with severe peripheral vascular disease led us to postulate ischaemic nerve damage as a mechanism of injury. Adrenaline-induced unopposed α-mediated vasoconstriction in a β-blocked patient is suggested as a possible mechanism of peripheral nerve injury worthy of further investigation.     

Continuous Peripheral Nerve Blocks at Home for Treatment of Recurrent Complex Regional Pain Syndrome I in Children

Background: Recurrent complex regional pain syndrome I is not rare in the pediatric population. The authors conducted this study to evaluate the efficacy of continuous peripheral nerve blocks with elastomeric disposable pumps associated with initial Bier blocks for the treatment of recurrent complex regional pain syndrome I in children.

Methods: After parental informed consent, 13 children who did not respond to conventional complex regional pain syndrome treatment were included (mean age, 13 yr; range, 9-16 yr). After general anesthesia, peripheral nerve block was performed using 0.5 ml/kg lidocaine, 1%, with epinephrine and 0.5% ropivacaine injected in the peripheral nerve block catheter. Then, a 20-min Bier block was performed using a tourniquet and 0.2 ml/kg lidocaine, 1%; 3 ml/kg hydroxyethyl starch 130/06; and 5 mg/kg buflomedil injected intravenously. A solution of 0.1 ml [middle dot] kg-1 [middle dot] h-1 continuous ropivacaine, 0.2%, was infused through the catheter using an elastomeric pump for 96 h. Need for rescue analgesia, occurrence of side effects, and status of motor and sensory block were recorded at hours 1, 6, 12, 24, 48, 72, and 96. Children and parents completed a satisfaction assessment. All of the children had follow-up visits after 2 months.

Results: Postoperative analgesia was excellent. The median pain score was 0 for each period studied. Motor blockade was minimal before 12 h (median, 1) and absent thereafter. One child needed rescue analgesia. All children were able to walk easily after the initial 24-h period (walking score, > 4). Children and parents were all satisfied. Children returned home under parental surveillance beginning in the 24th hour. Neither peripheral nerve block nor Bier block caused side effects. After 2 months, none of the children exhibited any clinical symptom of recurrent complex regional pain syndrome.     

灌注指数评估区域神经阻滞效果的研究进展

近年来区域神经阻滞发展迅速，在围术期多模式镇痛领域起到重要作用。目前评估区域神经阻滞效果仍以主观指标为主，客观指标相对匮乏。灌注指数(PI)作为一项无创、连续的客观参数，可通过反映外周灌注及血管张力早期评估区域神经阻滞的效果。本文就PI的作用原理、影响因素、评估区域神经阻滞的机制和应用现状进行综述，探索PI评估区域神经阻滞效果的临床应用价值，为优化围术期疼痛管理提供参考。     

Current topics in prevention, diagnosis and treatment of neuropathic pain from different causes: preface and comments

Neuropathic pain, as a chronic intractable pain, is well known to be difficult in prevention, diagnosis and treatment. Especially, neuropathic pain from different causes has each characteristics for prevention, diagnosis and treatment. These include post-herpetic pain, persistent chronic pain following traffic accident, pain after peripheral nerve injury in venipuncture, phantom limb pain originating from dysfunction of the primary motor cortex, pain from failed back surgery syndrome, and diabetic neuropathy, and are helpful for understanding prevention, diagnosis and treatment of neuropathic pain.     

星状神经节阻滞联合改良颈部椎旁神经阻滞治疗颈源性头痛

目的 探讨星状神经节阻滞联合改良颈部椎旁神经阻滞治疗颈源性头痛的临床疗效.方法 136例颈源性头痛患者随机分为星状神经节阻滞联合改良颈部椎旁神经阻滞(A组)和星状神经节阻滞联合外周神经阻滞(B组),每组68例.两组均以每2天治疗一次,4次为一疗程.治疗前后采用简化McGill疼痛问卷表评估疼痛程度,并结合颈椎活动度(ROM)评分来评定临床疗效.结果 与治疗前比较,两组治疗后疼痛评估指数(PRI)、疼痛强度指数(PPI)、VAS、ROM评分均降低(P<0.05).治疗后,A组PRI、PPI、VAS、ROM评分均较B组为低.治愈率较B组为高(P<0.05)结论星状神经节阻滞联合改良颈部椎旁神经阻滞治疗颈源性头痛的临床疗效优于联合外周神经阻滞.     

Ausgew?hlte interventionelle Verfahren zur Behandlung chronischer Schmerzen

Approximately 5?C8 million people in Germany suffer from chronic pain. Some patients can obtain relief from specific interventional techniques. In detail these are blocks of the sympathetic chain and peripheral nerve blocks, regional anesthetic techniques close to the spinal cord and neuromodulation. Part 1 of this article presents peripheral nerve blocks using the example of intercostal blocks and blocks of the sympathetic chain. Peripheral nerve blocks are important for postoperative pain treatment. Only a few methods are used for chronic pain and this applies primarily to the intercostal block which is used for the treatment of pain occurring after thoracotomy, intercostal neuralgia and pain associated with infiltration of cancer. Blocks of the vegetative nervous system are accomplished on the ganglions of the head and the sympathetic chain and are therefore most commonly applied to treat headache, neuropathic and sympathetic pain in the area of abdomen and the extremities.     

Selected interventional methods for the treatment of chronic pain: Part 1: peripheral nerve block and sympathetic block

Approximately 5-8 million people in Germany suffer from chronic pain. Some patients can obtain relief from specific interventional techniques. In detail these are blocks of the sympathetic chain and peripheral nerve blocks, regional anesthetic techniques close to the spinal cord and neuromodulation. Part 1 of this article presents peripheral nerve blocks using the example of intercostal blocks and blocks of the sympathetic chain. Peripheral nerve blocks are important for postoperative pain treatment. Only a few methods are used for chronic pain and this applies primarily to the intercostal block which is used for the treatment of pain occurring after thoracotomy, intercostal neuralgia and pain associated with infiltration of cancer. Blocks of the vegetative nervous system are accomplished on the ganglions of the head and the sympathetic chain and are therefore most commonly applied to treat headache, neuropathic and sympathetic pain in the area of abdomen and the extremities.