Continuous peripheral nerve block for postoperative pain control at home: a prospective feasibility study in children

BACKGROUND AND OBJECTIVES: We assessed the feasibility and efficacy of postoperative pain control by continuous peripheral nerve blockade (CPNB) in children after early home discharge under parental surveillance. METHODS: All children scheduled for primary elective ankle or foot surgery under sciatic popliteal CPNB and general anesthesia were evaluated. After obtaining the surgeon's consent, the children were discharged on either the day (D) of surgery (D0), or on postoperative D1 or D2 (depending on whether they needed a plaster cast or a suction drainage). The CPNB was continuously infused, using an elastomeric pump. Before the procedure, the parents were taught how to assess their children's pain, to use rescue analgesia, and to manage an infusion elastomeric pump device, and when to call the hospital in case of emergency. The children returned to the hospital for catheter removal and the recording of any postoperative event. RESULTS: Forty-seven children were entered into this observational study. Two were discharged home on the same day, 30 were discharged home 1 day after surgery, and 15 were discharged home 2 days after surgery. The mean duration of infusion elastomeric pump at home was 3 days (range, 2 to 4 days). Analgesia was rated as excellent or good in 89% of the cases, and the quality of sleep was always good, except for three patients. Some minor untoward effects were recorded. Two children returned to the hospital because of accidental disconnection of the infusion elastomeric pump from the catheter. Four patients presented skin redness at the puncture site, but no infection was observed, and all catheters remained sterile. No parents called the hospital. The children's quality of life was rated as excellent or as satisfactory overall, by both the children and their parents. CONCLUSIONS: Shortening hospital stays with the use of at-home CPNB under sole parental supervision is feasible, after selecting children with a suitable family environment.     

神经刺激仪引导下连续外周神经阻滞用于下肢术后镇痛的效果

目的观察神经刺激仪引导下连续外周神经阻滞用于下肢术后镇痛的效果。方法 90例择期行单侧下肢手术的患者,随机均分为:神经刺激仪引导下连续外周神经阻滞镇痛组(N组),连续硬膜外镇痛组(E组),连续静脉给药镇痛组(I组)。N组麻醉前根据手术情况选择适当的下肢神经在刺激仪的引导下定位、穿刺留置导管;E组麻醉前行腰段(L3~4)硬膜外穿刺留置导管。三组患者麻醉方法及用药相同,手术结束前10min,N组经留置导管推注0.2%罗哌卡因15ml;E组经留置导管推注0.2%罗哌卡因10ml,I组静脉推注地佐辛5mg后接镇痛泵,配方分别为:N组0.2%罗哌卡因;E组0.2%罗哌卡因与0.5μg/ml舒芬太尼混合液;I组1.0μg/ml舒芬太尼。记录麻醉前(T0)、术后1h(T1)、4h(T2)、12h(T3)、24h(T4)、48h(T5)的SBP、DBP、HR、SpO2、VAS评分和Ramsay镇静评分及不良反应发生情况。结果与I组比较,N组和E组术后T1~T5时VAS评分明显降低(P0.05);T1~T3时Ramsay镇静评分明显升高(P0.05)。与T0和N组比较,T1~T3时E组SBP、DBP明显下降(P0.05)。与N组比较,E组和I组恶心呕吐、瘙痒发生率也明显升高(P0.05);E组的尿潴留发生率也明显升高(P0.05)。三组头晕、运动阻滞发生率差异无统计学意义。结论神经刺激仪引导下连续外周神经阻滞用于下肢手术后镇痛简便、安全、镇痛完善且不良反应少,值得临床推广。     

刺激型导管连续股神经阻滞术后镇痛效果观察

目的 观察刺激型导管连续股神经阻滞在全膝关节置换术后的镇痛效果.方法 选择ASAⅠ或Ⅱ级行单侧全膝关节置换术患者80例.随机均分为刺激型导管组(S组)与普通型导管组(N组),全麻诱导前置入连续股神经阻滞导管.两组术后经导管均持续输注0.2%罗哌卡因5 ml/h,持续3 d.记录操作时间、起效时间、阻滞完善率、患者疼痛VAS评分与满意度评分及不良反应.结果 S组阻滞起效较快,完善率较高,操作时间延长(P<0.01);两组VAS评分及满意度评分差异无统计学意义.结论 刺激型导管用于股神经阻滞术后镇痛起效快,阻滞完善,但操作时间延长,镇痛效果无明显改善.     

亚太地区上肢周围神经损伤治疗进展

第五届亚太地区手外科学术大会,有关上肢周围神经外科交流论文95篇,主要涉及成人臂丛损伤、产瘫麻痹、上肢其它神经损伤及周围神经基础研究等方面。对于成人臂丛损伤,MR脊髓造影是诊断根性撕脱伤的有效手段,丛外或丛内神经移位术是主要治疗方法。改良Oberlin术式治疗上臂丛根性撕脱伤、健侧颈7神经移位与膈神经移位术、双重股薄肌移植(Doi术式)重建全臂丛根性撕脱伤手握持功能、产瘫麻痹晚期重建、肌肉内显微神经修复以恢复骨骼肌功能及免疫抑制剂FK506促神经再生研究等,推动了周围神经损伤治疗的临床与基础研究进展。     

Continuous lateral popliteal block with stimulating catheters

Foot surgery often induces severe postoperative pain. Sciatic nerve block is a good alternative for its treatment. We report two cases of continuous lateral popliteal sciatic nerve block using two different stimulating catheters. The lateral approach may offer some advantages. Stimulating catheters may be useful to verify correct catheter tip positioning. This technique seem to be easy to use and provided excellent pain relief.     

下肢手术支撑托的研制及临床应用

目的探讨自制下肢手术支撑托在下肢手术消毒铺巾中的应用效果。方法将80例行单侧下肢静脉曲张手术患者按手术顺序分为对照组和观察组各40例。对照组采用人力托举肢体方法进行消毒铺巾,观察组采用自制下肢手术支撑托托举肢体并进行消毒铺巾。结果两组均消毒合格,均未发生铺巾污染、皮肤受压;两组手术部位消毒时间比较,差异无统计意义(P>0.05);协助人员总耗时差异有统计学意义(P<0.01)。结论下肢手术支撑托用于下肢手术消毒铺巾效果好,可替代人力托举下肢,节省人力资源。     

下肢静脉造影在下肢静脉曲张患者中的应用及阻塞性下肢静脉曲张发生的预测因素

目的 探讨下肢静脉造影检查在下肢静脉曲张中应用的临床意义,并分析阻塞性下肢静脉曲张可能相关的预测因素.方法 选取2019年1月至2021年12月因下肢静脉曲张于海军军医大学第二附属医院诊治的74例患者(111条患肢)为研究对象,对所有患肢行下肢静脉造影检查,采用病例报告表形式记录患者相关信息,根据有无深静脉阻塞表现分为...     

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。     

Effect of mandibular nerve block on postoperative analgesia in patients undergoing oropharyngeal carcinoma surgery under general anaesthesia

BACKGROUND: Postoperative analgesia after oropharyngeal carcinoma surgery remains poorly studied. This study investigates the effects of mandibular nerve block (MNB) with ropivacaine 10 mg ml(-1) in conjunction with general anaesthesia (GA) on postoperative analgesia after partial glossectomy or transmandibular lateral pharyngectomy. METHODS: In a randomized double-blind study, 42 patients (21 in each group) received an MNB by the lateral extra-oral approach (MNB group) or a deep s.c. injection of normal saline (control group). Both groups received a standardized general anaesthetic. Postoperative analgesia included fixed dose of i.v. acetaminophen and morphine via a patient-controlled analgesia device. Consumption of morphine and supplemental analgesics and pain scores at rest were measured. RESULTS: The mean cumulative morphine consumption was reduced by 56 and 45% at 12 and 24 h after operation in the MNB group. The administration of analgesic rescue medications was delayed in the MNB group. The visual analogue scale (VAS) pain scores were comparable in the two groups during the first 24 h. Adequate analgesia (mean VAS < or = 3) was observed throughout the study period in the MNB group, but only from 4 h after operation onwards in the control group. The number of patients who experienced severe pain (VAS > 7) during the first postoperative day was lower in the MNB group than in the control group (3 vs 10. respectively, P < 0.05). CONCLUSIONS: In this study, MNB performed before GA for oropharyngeal carcinoma surgery improved postoperative analgesia, resulting in reduced morphine consumption at 24 h and severe pain in fewer patients.     

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目的探讨下肢浅静脉剥脱术后病人深静脉反流程度的变化。方法 2007年1月至2009年1月承德医学院附属医院血管外科收治下肢静脉曲张合并有节段性深静脉反流的病人46例,对其共48条下肢采用传统手术治疗,超声观察下肢深静脉反流程度,应用临床表现严重程度评分(VCSS)评估临床症状的改善情况。结果 42例病人随访2年,术后2年VCSS为1.95±1.78,低于术前(6.33±1.78),差异具有统计学意义(P<0.01)。2年后超声检查深静脉反流程度无改变肢体22条,改善14条,加重6条,手术前后深静脉反流程度差异无统计学意义。不同CEAP分级的反流程度的改善差异无统计学意义(P=0.359)。结论浅静脉剥脱术后能改善伴有深静脉反流病人的临床症状,对部分病人可改善深静脉反流程度,改善程度与CEAP分级不相关。     

高龄患者下肢静脉曲张日间手术的安全性及可行性探讨

目的 探讨高龄患者下肢静脉曲张日间手术的安全性及可行性.方法 收集2016年1月至2019年9月浙江大学医学院附属邵逸夫医院收治的186例行下肢静脉曲张射频消融日间手术高龄患者的临床资料,对所有患者均于术后3 d、1个月、3个月及1年进行随访,评估其手术成功率、手术时间、术中出血量及麻醉肿胀液使用量.统计并发症发生情况...     

内镜深筋膜下穿通静脉离断联合腔内激光治疗下肢静脉曲张

目的: 探讨内镜深筋膜下穿通静脉离断术（subfascial endoscopic perforator surgery, SEPS）联合腔内激光治疗（endovenous laser treatment,EVLT）术治疗下肢静脉曲张的可行性。方法: 2016年8月至2017年10月,静脉顺行造影诊断下肢穿通静脉瓣膜功能不全患肢81条,选择40条患肢行SEPS术,联合EVLT术闭合浅表曲张静脉,保留健康大隐静脉作为研究组;41条患肢作为对照组,行传统大隐静脉高位结扎抽剥术。结果: 研究组曲张静脉团块消失,下肢静脉血淤滞得到缓解,色素沉着减轻,溃疡愈合,随访5~11个月无复发。研究组手术时间少于对照组（1.1 h比3.0 h）,切口数也少于对照组（2.1个比5.8个）,住院时间缩短（1.1 d比3.9 d）,下肢淤斑面积减少（5.2 cm³比20.3 cm³）,差异均有显著统计学意义（P<0.01）。结论: SEPS联合EVLT术适合个体化微创治疗下肢静脉曲张,创伤小、恢复快。     

骨科全麻下肢手术患者术后超早期拔除尿管临床研究

目的探讨骨科全麻下肢手术患者术后超早期拔除尿管的效果。方法将281例骨科全麻下肢手术患者按病区分为干预组(134例)和对照组(147例)。干预组按指令完成眨眼后实行超早期拔除尿管方案,对照组按常规手术次日拔除尿管。结果干预组尿管留置时间、留置导尿相关膀胱不适、拔管后首次排尿不适显著短于/低于对照组(均P0.01);干预组恢复自主排尿时间较对照组长(P0.01),但两组拔管后复插率比较,差异无统计学意义(P0.05)。结论超早期拔除尿管能显著缩短骨科全麻下肢手术患者术后尿管留置时间,减轻患者留置导尿相关膀胱不适及拔管后首次排尿不适,不会增加拔管后复插率,拔管后自主排尿时间延长,但仍在正常范围内。     

Reliability of the mangled extremity severity score in combat-related upper and lower extremity injuries

Background:Decision of limb salvage or amputation is generally aided with several trauma scoring systems such as the mangled extremity severity score (MESS). However, the reliability of the injury scores in the settling of open fractures due to explosives and missiles is challenging. Mortality and morbidity of the extremity trauma due to firearms are generally associated with time delay in revascularization, injury mechanism, anatomy of the injured site, associated injuries, age and the environmental circumstance. The purpose of the retrospective study was to evaluate the extent of extremity injuries due to ballistic missiles and to detect the reliability of mangled extremity severity score (MESS) in both upper and lower extremities.Results:Amputation was performed in 39 extremities and limb salvage attempted in 100 extremities. The mean followup time was 14.6 months (range 6–32 months). In the amputated group, the mean MESS scores for upper and lower extremity were 8.8 (range 6–11) and 9.24 (range 6–11), respectively. In the limb salvage group, the mean MESS scores for upper and lower extremities were 5.29 (range 4–7) and 5.19 (range 3–8), respectively. Sensitivity of MESS in upper and lower extremities were calculated as 80% and 79.4% and positive predictive values detected as 55.55% and 83.3%, respectively. Specificity of MESS score for upper and lower extremities was 84% and 86.6%; negative predictive values were calculated as 95.45% and 90.2%, respectively.Conclusion:MESS is not predictive in combat related extremity injuries especially if between a score of 6–8. Limb ischemia and presence or absence of shock can be used in initial decision-making for amputation.     

干细胞移植治疗下肢缺血性疾病的临床进展

下肢缺血性疾病是一种严重危害健康的疾病.干细胞技术是21世纪最先进的技术之一,快速地应用于临床.其理论依据是干细胞为具有分化潜能的细胞,可以分化成各种机体组织细胞.自体干细胞移植正是利用这一原理,将外周血或骨髓中的干细胞移植到缺血的肢体肌肉或闭塞的血管中,使其分化、形成新生毛细血管,改善和恢复下肢血流,达到治疗下肢缺血的目的 .     

干细胞移植治疗下肢缺血性疾病的临床进展

下肢缺血性疾病是一种严重危害健康的疾病.干细胞技术是21世纪最先进的技术之一,快速地应用于临床.其理论依据是干细胞为具有分化潜能的细胞,可以分化成各种机体组织细胞.自体干细胞移植正是利用这一原理,将外周血或骨髓中的干细胞移植到缺血的肢体肌肉或闭塞的血管中,使其分化、形成新生毛细血管,改善和恢复下肢血流,达到治疗下肢缺血的目的 .     

干细胞移植治疗下肢缺血性疾病的临床进展

下肢缺血性疾病是一种严重危害健康的疾病.干细胞技术是21世纪最先进的技术之一,快速地应用于临床.其理论依据是干细胞为具有分化潜能的细胞,可以分化成各种机体组织细胞.自体干细胞移植正是利用这一原理,将外周血或骨髓中的干细胞移植到缺血的肢体肌肉或闭塞的血管中,使其分化、形成新生毛细血管,改善和恢复下肢血流,达到治疗下肢缺血的目的 .