Ultrasound Visibility of Spinal Structures and Local Anesthetic Spread in Children Undergoing Caudal Block

This study assessed ultrasound visibility of spinal structures in children and observed the extent of local anesthetic spread within the epidural space during caudal block. Spinal structures were evaluated with ultrasound from the sacral area to the thoracic area in 80 children, and drug spread levels were observed after caudal injection of 0.5, 1.0, 1.25 and 1.5 mL/kg local anesthetic. The conus medullaris, dural sac and dura mater were easily identified with ultrasound in most children. However, ligamentum flavum visibility declined with increasing vertebral level and markedly decreased at the thoracic level in children older than 7 mo or heavier than 8.5 kg. Drug spread was higher with increasing volume (p < 0.001) and in children ≤12 mo more than children >12 mo (p < 0.001); drug spread was significantly correlated with age (R² = 0.534). Spread levels assessed with ultrasound were roughly two to three segments lower than those in previous radiologic studies.     

经腹腔腹膜前腹腔镜腹股沟疝修补术与完全腹膜外手术入路疗效的Meta分析

目的探讨经腹腔腹膜前腹腔镜腹股沟疝修补术与完全腹膜外手术入路疗效的meta分析。方法利用在线数据检索法,对数据进行严格的分析与研究,同时收集我院2013年4月至2014年10月接受腹腔镜腹股沟疝修补术经腹腔腹膜前手术(TAPP)和完全腹膜外手术(TEP)患者300例的临床资料,对患者进行随机试验分析和质量评估,并对其进行系统的评价,分析两种手术方式的治疗效果。结果纳入分析的300例患者,TAPP组150例,TEP组150例;两组手术时间、CI、术后住院时间、术后复发率、并发症发生率方面没有显著的差异(P>0.05);但是TEP组术后24h疼痛明显轻于TAPP组,差异具有统计学意义(P<0.05)。结论两种手术入路方式疝修补术均安全、有效,二者在手术时间、住院时间、复发率、并发症率等发面没有明显的差异,在疼痛方面TEP组更有优势,其他方面的区别有待进一步研究。     

疝环充填式无张力疝修补术相关技术探讨

目的:探讨疝环充填式无张力疝修补术的相关技术.方法:采用疝环充填式补片对125例腹股沟疝患者施行无张力疝修补术135例次.现察手术时间、手术并发症、术后复发率.结果:手术经过均顺利,平均手术时间为38.5 min.术后并发症发生率5.2%,其中切口积液(浆液肿)2例、伤口感染1例、伤口下硬结1例、阴囊水肿1例、伤口部位疼痛不适或异物感2例;随访28-43个月,复发2例(1.5%).结论:提高疝环充填式无张力疝修补术技术可简便操作,减少并发症,降低复发率.     

两种手术方法治疗小儿腹股沟斜疝的疗效比较

目的 比较腹腔镜手术与传统手术治疗小儿腹股沟斜疝的疗效.方法 将257例小儿腹股沟斜疝患儿按住院号随机分为2组:腹腔镜手术组(n=162例)采用腹腔镜手术治疗,传统手术组(n=95例)采用传统手术方法治疗,对2组之间的手术时间、下地活动时间、住院时间、住院费用和术后并发症及复发率进行比较.结果 腹腔镜手术组除住院费用略高于传统手术组外,在手术时间、下地活动时间、住院时间及并发症方面均明显低于传统手术组,2组比较差异均有统计学意义(P<0.05或P<0.01).结论 腹腔镜手术治疗小儿腹股沟斜疝具有创伤小、疼痛轻、恢复快、术后并发症低等优点.     

超声引导下与神经刺激器联合超声引导下腋路臂丛神经阻滞在下肘部位手术患者麻醉中应用比较

[目的]比较神经刺激器联合超声引导及单纯超声引导行腋路臂丛神经阻滞在下肘部位手术患者麻醉中的应用效果.[方法]60例下肘部手术患者,随机分为观察组和对照组,各30例.对照组给予超声引导下腋路臂丛神经阻滞方案,观察组则予以神经刺激器联合超声引导下腋路臂丛神经阻滞方案.比较两组受试者操作时间、相关神经阻滞的起效时间、神经阻滞持续时间及0.5 h内阻滞成功率、一次性穿刺成功率差异及相关并发症发生情况.[结果]观察组0.5 h内臂丛神经阻滞总成功率显著高于对照组(100.0%vs 86.7%),相关并发症发生率则显著低于对照组(6.7%vs 26.7%),且差异均有显著性(P均<0.05).观察组平均操作时间及桡神经、尺神经、正中神经、肌皮神经等阻滞起效时间均显著低于对照组,神经阻滞持续时间则明显长于对照组(P均<0.05);两组一次性穿刺成功率比较差异无显著性(P>0.05).[结论]对下肘部位手术患者予以神经刺激器联合超声引导下腋路臂丛神经阻滞方案,利于提高其定位准确性及臂丛神经阻滞成功率,对降低其手术相关并发症发生风险、延长其神经阻滞持续时间等具有积极影响.     

PHS补片和UHS补片用于腹沟股疝修补术的近期疗效和卫生经济学价值比较

目的 回顾性分析腹股沟疝修补术中应用PHS和UHS补片的近期效果和卫生经济学价值.方法 纳入2007年9月至2012年9月在兰州大学第一医院住院治疗的可复性腹股沟疝成人患者105例,疝的类型包括单侧和双侧的直疝和斜疝.按术中植入材料的不同将患者分为PHS补片组(n=53)和UHS补片组(n=52).比较两组患者术后血清肿、阴囊水肿、术后住院天数、住院费用等项指标.结果 两组患者在年龄、性别、疝的类型以及术后发生的血清肿、阴囊水肿及住院天数方面的差异均无统计学意义.但在住院费用方面,PSH组材料费和住院总费用均明显低于UHS组,且差异具有统计学意义.结论 在腹股沟疝修补术中,使用PHS补片在减少短期并发症方面与UHS补片相当,且因其费用较UHS低,能明显减轻患者的经济负担.     

Analgesic Effect of Botulinum Toxin A in Myofascial Pain Syndrome Patients Previously Treated with Local Infiltration of Anesthetic and Steroids

The purpose of this study was to evaluate the analgesic effect of botulinum toxin A (BoNTA) injections in patients with myofascial pain syndrome (MPS) who were previously treated with the local infiltration of anesthetic and steroids (LIAS). The study included a retrospective phase and a longitudinal open-label prospective phase, which were conducted on consecutive patients with MPS previously treated with the local infiltration of anesthetic (levobupivacaíne 0.25%) and steroids (triamcinolone 40 mg). Eligible patients were treated with a single intramuscular injection of BoNTA (Botox; Allergan, Inc., Irvine, CA). The treatment efficacy was determined according to the degree of pain relief obtained. Eighty-two patients met the inclusion/exclusion criteria and were included in the study. Successful results were obtained for 32 (39.0%) and 30 (36.6%) patients, during treatment with BoNTA and LIAS, respectively. The mean (standard deviation) length of the analgesic effect was significantly longer with BoNTA (29.6 [SD = 17.7] weeks) than with LIAS (8.5 [SD = 6.4] weeks), P <.0001. As regards the side effects, 19 (23.2%) patients reported transient soreness at the injection site for 2 to 3 days with BoNTA. The MPS patients previously treated with a local infiltration of anesthetic and steroids who then received a single injection of BoNTA experienced significantly reduced pain for a relatively long time.     

Comparative Effectiveness of Two Ultrasound‐Guided Regional Block Techniques for Surgical Anesthesia in Open Unilateral Inguinal Hernia Repair

Transversus abdominis plane (TAP) and ilioinguinal/iliohypogastric (II/IH) nerve blocks have been described as analgesic adjuncts for inguinal hernia repair, but the efficacy of these techniques in providing intraoperative anesthesia, either individually or together, is not known. We designed this retrospective cohort study to test the hypothesis that combining TAP and II/IH nerve blocks (“double TAP” technique) results in greater accordance between the preoperative anesthetic plan and actual anesthetic technique provided when compared to TAP alone. Based on this study, double TAP may be preferred for patients undergoing open inguinal hernia repair who wish to avoid general anesthesia.     

不同浓度罗哌卡因配伍连续股神经阻滞用于全膝关节置换术后镇痛的效果

目的：观察不同浓度罗哌卡因配伍连续股神经阻滞用于全膝关节置换术后镇痛的效果。方法：选择美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级行单侧全膝关节置换患者60例,随机分为2组：高浓度组（0.25%罗哌卡因）和低浓度组（0.125%罗哌卡因）,每组30例。所有患者均实施气管插管全身麻醉,术后采用连续股神经阻滞进行镇痛。记录患者在静息、主动和持续被动功能训练时的视觉模拟评分（VAS）疼痛评分,同时记录开始下床活动时间,肌力分级和并发症发生率。结果：高浓度组患者在术后6h、24h、48h及72h的静息、主动和持续被动功能训练时的VAS疼痛评分均显著低于低浓度组患者（P〈0.05）;2组患者下床活动时间无显著差异[（25±2）h比（27±4）h,P〉0.05];2组患者的术后24～72h肌力评分平均大于3级;2组术中和术后均未出现并发症。结论：相对于0.125%的罗哌卡因,采用浓度0.25%的罗哌卡因配伍连续股神经阻滞可提供满意的术后镇痛。     

超声对腹壁切口疝修补术前后的应用价值

目的探讨超声对切口疝修补手术前后检查的应用价值。方法应用超声对38例切口疝修补手术前后患者进行检查。结果38例术前全部显示切口疝疝环的大小及位置,疝囊大小、位置及内容物。术后全部显示补片的位置、形态和大小,其中30例未见明显异常。7例提示补片外血肿,1例为补片外混合性高回声团。结论超声能够为医生提供切口疝较具体的数据情况,为医生选择补片种类及大小提供依据。术后能清晰的显示补片的位置、形态及相邻关系,有无并发症。     

The Feasibility of the Ultrasound-Guided Femoral Nerve Block Procedure with Low-Dose Local Anesthetic in Intracapsular and Extracapsular Hip Fractures

BackgroundThe local anesthetic dosages used in the current literature in regional applications of local anesthetics are frequently high for surgical purposes, and there are no sufficient dosage studies for emergency department (ED) management.ObjectivesThe aim of this study was to determine the success of lower local anesthetic dosages capable of reducing costs and excessive exposure to drugs in pain control in patients with femoral neck fractures (FNFs) in the ED.MethodsPatients ≥65 years of age with FNFs and reporting Wong-Baker Pain Rating Scales scores ≥8 were included in this prospective, interventional study. Patients underwent ultrasound-guided regional femoral block with 5 mL 2% prilocaine. Pain scores before the procedure and at 30 min and 2 h postprocedure were compared with the Friedman test and Wilcoxon test with Bonferroni correction.ResultsForty patients, 20 with intracapsular and 20 with extracapsular FNFs, were enrolled. The initial pain scores of patients with both intra- and extracapsular fractures were 8 (range 8–10). A statistically significant 50% decrease in pain scores was observed in both groups 30 min after the regional block procedure (p < 0.001). A statistically significant 75% decrease in pain scores was observed in both groups 2 h after the regional block procedure (p < 0.001). No statistically significant difference was determined in the change in 30-min and 2-h pain scores between the groups.ConclusionsThe administration of 5 mL 2% prilocaine for pain control in FNFs in elderly patients in the ED can reduce systemic analgesic requirements by establishing effective analgesia in both intracapsular and extracapsular fractures.     

超声引导下肩胛上神经阻滞在麻醉规范化培训住院医生疼痛科教学实践中的应用

目的：本研究旨评价超声引导技术 在麻醉规范化培训住院医生肩胛上神经阻滞临床教学中的可行性和有效性。方法：选取麻醉学住院医生规范化培训学生24名,随机分成试验组(超声引导)和对照组(解剖定位)。每组12名,每位医生进行12次操作。2组医生分别进行2小时的操作前培训,将理论教学、多媒体教学、模拟教学和临床教学相结合。观察两组肩胛上神经阻滞的效果,利用视觉模拟评分法(VAS)评定术前、术后患者的疼痛程度,以及患者满意度。结果：关于治疗后VAS评分,试验组在对照组的进行比较差异明显(P＜0.01)。试验组学生对肩胛下神经解剖内容掌握程度,以及临床操作满意程度相比对照组较高,差异显著(P<0.01),疼痛科实践教学满意度高。结论：应用超声影像学引导进行外周肩胛上神经阻滞在慢性疼痛临床教学中教学效果良好,具有明显优势。     

小切口微创手术与传统手术治疗小儿腹股沟疝临床效果比较研究

目的对比研究小切口微创手术与传统手术治疗小儿腹股沟疝的临床疗效。方法选取2009年3月~2016年3月我院收治的194例腹股沟疝患儿。根据治疗方法不同分为微创组和传统组各97例。微创组采用小切口微创手术治疗,传统组采用传统手术治疗。比较两组的治疗效果。结果微创组手术时间、术中出血量、切口长度、自主活动时间及住院天数均显著低于传统组(P0.05);微创组术后并发症总发生率明显低于传统组(P0.05);两组疝复发率比较无明显差异(P0.05)。结论与传统手术相比,小切口微创手术治疗小儿疝气具有操作简单、创伤小、术后恢复快、并发症少等优势,值得推荐。     

The Efficacy of Levobupivacaine, Ropivacaine, and Bupivacaine for Combined Psoas Compartment–Sciatic Nerve Block in Patients Undergoing Total Hip Arthroplasty

Background and Objectives:   The aim of our study was to compare postoperative analgesic efficacy, and the extent of sensory and motor blockade of levobupivacaine, ropivacaine, and bupivacaine administered in a combined psoas compartment–sciatic nerve block (PCSNB) for total hip arthroplasty.
Methods:   Forty-five patients undergoing total hip arthroplasty under general anesthesia combined with PCSNB, were randomly assigned to receive either 50 mL levobupivacaine 3 mg/mL, 50 mL ropivacaine 4.5 mg/mL or 50 mL bupivacaine 3 mg/mL with epinephrine. Postoperative, the pain intensity at rest, the degree of motor block (Modified Bromage Scale) and the extent of sensory block (pin prick test) were recorded at 4, 8, 12, 24, and 48 hours following initial injection in a double blind fashion.
Results:   The postoperative pain intensity was low and did not differ between groups, except for a significantly lower pain intensity in group ropivacaine compared with group levobupivacaine at 4 hours. Five patients (11%), equally divided over three groups, needed parenteral rescue opiates postoperatively. The extent of sensory block was not different between the three groups. In each group the majority of patients showed no sensory block in dermatome L1. Group levobupivacaine initially showed the least motor impairment. Motor impairment was found to be significantly higher in bupivacaine group compared with both ropivacaine and levobupivacaine groups at 12 ( P  = 0.012) and 48 hours ( P  = 0.003).
Conclusions:   Levobupivacaine, bupivacaine and ropivacaine are equally effective for PCSNB in patients undergoing total hip arthroplasty. Residual pain may be due to the lack of sensory block in dermatome L1, suggesting that modification of this technique should be considered for this type of surgery. ▪     

瑞芬太尼与七氟醚在小儿腹腔镜疝囊高扎术中的麻醉效果比较

【目的】比较小儿腹腔镜疝囊高扎术中瑞芬太尼与七氟醚的麻醉效果。【方法】行择期腹腔镜疝囊高扎术患儿80例,AsAI级,年龄1～6岁,体重9～22k,随机分为瑞芬太尼幼儿（1～3岁）组（R1组）和瑞芬太尼学龄前儿童（3～6岁）组（R2组）、七氟醚幼儿（1～3岁）组（S1组）和七氟醚学龄前儿童（3～6岁）组（s2组）,每组20例。麻醉诱导：R1、R2组微量注射泵泵入瑞芬太尼1μg／（kg·min）;S1、S2组高流量吸入8％七氟醚,四组诱导后均置入喉罩。麻醉维持：R1、R2组瑞芬太尼0．1～1／μg／（kg·min）;s1、s2组持续吸入2％～6％七氟醚,术中患儿保留自主呼吸。四组均于手术结束前5min停药。记录患儿不同时间点的平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2）、呼吸频率（RR）、肺潮气量（VT）等指标,观察患儿诱导期不良反应、术中肢体活动的情况、苏醒期躁动情况及其他不良反应。【结果】四组惠几术中麻醉平稳,无肢体活动,MAP、HR变化无统计学差异（P〉0．05）,R1组有4例、R2组有3例在麻醉诱导时出现呼吸抑制,予辅助呼吸后恢复。S1、S2组诱导时间较R1、R2组缩短,苏醒时间较R1、R2组长,R1组麻醉维持时SpO2、RR、VT较S1组降低,R2组麻醉维持时sp02、RR较S2组降低。S1、S2组拔喉罩时喉痉挛各1例,苏醒期躁动R1、R2组发生率较S1、S2组高,术后恶心呕吐等其他不良反应的发生率无明显差异。【结论】瑞芬太尼与七氟醚在小儿腹腔镜疝囊高扎术中的麻醉效果均较好,两种麻醉方法各有其相对优势。     

腹腔镜经腹腹膜前和全腹膜外腹腔镜疝修补术的临床应用对比研究

目的：比较腹腔镜经腹腹膜前疝修补术（TAPP）与完全腹膜外腹腔镜疝修补术（TEP）治疗成人腹股沟疝的效果。方法回顾分析2007年10月～2013年02月收治的214例（235侧）腹股沟疝患者的临床资料,根据手术方式分为TAPP组58例和TEP组156例,将2组的临床资料进行比较分析。结果TEP组手术时间较短（P＜0.01）、住院费用较低（P＜0.01）。术后下床活动时间、住院时间、术后不适感方面,TAPP组与TEP组差异无统计学意义;TAPP组术中发现隐匿疝4例;术后并发症、复发率,TAPP组和TEP差异无统计学意义。结论TAPP与TEP各具优点,TAPP较TEP更利于发现隐匿疝。但是TEP较TAPP手术时间更短,住院费用更低。