臂丛神经阻滞复合氯胺酮麻醉在小儿上肢手术中的应用

目的对比分析臂丛神经阻滞复合氯胺酮麻醉与氯胺酮复合咪唑安定麻醉分别用于小儿上肢手术的麻醉效果。方法选年龄1~10岁的上肢手术患儿80例,随机分成臂丛神经阻滞复合氯胺酮组(A组)和氯胺酮复合咪唑安定组(B组),每组40例;记录注射氯胺酮入睡后;手术开始后1、5、101、5 min时HR、SpO2、MAP的变化;观察记录麻醉期间氯胺酮的用量及术毕苏醒时间(指手术结束时至病人睁眼时)。结果A组与B组相比,其氯胺酮总用量明显减少,苏醒时间显著缩短(P<0.01)。A组手术前后呼吸循环无明显变化,B组术中较注药后HR明显增快,MAP显著增高(P<0.05)。结论臂丛神经阻滞复合氯胺酮麻醉用于小儿上肢手术麻醉效果完善,安全性高,值得临床推广应用。     

207例上肢手术臂丛神经阻滞效果观察

我院1982年1月至1987年4月上肢手术臂丛神经阻滞207例。现报道如下。一般资料 207例中,男128例,女79例,年龄6～68岁。术前药:阿托品0.3～0.5mg、苯巴比妥钠0.08～0.1,麻醉前1h肌注。局麻药系利地(1～1.33％利多卡因。0.2％     

臂丛神经阻滞麻醉导致臂丛神经损伤

臂丛神经阻滞麻醉是上肢手术最常用的麻醉方法。笔者自 2 0 0 1年 5月以来 ,遇 3例臂丛神经阻滞麻醉引起臂丛神经损伤病例。报告如下。1　病例报告例 1,女 ,40岁。 2 0 0 1年 5月左前臂双骨折 ,于腋路臂丛神经阻滞麻醉上行内固定术。麻醉者于左侧 ,以 1.3 %利多卡因2 5ml于腋动脉搏动明显处 ,在腋动脉上方穿刺注入 ,当即出现异感 ,手术历时 1h3 0min ,麻醉效果满意。麻醉药物消失后 ,患者诉左手桡、掌侧麻木 ,感觉过敏 ,查屈拇长肌、屈指肌失用。 3个月复查 ,尺侧屈指肌肌力恢复 ,食、中、拇屈指肌M2 ,正中神经感觉区S2 ,腋窝Tinel征 ( ) …     

静脉留置针用于连续臂丛神经阻滞的临床观察

近年来,我院对32例上肢手术患者采用静脉留置针经斜角肌间沟注射局麻药物作连续臂丛神经阻滞麻醉,效果满意,现报道如下。资料与方法一般资料男21例,女11例,年龄15~80岁,ASAⅠ~Ⅱ级。行断指再植术8例,断腕再植术2例,上肢严重挤压伤清创术12例,肱骨骨折内固定术9例,肩关节置换术1     

臂丛神经阻滞对小儿静脉复合麻醉苏醒的影响

由于小儿的生理及心理发育特点,其耐受能力较差,对手术有恐惧心理,不能配合手术。并且小儿呼吸系统发育不完善,使得小儿的麻醉管理比较复杂。单纯采用全身麻醉,用药量大,将对小儿的机体产生副作用。单纯采用臂丛神经阻滞麻醉,小儿无法配合手术。为使小儿能安全舒适地度过手术过程,并尽可能地减少药物的不良反应,将臂丛神经阻滞和全麻结合起来,用于小儿上肢手术是安全可行的。     

连续臂丛神经阻滞在上肢手术中的应用

臂丛神经阻滞是上肢手术常用的麻醉方法，应用动静脉留置针行连续臂丛神经阻滞有许多优点，现报道如下。     

64例小儿臂丛神经阻滞麻醉的分析

近年来 ,我们应用臂丛神经阻滞方法为 64例小儿上肢手术施行麻醉 ,取得了满意的效果。现将临床经验总结如下 ,以供同道们参考。一、资料与方法1.一般资料 :本组共 64例 ,男 47例 ,女 17例 ;年龄最大 12岁 ,最小 1.5岁。伤因 :大部为上肢烧伤、烫伤或电击伤后的瘢痕挛缩 ,小部分为手外伤、爆炸伤等急诊患者及血管瘤病例。手术时间最长 4ｈ 2 5ｍｉｎ ,最短 3 0ｍｉｎ。2 .术前用药 :术前 1ｈ ,根据患儿体重 ,常规给鲁米钠(2ｍｇ/ｋｇ)或复方冬眠灵 (1ｍｇ/ｋｇ) ,及阿托品 (0 .0 1～ 0 .0 2ｍｇ/ｋｇ)肌肉注射。对于不合作的小儿 ,须给予完善…     

垂直锁骨下臂丛神经阻滞麻醉41例报告

<正> 臂从神经阻滞麻醉是上肢手术最简便有效的麻醉方法之一,其阻滞方法及入路较多,且各有利弊。为加强阻滞效果,提高麻醉成功率,减少并发症,笔者近两年来根据臂丛神经干解剖走行及臂丛鞘原理行垂直锁骨下臂丛神经阻滞41例取得满意效果,现报告如下。 1 资料与方法 1.1 一般资料:本组共41例,男24例,女17例,年龄15～75岁。均为肩关节以下手术患者,手术时间为10min至4h20min。术前用药:鲁米那钠针0.1～0.15g肌肉注射。0.75％布比卡因10ml、2％利多卡因15ml、生理盐水5ml配成30ml局麻药备用。     

局部神经阻滞麻醉在足部手术的临床应用

足部疾病是骨科常见疾病之一 ,以往足部手术多在椎管内麻醉下完成 ,近年来 ,随着手术方法的不断改进 ,即使是骨性手术亦要求尽早下地活动 ,以减少对患者生活工作的影响和并发症的产生。自 1999年 12月至 2 0 0 0年 5月 ,我科对 5 2例足部手术患者采用局部神经阻滞麻醉 ,本研究观察其临床疗效 ,并对优缺点进行分析 ,进一步评价其临床应用价值。1　临床资料5 2例足部疾病患者 ,男性 11例 ,女性 41例 ,年龄 30～ 6 7岁 (平均 5 8岁 ) ,外翻截骨矫形 35例 ,糖尿病足前足、中足截肢 7例 ,跖骨骨折内固定 3例 ,跖间神经瘤 3例 ,跖骨肿瘤 2例 ,跖…     

The Efficacy and Safety of Regional Nerve Blocks in Total Hip Arthroplasty: Systematic Review and Direct Meta-Analysis

BackgroundRegional nerve blocks may be used as a component of a multimodal analgesic protocol to manage postoperative pain after primary total hip arthroplasty (THA). The purpose of our study was to evaluate the efficacy and safety of regional nerve blocks after THA in support of the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and American Society of Regional Anesthesia and Pain Management.MethodsWe searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials for studies published prior to March 24, 2020 on fascia iliaca, lumbar plexus, and quadratus lumborum blocks in primary THA. All included studies underwent qualitative and quantitative homogeneity testing followed by a systematic review and direct comparison meta-analysis to assess the efficacy and safety of the regional nerve blocks.ResultsAn initial critical appraisal of 3,382 publications yielded 11 publications representing the best available evidence for an analysis. Fascia iliaca, lumbar plexus, and quadratus lumborum blocks demonstrate the ability to reduce postoperative pain and opioid consumption. Among the available comparisons, no difference was noted between a regional nerve block or local periarticular anesthetic infiltration regarding postoperative pain and opioid consumption.ConclusionLocal periarticular anesthetic infiltration should be considered prior to a regional nerve block due to concerns over the safety and cost of regional nerve blocks. If a regional nerve block is used in primary THA, a fascia iliaca block is preferred over other blocks due to the differences in technical demands and risks associated with the alternative regional nerve blocks.     

Regional anaesthesia for surgery of the forearm and hand

Eighty patients who presented for surgery of the forearm or hand were allocated randomly to one of two groups. In Group A, surgery was performed under supraclavicular brachial plexus block only; a mixture of equal parts of prilocaine 1% and bupivacaine 0.5% without adrenaline was used. In Group B, supraclavicular brachial plexus block was performed using prilocaine 1% alone, but in addition discrete nerve blocks were performed at elbow level using 0.5% bupivacaine without adrenaline. Patients in Group B had a significantly shorter duration of unwanted postoperative motor blockade and a significantly longer duration of postoperative analgesia (p less than 0.005).