肩胛上神经阻滞并用三复合神经阻滞法治疗肩关节周围炎的作用

目的研究和探讨肩胛上神经阻滞为主合用肩峰下关节阻滞、肩肱关节及触痛点阻滞、肱二头肌三角肌长肌腱肌束内浸润阻滞三复合神经阻滞法治疗肩关节周围炎(简称肩周炎)的疗效。方法①肩胛上神经阻滞按常规进行穿刺操作,注入10g/L利多卡因10mL。②三复合一是肩峰下关节阻滞,即肩峰下滑囊内穿刺注入“利泼合液”(5g/L利多卡因4mL+泼尼松62.5mg即2mL,共6mL)2mL;二是肩肱关节阻滞,即肱骨头与锁骨肩峰端交接处内下方3cm处刺针,注入同液2mL及肩胛骨内外侧缘触痛点局部阻滞;三是向肱二头肌、肱三角肌长肌腱肌束内用5g/L利多卡因行浸润阻滞。隔天1次,6次为1个疗程。结果治愈164例,占86.8%;好转17例,占9.0%;无效8例,占4.2%。结论肩胛上神经阻滞合用三复合神经阻滞是治疗肩周炎良好的基本方法。当遇到伴有放散痛或麻木时可并用星状神经节、颈部硬膜外阻滞以提高疗效。     

Sonographically guided ilioinguinal nerve block.

OBJECTIVE: The aim of this study was to describe a sonographically guided ilioinguinal nerve block in adults. METHODS: We developed a useful step-by-step technique of sonographically guided ilioinguinal nerve block based on visualization of abdominal muscles, fascial planes, and the branch of the deep circumflex iliac artery. RESULTS: We performed 9 sonographic examinations with subsequent blockade of the ilioinguinal nerve. All injections resulted in a clinically successful sensory block. CONCLUSIONS: This technique is reliable and reproducible. The block is achievable by a low-volume local anesthetic injection. Visualization of the intestines and blood vessels in the abdominal wall may help prevent an inadvertent injury.     

神经阻滞和偏振红外光治疗三叉神经痛的近期效果比较

目的通过对比观察单纯外周神经阻滞加偏振红外光照射患侧颈胸神经节治疗三叉神经痛近期效果,探讨不同方法治疗三叉神经痛的效果特征。方法38例三叉神经痛的患者,分为两组。A组(n=20)用20g/L利多卡因注射液5ml+维生素B120.5mg+生理盐水至10ml单纯外周神经阻滞治疗,间隔一两天重复1次,5次为1个疗程。B组(n=18)在上述阻滞后加偏振红外光照射患侧颈胸神经节,偏振红外光治疗功率60%～80%设置模式23,治疗时间10min。用视觉模拟评分法(VAS)于每次治疗前及治疗后10～15min对疼痛的程度进行评估。结果A组患者治疗前VAS为7.6±2.2,B组患者治疗前VAS为7.6±1.1,组间无明显差别(t=0.01,P>0.05)。每次阻滞前后疼痛明显减轻(t=15.48～43.71,P<0.001)。随着治疗次数的增加,疼痛逐渐减轻或消失。经过5次治疗后,A组VAS评分降为2.6±2.4,疼痛缓解率平均达到64%。B组VAS评分降为3.5±1.8,疼痛缓解率平均达到51%。每次治疗前后VAS的变化两组间比较无显著性差异。结论外周神经阻滞治疗三叉神经痛有效。三叉神经阻滞配伍同侧颈胸神经节偏振红外光照射没有显示出优越的近期镇痛效果。     

Dorsal penile nerve block for newborn circumcision

Dorsal penile nerve block with lidocaine is safe and effective for reducing the pain associated with newborn circumcision. Administering the anesthesia adds little time or expense to the overall routine. Complications are minor, limited to local bleeding and hematoma formation. Family physicians performing circumcision should be prepared to use penile nerve block and to advocate it to parents who choose newborn circumcision.     

Fatal outcome of a cervical nerve block

A patient with brachialgia was admitted to a surgical clinic and a cervical nerve block was performed under fluoroscopic guidance. Acute severe cervical pain prevented completion of the procedure. On the following day the patient developed incomplete paralysis of both legs and arms and was transferred to a neurosurgical department for further diagnosis and therapy. The CT scan showed a space-occupying cervical intraspinal haematoma, which was removed immediately as far as possible by a dorsal approach. Postoperatively little improvement of neurologic function was noticed, and 11 days after the event the patient died from a massive pulmonary embolism despite intense resuscitation efforts.     

Thermal sensibility changes during ischemie nerve block

Changes in perception of pure thermal stimuli delivered to the hand at threshold intensity were observed during ischemic nerve block in 27 healthy subjects in order to study the significance of unmyelinated cutaneous cold receptors for thermal sensibility.Paresthesias and an increasing feeling of numbness were followed by a sudden change in cold sensation which developed a clearly dysesthetic quality. When complete motor block was reached and no myelinated axon functions were left, cold stimuli were still clearly but abnormally perceived. Warm sensation was little affected during the whole course of nerve block.The results indicate that the information from unmyelinated low threshold cold receptors alone leads to a dysesthetic cold sensation which normally is suppressed by the activity of myelinated cold afferents. Obviously these receptors are not needed for the discrimination of minor cold stimuli but they seem to be essential for the perception of the first burning cold pain.     

Thermal sensibility changes during ischemic nerve block

Changes in perception of pure thermal stimuli delivered to the hand at threshold intensity were observed during ischemic nerve block in 27 healthy subjects in order to study the significance of unmyelinated cutaneous cold receptors for thermal sensibility.

Paresthesias and an increasing feeling of numbness were followed by a sudden change in cold sensation which developed a clearly dysesthetic quality. When complete motor block was reached and no myelinated axon functions were left, cold stimuli were still clearly but abnormally perceived. Warm sensation was little affected during the whole course of nerve block.

The results indicate that the information from unmyelinated low threshold cold receptors alone leads to a dysesthetic cold sensation which normally is suppressed by the activity of myelinated cold afferents. Obviously these receptors are not needed for the discrimination of minor cold stimuli but they seem to be essential for the perception of the first burning cold pain.     

Nurse-administered femoral nerve block after hip fracture

Hip fracture is a common injury that predominantly affects older people. Pain following fracture of the neck of the femur is present throughout the illness trajectory, including the preoperative and postoperative periods. This article describes how nurses at one trust implemented an innovative nurse-administered femoral nerve block service.     

Facet, nerve root, and epidural block.

Percutaneous spinal blocks are diagnostic or therapeutic procedures designed to help the neurologist or orthopaedist in their evaluation of confounding low back and/or lower extremity pain. During the initial workup, nonspinal percutaneous blocks, such as hip or sacroiliac joint injection, may be necessary to exclude one of these sites as the origin of the patient's symptoms. Generally, these blocks are safe, quick and easily performed under fluoroscopic guidance. Once the appropriate needle position has been obtained and the short-and/or long-acting anaesthetics instilled into the appropriate site, the patient's response to the block should be documented and transmitted to their referring physician. In the case that the block is successful, the block may be repeated at intervals for pain control, particularly in patients who chose not to have surgery or who are poor surgical candidates. Ultimately, however, as the patient's arthritis and/or disc degeneration progresses, the blocks will become less and less effective and a more permanent solution will be required. This chapter explains the indications, injection options, and methods of performing these various spinal blocks.     

星状神经节和局部神经阻滞治疗顽固性头痛疗效观察

目的探讨顽固性头痛治疗的新方法。方法总结2004年12月至2009年12月采用同时注射药物阻滞痛侧星状神经节和痛区局部神经治疗447例顽固性头痛的临床疗效。结果经1~3次治疗头痛消失且1年内无复发者161例（36.02%）;经4~5次治疗头痛消失且1年内无复发者183例（40.94%）;经6~7次治疗头痛消失且1年内无复发者98例（21.92%）;经7次治疗头痛次数明显减少或头痛程度明显减轻者5例（1.12%）。结论同时阻滞患侧星状神经节和痛区局部神经是顽固性头痛的一种有效治疗方法 。     

神经刺激器定位下腰丛-坐骨神经阻滞应用于老年患者膝关节部位手术的效果评价

目的比较神经刺激器(PNS)定位下腰丛-坐骨神经阻滞和硬膜外麻醉用于老年患者单侧膝关节部位手术的麻醉效果及对血液动力学的影响。方法选择40例行单侧膝关节部位手术的老年患者,ASAⅡ～Ⅲ级,分为A组(腰丛-坐骨神经联合阻滞组)、B组(硬膜外麻醉组)各20例,观察并纪录两组麻醉前及麻醉后5、10、20、30、60分钟的平均动脉压(MAP)和心率(HR),感觉运动神经阻滞的起效、完善及维持时间,以及局麻药和辅助药物用量、术中输液量、术中及术后不良反应等指标。结果术中所有患者都获得满意的麻醉效果,A组患者的感觉及运动神经阻滞起效时间均快于B组(P0.05),维持时间也长于B组(P0.05),整个麻醉过程中的MAP、HR均无显著性变化(P0.05);B组患者注药后5分钟的MAP与麻醉前比较无显著性变化(P0.05),而20、30、60分钟的MAP较麻醉前及注药后5分钟均显著降低(P0.05),整个麻醉过程中HR均无显著性变化(P0.05),B组术中输液量、术后尿潴留发生率及血管活性药使用率均显著高于A组(P0.05)。结论与硬膜外麻醉相比较,PNS定位下行单侧腰丛联合坐骨神经阻滞安全有效,对血液动力学影响小,术后不良反应少,镇痛时间长,有利于术后早期恢复,更适用于老年患者的单侧膝关节部位手术。