腰方肌阻滞与肋缘下腹横肌平面阻滞在腹腔镜胃癌根治术后镇痛效果的比较

目的:比较超声引导下腰方肌阻滞（quadratus lumborum block, QLB）与肋缘下腹横肌平面阻滞（transverse abdominal plane block, TAPB）用于腹腔镜胃癌根治术的术后镇痛效果。方法:选择2021年1月至2021年7月择期在全身麻醉下行腹腔镜胃癌根治术的患者60例,采...     

超声引导竖脊肌平面阻滞与椎旁神经阻滞治疗老年带状疱疹性神经痛：随机对照非劣效性研究

目的:观察对比超声引导竖脊肌平面阻滞（erector spinae plane block, ESPB）与超声引导椎旁神经阻滞（paravertebral nerve block, PVB）治疗老年带状疱疹性神经痛的疗效。方法:90例老年带状疱疹患者,按随机数字表法分为竖脊肌平面阻滞组（E组）和椎旁神经阻滞组（P组）,...     

全麻复合硬膜外阻滞用于高龄患者腹腔镜直肠癌手术的观察

为评价全麻复合硬膜外阻滞在高龄患者腹腔镜直肠癌根治术中对循环功能及用药量的影响,选择70岁以上择期行腹腔镜直肠癌根治术患者40例,ASAⅠ、Ⅱ级,随机分为全麻组（G组）20例;全麻复合硬膜外阻滞组（GA组）20例。两组全麻诱导方法：咪哒唑仑0．04mg／kg,芬太尼3μg／kg,依托咪酯0．2～0．3mg／kg,顺阿曲库胺0．15～0．20mg／kg。GA组于诱导前取L1-2硬膜外腔穿刺置管,注入0．5％罗哌卡因5ml。术中每2h追加5～7ml。诱导前以PhilipsMP40监测仪监测平均动脉压（MAP）,心率（HR）,心电图（ECG）等生命体征,同时记录全麻用药量及术中知晓、术后躁动情况。结果显示,GA组气腹后,气管插管拔除前MAP、HR明显低于G组（P〈0．05）;GA组七氟烷用药浓度,顺阿曲库胺用药量低于G组（P〈0．05）。结果表明,高龄患者在腹腔镜直肠癌根治术中应用全麻复合硬膜外阻滞,可使患者术中循环稳定,全麻用药量减少,是一种安全可行的麻醉方法。     

超声引导下多点肋缘下腹横肌平面阻滞在开腹胃癌根治术中的应用

目的观察双侧多点肋缘下腹横肌平面阻滞(transversus abdominis plane block,TAP)对开腹胃癌根治术患者术后镇痛效果的影响。方法择期全麻下行开腹胃癌根治术患者60例,男35例,女25例,年龄50~70岁,ASAⅠ或Ⅱ级,随机分为两组,每组30例。全麻诱导成功后,超声引导下行双侧肋缘下多点腹横肌平面阻滞,两组患者分别注入0.5%罗派卡因40ml(研究组)或等量生理盐水(对照组)。手术结束患者清醒拔管后被推入PACU,患者离开PACU之前连接静脉自控镇痛泵。记录拔管后2、6、12、24和48h的疼痛VAS评分,记录术中舒芬太尼、瑞芬太尼及血管活性药物的总用量,术后镇痛泵按压次数及舒芬太尼的总用量。结果术后6、12、24h,研究组VAS评分明显低于对照组(P0.05)。研究组术中舒芬太尼、瑞芬太尼和血管活性药物的总用量,术后镇痛泵按压次数,及术后舒芬太尼的总用量均明显少于对照组(P0.05)。结论腹横肌平面阻滞通过阻滞前腹壁腹横肌平面的周围神经,为开腹胃癌根治术患者提供良好的术后镇痛。     

全麻联合胸椎旁神经阻滞在乳腺癌改良根治术中的应用

目的评价全麻联合胸稚旁神经阻滞在乳腺癌改良根治术的麻醉及术后镇痛方面的效果。方法将本院2012年1月至11月60例乳腺癌改良根治术患者随机分为两组,各30例。观察组采用全麻联合胸椎旁神经阻滞麻醉,对照组单纯采用全麻,观察并比较两组诱导前（T0）、切皮时（T1）及手术结束时（T2）平均动脉压（MAP）和心率（HR）及全麻苏醒期即刻（T3）、术后6小时（T4）、12小时（rr5）、24小时（R）的静息状态时疼痛视觉模拟评分（VAS评分）。结果观察组在切皮时及手术结束时MAP和HR均较对照组有统计学差异（P〈0．05）,两组术后镇痛效果比较有统计学差异（P〈0．05）。结论全麻联合胸椎旁神经阻滞麻醉可以安全有效应用于乳腺癌改良根治术,其生理干扰轻微并能提供良好的术后镇痛效果。     

硬膜外阻滞复合全麻对手术病人血糖和促甲状腺激素的影响

硬膜外阻滞复合全麻在胸膜腔大手术病人应用日益增多 ,临床观察提示 ,该法易维持心血管功能稳定 ,全麻药用量减少 ,苏醒快 ,便于实施术后镇痛 ,提高术后恢复质量[1,2 ] 。本文观察硬膜外阻滞复合全麻 ,患者血糖及血浆促甲状腺激素 (ＴＳＨ)的变化 ,并与单纯全麻比较。资料与方法一般资料　选择ＡＳＡⅠ～Ⅱ级 ,年龄 32～ 6 5岁 ,体重 48～ 82ｋｇ ,择期食管癌、肺癌或胃癌根治术患者共 43例。随机分为硬膜外阻滞复合全麻组 (Ⅰ组 ,ｎ =2 3)和单纯全麻组 (Ⅱ组 ,ｎ =2 0 ) ,两组患者年龄、体重及手术部位上均无明显差异。麻醉方法　两组患者…     

腹股沟上髂筋膜间隙阻滞与腰丛阻滞对直接前入路全髋关节置换镇痛效果的影响比较

目的:比较腹股沟上髂筋膜间隙阻滞（supra-inguinal fascia iliaca compartment block, S-FICB）和腰丛阻滞（lumbar plexus block, LPB）对直接前入路全髋关节置换术（total hip arthroplasty, THA）患者镇痛效果的影响。方法:择期...     

不同麻醉方式对结直肠癌根治术患者围手术期免疫功能及苏醒期质量的影响

目的:探讨4种不同麻醉方式对结直肠癌根治术患者围手术期机体免疫功能及苏醒期质量的影响。方法:择期行腹腔镜下结直肠癌根治术患者120例,按随机数字表法分为4组（每组30例）：全凭静脉麻醉组（N组）、腹横肌平面阻滞（transversus abdominis plane block, TAPB）联合全身麻醉组（T组）、硬膜...     

连硬外阻滞联合臂丛神经阻滞在乳腺癌根治术中的麻醉效果测评

目的 :测试连硬外阻滞联合臂丛神经阻滞在乳腺癌根治术中的麻醉效果。方法 :2 4例乳腺癌择期手术病人随机分成A、B、C三组 ,三组人数均为 8例。A组运用胸 4～ 5棘突间隙连续硬膜外神经阻滞联合肌间沟臂丛神经阻滞 ;B组选用单纯胸 4～ 5棘突间隙连续硬膜外神经阻滞 ;C组选用循环密闭式静脉吸入气管插管。结果 :A组病人整个手术过程中生命体征稳定 ,肌肉松弛满意 ,手术顺利 ;B组病人术中清扫腋窝淋巴结期间牵拉疼痛不适感强烈 ,生命体征有较大波动 ;C组病人全麻诱导及术毕清醒拔管期间心血管反应明显 ,生命体征波动剧烈。结论 :连硬外阻滞联合臂丛神经阻滞用于乳腺癌根治术具有术中镇痛充分、肌肉松弛理想、生命体征稳定等优点 ,是乳腺癌根治术理想的麻醉方式。     

复合硬膜外阻滞对全麻胃癌根治术患者核心体温的影响

目的:观察全麻与全麻复合硬膜外阻滞对胃癌根治术患者核心体温的影响。方法:择期胃癌根治术患者30例,年龄31~73岁,ASA分级Ⅰ~Ⅱ级,随机均分为两组,全麻组(G组)和全麻复合硬膜外阻滞组(GE组)各15例。用红外耳温计从麻醉诱导前5 min至术毕每隔15 min监测患者的鼓膜温度。观察两组患者低体温的发生率及持续时间、术中出血量、寒战的发生率、拔管时间、患者术后3 d内发热的发生率。结果:麻醉诱导后1h内两组患者核心温度下降较快,GE组术毕时核心温度(35.93±0.36)℃。低于G组(36.35±0.49)℃(P0.05),GE组术中低体温的发生率(80%)高于G组(20%,P0.01),GE组术中最低温度(35.79±0.32)℃,低于G组(36.17±0.36)℃(P0.01),且GE组低体温的持续时间长于G组(P0.05)。结论:胃癌根治术采用全麻复合硬膜外阻滞比单纯全麻更易于发生围术期低体温,应重视围术期保温。     

Infraclavicular brachial plexus block effects on respiratory function and extent of the block

Background and Objectives. Axillary block is devoid of severe respiratory complications. However, incomplete anesthesia of the upper limb is the main disadvantage of the technique. Theoretically, the more proximal infraclavicular approach would produce a more extensive block without the risk of pneumothorax. However, neither its effects on respiratory function nor a detailed characterization of the extent of neural block has been assessed. The goal of this study was to evaluate the possible changes in respiratory function and also the extent of the block after infraclavicular block. Methods. We performed an infraclavicular block with a mixture of 40 mL 1.5% plain mepivacaine and 4 mL 8.4% sodium bicarbonate in 20 patients. Forced expiratory volumes were measured before and 15 minutes after the injection of local anesthetic, and sensory and motor block were evaluated at 10 and 20 minutes. Results. We did not find significant differences from baseline in the forced expiratory volumes in any of the patients. Axillary and musculocutaneous nerve distributions had the lowest rate of sensory block at 20 minutes. Conclusions. Infraclavicular block does not produce a reduction in respiratory function.     

Pneumocephalus during continuous epidural block

We report a case of pneumocephalus during continuous epidural infusion. A 52-year-old malnourished man with rectal cancer had been treated with continuous epidural block for the relief of pain in the left thigh. Eleven days after catheter insertion, a dull, persistent headache occurred in the frontal region, and it worsened gradually. It was precipitated by any head motion and was not relieved by the supine position. A head computed tomography (CT) scan taken 3 days after the onset of the headache revealed about 15 ml of intracranial air and backward compression of the brain. The catheter was removed and the patient maintained bed-rest. The headache disappeared 2 days later. It is speculated that the air was sucked in through the space along the epidural catheter.     

Thoracic paravertebral block versus pectoral nerve block for analgesia after breast surgery

BackgroundPectoral nerve block (Pecs) is a novel interfascial plane block which can provide analgesia after breast surgery while paravertebral block (PVB) is widely used for this purpose. We evaluated the difference between the two techniques in regard to morphine consumption and analgesic efficacy after modified radical mastectomy (MRM).MethodsSixty patients undergoing elective MRM were randomly allocated into either PVB with 15–20 ml of levobupivacaine 0.25% at the level of fourth thoracic vertebra or Pecs block with 10 ml of levobupivacaine 0.25% injected inbetween pectoralis major and pectoralis minor muscle and another 20 ml levobubivacaine 0.25% inbetween pectorlis minor and serratus anterior muscle. Primary outcome measure was morphine consumption in the first 24 h while secondary outcome measures included pain scores, intraoperative fentanyl consumption as well as postoperative nausea and vomiting (PONV).ResultsPostoperative morphine consumed at 24 h was significantly lower in Pecs group [21 (20–25) mg] than in PVB group [28 (22–31) mg], (p = 0.002). Time for first request of morphine was longer in Pecs group [175 (155–220) min] than in PVB group [137.5 (115–165) min], (p < 0.001). Numerical rating score (NRS) at rest was lower in Pecs group compared with PVB group at 1 h, 6 h and 12 h (p < 0.001) but at 18 h and 24 h it was lower in PVB group compared with Pecs group (p = 0.008 and <0.001 respectively). During movement, NRS was significantly lower at 1st hour in Pecs group (p < 0.001) while at 18 h and 24 h it was significantly lower in PVB group (p < 0.001). PONV was comparable between both groups.ConclusionPecs block reduced postoperative morphine consumption in the first 24 and pain scores in the first 12 h in comparison with PVB after mastectomy.     

超声引导下三点阻滞与椎旁阻滞用于剖腹肝胆手术术后镇痛的比较

目的观察术前给予超声引导下三点法阻滞(低位前锯肌阻滞、肋缘下腹横肌平面阻滞和腹直肌后鞘阻滞)或单侧胸椎旁阻滞对肝胆手术患者术后镇痛及相关围术期转归的影响。方法选择择期右上腹部切口行肝胆手术的患者95例,男69例,女26例,年龄18～65岁,ASAⅠ或Ⅱ级。随机分为三点组(n=48)和椎旁组(n=47)。三点组患者入室后采用0.375%罗哌卡因行超声引导下低位前锯肌阻滞(10 ml)、肋缘下腹横肌平面阻滞(15 ml)复合腹直肌后鞘阻滞(15 ml),椎旁组采用0.375%罗哌卡因20 ml行超声引导下T_(7-9)椎旁阻滞。记录术后24 h舒芬太尼用量;记录切皮前、切皮后1和5 min时HR和SBP的变化、麻醉后恢复室内和术后24 h VAS疼痛评分,以及患者过敏、局麻药中毒、穿刺损伤等不良反应发生情况。结果两组患者术后24 h内舒芬太尼用量差异无统计学意义[(0.98±0.33)μg/kg vs (0.95±0.28)μg/kg]。患者麻醉后恢复室内和术后24 h VAS疼痛评分差异无统计学意义。椎旁组术中低血压发生率31例(66.0%) vs 11例(22.9%)和去甲肾上腺素用量[(3.5±1.6)μg/kg vs (1.2±0.4)μg/kg]明显高于三点组(P0.01)。两组患者均未见过敏、局麻药中毒、穿刺损伤等不良反应。结论低位前锯肌阻滞、肋缘下腹横肌平面阻滞、腹直肌后鞘阻滞三点阻滞复合可以产生与单侧椎旁阻滞相当的术中和术后镇痛作用,而且前者的低血压发生率明显低于椎旁阻滞,是一种可供临床选择的上腹部神经阻滞方式。     

超声引导下胸肋间筋膜阻滞的研究进展

肋间神经走行于肋间肌之间,在靠近胸骨的位置发出前皮支分布在皮肤表面,支配前胸壁区域的皮肤感觉。超声引导下胸肋间筋膜阻滞（PIFB）是近年来一种新兴的筋膜平面区域阻滞技术,通过将局麻药注射在胸大肌与肋间肌之间,在肋间神经移行途中将其阻断从而实现前胸壁区域的麻醉与镇痛。PIFB以其有效的镇痛效果、操作安全且易于学习的特点应用于乳腺、胸科、心脏等手术领域中,得到了患者和医师的广泛认可。本文通过对PIFB的解剖情况、操作技术、作用特点及临床应用方面进行论述,为PIFB的更多研究提供参考。     

Dorsal penile nerve block

BACKGROUND: The dorsal penile nerve block (DPNB) is a common form of regional anaesthesia for circumcisions in children. The safety of this block has been questioned following several case reports of potentially serious complications. METHODS: We performed a retrospective review of all the incidents related to the conduct of this block in our institution over a period of 53 months. RESULTS: A total of 3909 circumcisions were performed under DPNB and nine incidents were recorded. This included two cases of bleeding from the prepuce, two urethral injuries, three haematomas and two drug errors. Two cases required further surgical intervention but all of the patients recovered with no apparent long-term sequelae. CONCLUSIONS: We feel that the DPNB is a safe technique for circumcisions in infants and children.     

超声引导下椎旁神经阻滞与肋间神经阻滞用于胸腔镜肺部术后镇痛效果的比较

目的 探讨超声引导下椎旁神经阻滞与肋间神经阻滞对胸腔镜术后镇痛效果的影响。方法 选取2016年1月至2018年12月择期行胸外科手术患者1 190例,男516例,女674例,年龄18~75岁,BMI 15~35 kg/m²,ASA Ⅰ—Ⅲ级。根据接受神经阻滞的类型分为两组：椎旁神经阻滞组（P组,n=327例）和肋间神经阻滞组（I组,n=863例）。P组术前行T3-4和T6-7椎旁神经阻滞;I组于手术结束时在胸腔镜监测下在切口及其相邻上下两个肋间实施肋间神经阻滞。记录患者性别、年龄、身高、体重,既往合并症,术后第1、2和3天舒芬太尼用量和镇痛泵有效按压次数,术后第1、2和3天静息和活动时疼痛数字（NRS）评分、恶心呕吐,记录术后头晕发生率和术后住院时间。结果 与I组比较,P组术后第1和2天舒芬太尼用量明显减少（P<0.05）,术后第1天镇痛泵有效按压次数明显减少（P<0.05）,术后第1天活动时NRS评分、恶心呕吐发生率明显降低（P<0.05）,术后头晕发生率明显降低(P<0.05),术后住院时间明显缩短（P<0.05 ）。术后第2和3天两组静息和运动时NRS评分、恶心呕吐发生率差异无统计学意义。结论 与肋间神经阻滞比较,椎旁神经阻滞可以减少胸腔镜肺部术后阿片类药物的用量,减少术后不良反应,缩短术后住院时间。     

腰方肌阻滞临床应用的研究进展

腰方肌阻滞是一种将局麻药物注射至腰方肌周围的躯干神经阻滞技术。近年来,腰方肌阻滞的临床应用已成为研究热点,是广受欢迎的镇痛方式。腰方肌阻滞逐渐被应用于剖宫产手术、胃肠道手术、泌尿手术、下肢手术等围术期多模式镇痛,并且在慢性疼痛治疗中也有报道。全文就腰方肌阻滞的应用解剖、穿刺入路、临床应用及可能的作用机制进行综述,为其临床应用提供参考。