The analgesic effect of lornoxicam when added to lidocaine for intravenous regional anaesthesia

Background. The aim of the study was to evaluate the effectof lornoxicam (L) on sensory and motor block onset time, tourniquetpain, and postoperative analgesia, when added to lidocaine inintravenous regional anaesthesia (IVRA). Methods. Forty-five patients undergoing hand surgery were randomlyand blindly divided into three groups as to receive either i.v.saline and IVRA with lidocaine 0.5% (Control group, n=15), i.v.saline and IVRA lidocaine 0.5% with lornoxicam (L-IVRA group,n=15), or intravenous lornoxicam and IVRA lidocaine 0.5% (L-IVgroup, n=15). Sensory and motor blocks onset time, and tourniquetpain was measured after tourniquet application at 5, 10, 20,and 30 min, and analgesic use were recorded during operation.After the tourniquet deflation, at 1, 30 min, and 2, 4 h, visualanalogue scales score, the time to first analgesic requirement,total analgesic consumption in first 24 h, and side effectswere noted. Results. Sensory and motor block onset times were shorter andthe recovery time prolonged in the Group L-IVRA compared withthe other group (P=0.001). A decreased tourniquet pain, a prolongedtime first analgesic requirement [229 (85) min vs 28 (20) and95 (24) min, P=0.0038) and less postoperative analgesic requirementsduring 24 h were found in Group L-IVRA compared with the othergroups (P<0.05). Conclusions. The addition of lornoxicam to lidocaine for intravenousregional anaesthesia shortens the onset of sensory and motorblock, decreases tourniquet pain and improves postoperativeanalgesia without causing any side effect.     

Transillumination: a new tool to eliminate the impact of venous stasis during the procedure for the collection of diagnostic blood specimens for routine haematological testing

Introduction: The collection of diagnostic blood specimens for routine haematological testing (RHT) is traditionally performed with tourniquet. However, the transillumination devices based on cold near‐infrared LEDs have been formerly proposed as a valuable tool for identifying reliable venous accesses, especially in patients with difficult or small veins, such as children. This study was aimed to evaluate whether a transillumination device can advantageously replace the use of the tourniquet during the procedure for collection of blood specimens for RHT and thereby eliminating the discomfort and risk of spurious results caused by excessive or prolonged venous stasis. Methods: Two hundred and fifty volunteers were divided into five groups (G1, G2, G3, G4 and G5) to compare the results of RHT between blood sample collected with transilluminator device (left arm) and with tourniquet application (right arm) for 30 s(G1), 60 s(G2), 90 s(G3), 120 s(G4) and 180 s(G5). Results: No significant increases were observed in any of the haematological parameters tested in G1 when compared with blood collected by the transilluminator device. From G2 to G5, significant increases were observed for the platelet count, red blood cell count, haemoglobin, haematocrit, white blood cell count, neutrophils, monocytes and eosinophils. From G3–G5, further increases were observed for lymphocytes. Clinically significant variations were, however, observed for basophils in G2; red blood cell count, haemoglobin, haematocrit and basophils in G3 and eosinophils in G3 only. Conclusion: As such, considering that inappropriate use of the tourniquet is commonplace, we conclude that transillumination devices can represent a suitable tool to eliminate the venous stasis and to improve the quality of phlebotomy procedures.     

简易止血带应用于妇科开腹手术的效果分析

目的：探讨一种在基层医院妇科开腹手术中应用简单、方便、快速、有效、安全的止血方法及临床效果。方法：将2010—2011年妇科开腹192例手术患者作为研究组,采用简易止血带环扎子宫动、静脉,即时止血后,快速手术;另选择2008—2009年妇科开腹手术189例患者作为对照组,采用常规宫体注射缩宫素20U或垂体后叶素6U止血。比较两组术中出血量、手术时间、肛门排气时间、术后体温、抗生素应用时间、住院天数、住院费用。结果：研究组术中出血量、手术时间明显减少,两组比较差异均有统计学意义（P〈O．01）;研究组肛门排气时间、术后体温异常、抗生素应用时间、住院天数、住院费用亦减少,差异均有统计学意义（P〈O．05）。结论：基层医院妇科开腹手术采用简易止血带环扎子宫动、静脉,即时止血后手术,能明显缩短手术时间,减少术中出血量,降低术后并发症发生,具有创伤小、恢复快、经济、安全、有效等优点。     

Hair Toe Tourniquet Syndrome in a Four-year-old Boy

Background

Hair toe tourniquet syndrome is a condition in which a hair or thread encircles a digit and results in acute digital ischemia. It usually occurs in children under the age of 1 year. Prompt recognition and surgical removal of the constricting material can save the digit from irreversible tissue necrosis and the loss of digit.

Case Report

We report the first known case of hair toe tourniquet syndrome in a 4-year-old child, who had successful diagnosis and treatment of this condition.

Conclusion

We suggest that hair toe tourniquet syndrome should be considered as a cause of acute digital swelling and discoloration in children of all ages.     

下肢手术时气囊止血带充气压力研究

目的 :比较下肢手术使用气囊止血带时两种不同充气压力的止血效果和止血带副损伤的发生情况 ,以找出适宜的个体充气压力。方法 :将 2 0 0例下肢择期手术成年病人随机分为试验组和对照组 ,每组 10 0例。试验组采用个体充气压力 ,即以缚扎止血带处肢体周径(cm )作为气囊止血带充气压力值 (kPa) ;对照组采用传统充气压力 ( 5 3 .2kPa～79 .8kPa) ,观察止血效果和止血带副损伤的发生情况。结果 :两组止血效果均满意 ,而对照组止血带副损伤发生率明显高于试验组 (P <0 .0 0 5 )。结论 :以下肢缚扎止血带处周径 (cm )作为气囊止血带充气压力值 (kPa)是下肢手术时适宜的充气压力。     

American College of Foot and Ankle Surgeons® Clinical Consensus Statement: Perioperative Management

A wide range of factors contribute to the complexity of the management plan for an individual patient, and it is the surgeon's responsibility to consider the clinical variables and to guide the patient through the perioperative period. In an effort to address a number of important variables, the American College of Foot and Ankle Surgeons convened a panel of experts to derive a clinical consensus statement to address selected issues associated with the perioperative management of foot and ankle surgical patients.     

Preliminary uterine artery ligation versus pericervical mechanical tourniquet in reducing hemorrhage during abdominal myomectomy

Objective

To compare the effectiveness of preliminary uterine artery ligation versus pericervical mechanical tourniquet in reducing hemorrhage during myomectomy.

Methods

A total of 103 patients undergoing myomectomy were randomly allocated to undergo preliminary uterine artery ligation (52 patients) or pericervical tourniquet (51 patients). The primary outcome measure was estimated blood loss. Secondary outcomes included duration of the operation, duration of hospital stay, postoperative hemoglobin, and the need for postoperative analgesia.

Results

Operative blood loss was significantly less with uterine artery ligation compared with tourniquet (433.80 ± 285.21 vs 823.23 ± 237.33 mL, P < 0.001). The mean duration of the operation was lower in the uterine artery ligation group compared with the tourniquet group (50.5 ± 8.7 vs 76.3 ± 9.4 minutes, P < 0.001). Postoperative hospital stay was significantly shorter in the uterine artery ligation group compared with the tourniquet group (4.1 ± 0.1 vs 5.1 ± 0.2 days; P < 0.001). Postoperative hemoglobin concentrations and the need for postoperative analgesia were higher in the uterine artery ligation group (P = 0.012 and P < 0.001, respectively).

Conclusion

Uterine artery ligation was more effective than pericervical tourniquet as a preliminary step in reducing blood loss during abdominal myomectomy.     

穴位按摩预防下肢骨科手术患者上止血带致心血管应激反应的效果观察

目的研究穴位按摩预防下肢骨科手术止血带心血管应激反应的效果.方法选取下肢择期骨科手术应用止血带的患者180例,将患者随机分成两组,对照组给予止血带常规护理,观察组在常规护理的基础上,在止血带充气开始时即刻进行合谷、内关、神门穴位按摩,每穴按摩2 min,3个穴各完成按摩1次为一循环,隔10 min再开始下一循环穴位按摩直至手术结束,放气阶段及放气后5 min内均进行穴位按摩.比较两组充气后30、60 min,放气后0、1、3、5 min血压和心率情况.结果上止血带后,观察组充气后30、60 min,放气后0、1、3、5 min血压及心率波动明显小于对照组,差异均有统计学意义(P<0.05).结论穴位按摩能预防下肢骨科手术止血带心血管应激反应,可提高护理配合的质量.     

止血带辅助下点式剥脱术治疗原发性大隐静脉曲张

目的探讨止血带、驱血带辅助下大隐静脉高位结扎点式剥脱术治疗大隐静脉曲张的效果。方法止血带、驱血带辅助下采用大隐静脉高位结扎点式剥脱术治疗大隐静脉曲张病人126例共156条患肢。结果单侧患肢手术时间55~90 min,平均（60±10）min;术中出血5~15 mL,平均（10±3）mL;术后6 h均能下床活动,曲张静脉全部消失;腹股沟Ⅰ类切口均一期甲级愈合,其中6条（3.8%）患肢术后当天切口有少量渗血,8条（5.1%）患肢术后出现小腿内侧皮下血肿,于3~6个月内吸收软化。10条（6.4%）患肢术后出现足靴区麻木感,均于6个月内麻木感消失。126例病人获随访110例129条患肢,随访率为87.3%。随访时间3~15个月,平均8个月,疗效满意。结论止血带、驱血带辅助下大隐静脉高位结扎点式剥脱手术操作简单,手术时间短,出血少,易于掌握,且疗效理想,值得推广。