A randomized controlled trial: Comparison of one-per-mil tumescent technique and tourniquet in surgery for burn hand contracture in creating clear operative field and assessment of functional outcome

BackgroundThis study aims to compare the use of one-per-mil tumescent solution (a mixture of epinephrine and 0.2% lidocaine in a ratio of 1:1,000,000 in normal saline solution) and tourniquet to create clear operative fields and to evaluate the functional outcomes after post burn hand contracture surgery.MethodsThe subjects of this randomized controlled trial were divided into one-permil tumescent technique and tourniquet group for a similar surgical procedure. Three independent assessors evaluated the clarity of the operative fields through recorded videos for the first 15 min and the first 10-minute of each hour of the surgery. Functional outcome was evaluated at least three months postoperatively using total active and passive motion (TAM and TPM) of each digit. Malondialdehyde (MDA) and tumor necrosis factor alpha (TNF-α) were tested during baseline (5 min before the procedures), ischemia phase, and reperfusion phase (a phase when the blood flow returned to the tissue).Results35 subjects were included in this study: 17 in the tumescent group and 18 in the tourniquet group. We found a significant difference in the clarity of operative field between tumescent and tourniquet groups, 5 vs 35 bloodless operative fields, respectively (p < 0.05). TAM and TPM of each digit before surgery and 3 months postoperatively showed no significant difference between both groups (p > 0.05). Furthermore, we found no difference in MDA and TNF-α levels between both groups at their respective phases.ConclusionsThe use of one-per-mil tumescent technique does not replace tourniquet use to create bloodless operative fields in burned hand contracture surgery. However, the postoperative functional results were similar in both groups showing that tumescent technique can be used as an alternative to tourniquet without compromising outcomes. The MDA and TNF-α examinations do not provide conclusive outcomes regarding ischemia and reperfusion injury.     

青霉素配伍利多卡因后的药物动力学研究

本文报道青霉素配伍利多卡因后的药物动力学及生物利用度研究结果,证明利多卡因对青霉素的生物利用度无影响,且可促进青霉素的吸收,为良好的青霉素无痛溶媒,建议推广使用。     

236例无痛人工流产术的疗效观察

目的:探讨异丙酚和芬太尼混合液静脉麻醉、笑气吸入麻醉及2%利多卡因宫颈局部浸润麻醉三种镇痛方法在人工流产手术中的疗效比较。方法:自2003年8月至2004年1月对236例妇科门诊早孕要求终止妊娠的妇女实施无痛人工流产术。随机分成3组。A组:异丙酚+芬太尼静脉麻醉(85例);B组:N2O(笑气)吸入麻醉(88例);C组:2%利多卡因宫颈局部浸润麻醉(63例),观察人流术中其镇痛效果并对疼痛进行分级。结果:A组85例100%可达到完全不痛(疼痛分级为0级);B组65.90%可达到完全不痛,Ⅰ级23.86%,Ⅱ级9.09%,Ⅲ级1.15%;C组0例可达到完全不痛,Ⅰ级63.49%,Ⅱ级30.16%,Ⅲ级6.35%。结论:受术者如无心肺疾患及人流禁忌证,无痛人工流产术应选择异丙酚+芬太尼静脉麻醉可达到完全无痛,痛苦最小。     

剖宫产孕妇硬膜外给局麻药的药代动力学

为了解孕妇硬膜外给局麻药的药代动力学，选择２０名实施剖宫产手术的健康临产妇，随机分成硬膜外腔给予了哌卡因组（Ｂ１组）和给予利多卡因组（Ｌ组）。另外， ６例非妊娠患者硬膜外腔给予了哌卡因（Ｂ２组）。Ｂ１和Ｂ２组均给予０．７５％丁哌卡因１～１．５ｍｇ·ｋｇ－１，Ｌ组给予２％利多卡因４～４．５ｍｇ·ｋｇ－１。采用高效液相色谱（ＨＰＬＣ）测定硬膜外给药后血浆药物浓度。结果表明三组病例血药浓度均在安全范围内。Ｂ１组的血药浓度达高峰时间（Ｔｐｅａｋ）和脐静脉与母体血药浓度比（ＵＶ／ＭＶ）值均小于Ｌ组，表明丁哌卡因在硬膜外腔的吸收比利多卡因快，且透过胎盘屏障的药量小于利多卡因，新生儿Ａｐｇａｒ评分在娩出后５分钟均为１０分。Ｂ１组的药代动力学参数与Ｂ２组基本相似。结论：剖宫产手术硬膜外腔给予临床剂量的局麻药是安全的。     

重复腋路臂丛麻醉不同穿刺定位法的效果比较

目的：观察应用不同穿刺定位法施行重复腋路臂丛阻滞麻醉效果。方法：３２４例随机分为两组，在局麻药浓度、容量相同的情况下，Ａ组采用一针穿刺单次给药逐次移位定向挤压法，１６２例中，臂丛阻滞７３０次；Ｂ组采用一针穿刺单次给药法，１６２例中，臂丛阻滞６７０次。结果：在诱导时间、维持时间和阻滞完全方面，Ａ组均明显优于Ｂ组。结论：臂丛神经处于椎前筋膜及其延续的筋膜间隙中，因此，一针穿刺单次给药能获得有效的阻滞。     

肿胀局麻技术的临床应用

目的探讨肿胀技术在体表外科手术中的应用价值。方法随机选择体表肿物与先天性畸形、体表瘢痕、乳房整形、脂肪抽吸、腹壁整形、除皱、隆胸、褥疮、面瘫及颅骨电烧伤等２３０例体表外科手术应用肿胀技术，成人１６４例，完全采用肿胀法局麻技术，儿童６６例，在全麻下应用肿胀技术。并与相应手术非肿胀法下施行进行了比较。结果脂肪抽吸术中利多卡因用量可达３０～６０ｍｇ／ｋｇ体重。肿胀技术具有易于进行解剖间隙的分离、减少术中失血、增强麻醉效果、增加手术安全性和术后恢复快等优点。结论肿胀技术可推广到体表外科手术中广泛应用，对儿童更为适宜，对减少输血造成的疾病具有重要意义。     

利多卡因对小血管直径的影响

目的：利多卡因局部应用以解除血管痉挛。但对于其周围血管活性作用究竟是使血管扩张还是收缩，尚存在明显分歧。方法：采用展开的大白鼠睾提肌膜型，在显微镜下活体观察用肾上腺素致痉的小血管对２％、５％、１０％、２０％和２５％浓度的利多卡因局部滴注的反应，以及未致痉的小血管对２％利多卡因的反应。结果：不同浓度的利多卡因对痉挛的小动脉均有短暂的扩张作用，但１分钟后，动脉直径又开始回缩；１０分钟时，２％和５％利多卡因进一步加重了痉挛，其它浓度的利多卡因也未能解除痉挛。静脉对不同浓度的利多卡因均无明显反应。未致痉的小动脉对２％利多卡因亦呈强烈收缩反应。结论：不宜用利多卡因局部滴注以求解除血管痉挛。