Dexamethasone as an adjuvant for peripheral nerve blockade: a randomised,triple-blinded crossover study in volunteers

Background

The efficacy of dexamethasone in extending the duration of local anaesthetic block is uncertain. In a randomised controlled triple blind crossover study in volunteers, we tested the hypothesis that neither i.v. nor perineurally administered dexamethasone prolongs the sensory block achieved with ropivacaine.

严重慢性阻塞性肺疾病患者食管切除术围手术期并发症及处理

目的 探讨重度慢性阻塞性肺疾病简称慢阻肺病人食管切除术围手术期常见并发症及其处理。方法 45例重度慢阻肺的病人在全麻联合硬膜外阻滞下进行开胸食管切除手术，围手术期处理包括术前戒烟、胸部理疗、预防和控制呼吸道感染、解痉化痰、呼吸功能锻炼、营养支持和氧疗；术后硬膜外镇痛、早期锻炼、保持呼吸道通畅，部分病人予以呼吸支持。结果 术中3例出现低氧血症。术后所有病人PaO2均有不同程度的下降，6例出现肺部感染，6例行纤维支气管镜吸痰，2例通过气管插管给予呼吸机支持，2例行气管切开术，1例酸碱平衡紊乱使用盐酸精氨酸治疗。所有病人均痊愈出院。结论 重度慢阻肺病人并非开胸食管切除手术的绝对禁忌证，积极的术前准备和严格的术后管理可减少和控制术后急性发作，有助于确保此类病人的围手术期安全和康复。     

甲磺酸罗比卡因与盐酸罗比卡因用于硬膜外阻滞的效应比较

目的 评价甲磺酸罗比卡因用于硬膜外阻滞的效应和安全性。方法 45例择期行下腹或下肢手术病人,随机分别接受用甲磺酸罗比卡因(8.94 mg/ml,观察组)或盐酸罗比卡因(7.5mg/ml,对照组)施行的硬膜外阻滞。观察两组在感觉阻滞、运动阻滞、镇痛和肌肉松弛方面的效果,同时观察用药前后肝肾功能变化。结果 观察组和对照组感觉阻滞平面达到T6以上的病例分别为84.3％和76％(P>0.05),Bromage≥3级的病例分别90％和92％(P>0.05)。两组感觉阻滞平面固定时间、Bromage达到最大级别时间、最大级别维持时间和运动阻滞维持时间均无显著性差异(P>0.05)。两组镇痛及肌松满意率无显著性差异。观察组术中2例发生低血压,2例发生心动过缓,而对照组仅1例发生低血压。两组术后24 h天冬氨酸氨基转移酶(AST)、天冬氨酸转氨酶(ALT)、尿素氮(BUN)和肌酐(Cr)均在正常范围。结论 甲磺酸罗比卡因与盐酸罗比卡因行硬膜外阻滞的效应基本相同,且无明显毒性。     

Local analgesic and vascular effects of intradermal ropivacaine and bupivacaine in various concentrations with and without addition of adrenaline in man

Ropivacaine, a new long–acting amino–amide local anaesthetic agent, and bupivacaine, in various concentrations with or without addition of adrenaline, were tested in a randomized, double–blind study using intradermal wheals. Ten non–smoking, healthy, young male volunteers participated. In series I plain solutions of ropivacaine (0.25%, 0.5%, 0.75% and 1%) and bupivacaine (0.25%, 0.5% and 0.75%) were injected intradermally and in series II the same concentrations, with the addition of adrenaline 5 ug ml^-1 ( 1 :200 000), were used. The same volunteers took part in both series, with an interval of at least three weeks between the experiments. Saline was included as control in both series. Pin–pricking was used to assess the dermal analgesia. Plain solutions of ropivacaine produced significantly longer durations of dermal analgesia than did plain solutions of bupivacaine, in all tested concentrations. A significant increase in duration was seen for both local anaesthetics when adding adrenaline. Local vascular effects at the injected areas were determined by visual inspection (nil, pink, pale). Local blanching (pale) was significantly more frequent for plain solutions of ropivacaine, in all tested concentrations. Local redness (pink) was significantly more frequent with plain bupivacaine, in a dose–dependent relation. An initial redness was frequently observed for both local anaesthetics containing adrenaline, followed by blanching at most sites.     

两种局麻药术后镇痛效果及副作用比较

目的：观察比较0．2％罗哌卡因和0．15％布比卡因两种同麻药在硬膜外自控镇痛(PCEA)中的镇痛效果及副作用。方法：选用0．2％罗哌卡因和0．15％布比卡因两种同麻药用于PCEA中．对其效果进行对比分析。结果：0．2％罗哌卡因、0．15％布比卡因分别与0．1mg芬太尼联合用于PCEA中，镇痛效果确切．毒副作用轻微，并发症少。结论：将0．2％罗哌卡因替代0．15％布比卡因与0．1mg芬太尼合用后．病人术后行走能力的早期恢复可得到改善。     

Wide Awake Open Carpal Tunnel Release: The Effect of Local Anesthetics in the Postoperative Outcome

Introduction  Wide awake open carpal tunnel decompression is a procedure performed under local anesthesia. This study aimed to present the effect of various local anesthetics in peri and postoperative analgesia in patients undergoing this procedure. Materials and Methods  A total of 140 patients, with 150 hands involved, underwent carpal tunnel release under local anesthesia. Patients were divided in five groups according to local anesthetic administered: lidocaine 2%, ropivacaine 0.75%, ropivacaine 0.375%, chirocaine 0.5%, and chirocaine 0.25%. Total 400 mg of gabapentin were administered to a subgroup of 10 cases from each group (50 cases totally), 12 hours before surgery. Patients were evaluated immediately, 2 weeks and 2 months after surgery according to VAS pain score, grip strength, and two-point discrimination. Results  In all patients, pain and paresthesia improved significantly postoperatively, while the use of gabapentin did not affect outcomes. Grip strength recovered and exceeded the preoperative value 2 months after surgery, without any difference between the groups. No case of infection, hematoma, or revision surgery was reported. Conclusion  Recovery after open carpal tunnel release appears to be irrelevant of the type of local anesthetic used during the procedure. Solutions of low local anesthetic concentration (lidocaine 2%, ropivacaine 0.375%, and chirocaine 0.25%) provide adequate intraoperative analgesia without affecting the postoperative course.     

罗哌卡因与布比卡因用于硬膜外阻滞的临床对比观察

目的：将新型酰胺类局麻药罗哌卡因药效学与布比卡因进行比较。方法：选择行择期下肢手术病人40例,随机分成四组进行硬膜外麻醉,分别在硬膜外注入0．75％罗哌卡因（n=10例）,0．5％罗哌卡因（n=10例）和0．75％布比卡因（n=10例）,0．5％布比卡因（n=10例）15－18ml。分别观察感觉阻滞起效,最大运动阻滞,感觉、运动恢复时间及最高阻滞平面,最大Bromage评分及术中不良反应的情况。结果：罗哌卡因起效快,产生的麻醉平面广,镇痛、运动阻滞效果好。术中有低血压、心率减慢等副作用发生。结论：罗哌卡因应用于临床麻醉有可靠的麻醉性能及安全性,利用其感觉运动神经分离作用,利于病人术后早期活动,具有良好的临床应用前景。     

多区域浸润麻醉减轻腹腔镜胆囊切除术后早期症状

目的探讨躯体、内脏局部浸润麻醉对择期腹腔镜胆囊切除术后疼痛、恶心症状的影响.方法随机将50例病人分为对照组和实验组,在门静脉周围和腹膜内分别浸润生理盐水66ml和罗吡卡因66ml;术后3h记录疼痛和恶心的程度、部位及所补充的哌替啶用量.结果罗吡卡因局部浸润可减轻术后3h的切口疼痛和恶心症状,但对腹内和肩部疼痛无明显效果;且术后3h所补充的哌替啶的用量显著减少.结论躯体、内脏局部浸润麻醉可减轻术后3h的切口疼痛、恶心及哌替啶用量.     

马来酸单甲酯构型转化反应的研究

目的 :探讨硫脲、盐酸和亚硫酸氢钠催化下马来酸单甲酯的构型转化反应。方法 :正交试验和方差分析。结果 :盐酸用量和反应时间对结果的影响具统计学差异 ,而硫脲和亚硫酸氢钠的用量对结果的影响不具备统计学差异。结论 :盐酸用量和反应时间对马来酸单甲酯的构型转化反应均有高度显著性影响 ,而硫脲和亚硫酸氢钠的用量则无