ABSTRACT
Objective To evaluate the efficacy of transversus abdominis plane block (TAPB) with different doses of dexmedetomidine mixed with ropivacaine in the pediatric patients undergoing laparoscopic surgery with general anesthesia.Methods Eighty patients of both sexes,aged 3-6 yr,weighing 10-30kg,scheduled for elective single-channel laparoscopic appendectomy,were divided into 4 groups (n =20each) using a random number table method:0.5 μg/kg dexmedetomidine plus ropivacaine group (group DR1),1.0 μg/kg dexmedetomidine plus ropivacaine group (group DR2),1.5 μg/kg dexmedetomidine plus ropivacaine group (group DR3),and ropivacaine group (R group).Bilateral TAPB was performed under ultrasound guidance after the end of anesthesia induction.In group TR,0.25％ ropivacaine 0.5 ml/kg was injected,the 0.5 ml/kg mixture of 0.5,1.0 and 1.5 μg/kg dexmedetomidine and ropivacaine at a final concentration of 0.25％ was injected in DR1,DR2 and DR3 groups.Anesthesia was maintained by intravenously infusing remifentanil and inhaling sevoflurane.Cisatracurium was intermittently injected to maintain muscle relaxation.Ibuprofen was taken orally to maintain postoperative FLACC score ＜4.The intraoperative consumption of remifentanil,tracheal extubation time,duration of anesthetic recovery room stay,requirement for ibuprofen,and occurrence of opioids-and TAPB-related complications were recorded.Results There was no significant difference in the intraoperative consumption of remifentanil or tracheal extubation time between four groups (P＞0.05).Compared with group R,the requirement for ibuprofen was significantly decreased in DR2 and DR3 groups,the duration of anesthetic recovery room stay was significantly prolonged in group DR3 (P＜0.05),and no significant change was found in the requirement for ibuprofen in group DR1 or in the duration of anesthetic recovery room stay in DR1 and DR2 groups (P＞0.05).Compared with group DR1,the duration of anesthetic recovery room stay was significantly prolonged,and the requirement for ibuprofen was decreased in group DR3,and the requirement for ibuprofen was significantly decreased (P＜0.05),and no significant change was found in the duration of anesthetic recovery room stay in group DR2 (P＞0.05).Compared with group DR2,the duration of anesthetic recovery room stay was significantly prolonged (P＜0.05),and no significant change was found in the other parameters in group DR3 (P＞ 0.05).No patients developed opioids-or TAPB-related complications.Conclusion TAPB with 1.0 μg/kg dexmedetomidine mixed with ropivacaine provides good efficacy for the pediatric patients undergoing laparoscopic surgery with general anesthesia.
ABSTRACT
Objective@#To evaluate the efficacy of transversus abdominis plane block (TAPB) with different doses of dexmedetomidine mixed with ropivacaine in the pediatric patients undergoing laparoscopic surgery with general anesthesia.@*Methods@#Eighty patients of both sexes, aged 3-6 yr, weighing 10-30 kg, scheduled for elective single-channel laparoscopic appendectomy, were divided into 4 groups (n=20 each) using a random number table method: 0.5 μg/kg dexmedetomidine plus ropivacaine group (group DR1), 1.0 μg/kg dexmedetomidine plus ropivacaine group (group DR2), 1.5 μg/kg dexmedetomidine plus ropivacaine group (group DR3), and ropivacaine group (R group). Bilateral TAPB was performed under ultrasound guidance after the end of anesthesia induction.In group TR, 0.25% ropivacaine 0.5 ml/kg was injected, the 0.5 ml/kg mixture of 0.5, 1.0 and 1.5 μg/kg dexmedetomidine and ropivacaine at a final concentration of 0.25% was injected in DR1, DR2 and DR3 groups.Anesthesia was maintained by intravenously infusing remifentanil and inhaling sevoflurane.Cisatracurium was intermittently injected to maintain muscle relaxation.Ibuprofen was taken orally to maintain postoperative FLACC score <4.The intraoperative consumption of remifentanil, tracheal extubation time, duration of anesthetic recovery room stay, requirement for ibuprofen, and occurrence of opioids- and TAPB-related complications were recorded.@*Results@#There was no significant difference in the intraoperative consumption of remifentanil or tracheal extubation time between four groups (P>0.05). Compared with group R, the requirement for ibuprofen was significantly decreased in DR2 and DR3 groups, the duration of anesthetic recovery room stay was significantly prolonged in group DR3 (P<0.05), and no significant change was found in the requirement for ibuprofen in group DR1 or in the duration of anesthetic recovery room stay in DR1 and DR2 groups (P>0.05). Compared with group DR1, the duration of anesthetic recovery room stay was significantly prolonged, and the requirement for ibuprofen was decreased in group DR3, and the requirement for ibuprofen was significantly decreased (P<0.05), and no significant change was found in the duration of anesthetic recovery room stay in group DR2 (P>0.05). Compared with group DR2, the duration of anesthetic recovery room stay was significantly prolonged (P<0.05), and no significant change was found in the other parameters in group DR3 (P>0.05). No patients developed opioids- or TAPB-related complications.@*Conclusion@#TAPB with 1.0 μg/kg dexmedetomidine mixed with ropivacaine provides good efficacy for the pediatric patients undergoing laparoscopic surgery with general anesthesia.
ABSTRACT
OBJECTIVE:To explore the anti-shear force,stability and plasticity of reconstruction plate implantation,and to investigate its role in treating acetabular fractures complicated by free bone graft in the joint.METHODS:A computer-based online search of Science Direct and Ei databases (1960-01/2009-10) was performed for related English articles with the keywords of "acetabular fractures,modified ilioinguinal approach,reconstruction plate".In addition,CNKI and CBM database (1994-01/2009-10) were searched for related Chinese articles with the same key words in Chinese.Moreover,related works were manually searched.Studies regarding reconstruction plate implantation in treating acetabular fractures were included,including basic and clinical experiments.RESULTS:Acetabular top is weight loading region of human body,and the fracture should be reducted by the operation.Prior to reconstruction plate for acetabular fracture fixation,bone hook,and Kirschner wire can be used for temporary fixation,and the plate bending angle should be adjusted to accordant with lateral posterior wall or medial anterior wall of the acetabular top,followed by screw threading for fracture fixation.In addition,the screw entrance angle is very important.If the fixation of one plate is not satisfactory,one or two cancellous bone screw or Kirschner wire can be used to enhance the fixation.But the Kirschner wire tail should be bended to prevent dislocation into the pelvic cavity.Moreover,additional plate can be used for further fixation.Reconstruction plate fixation has advantages of anti-shear force,high stability and plasticity,which fully adapt the special appearance of acetabulum.Moreover,the incidence of postoperative plate loosening and breakage is low,and the satisfaction is high.Free bone blocks can be temporarily fixed by Kirschner wire,followed by reconstruction plate fixation.CONCLUSION:Reconstruction plate fixation has good clinical effect and few complications in treating acetabular fractures complicated by free bone blocks in the joint.