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Objective:To evaluate the optimization efficacy of anterior quadratus lumborum block at supra-arcuate ligament (SA-AQLB) combined with general anesthesia for laparoscopic gynecological surgery.Methods:Eighty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 28-64 yr, weighing 52-78 kg, with height of 154-166 cm, scheduled for elective laparoscopic gynecological surgery, were divided into general anesthesia group (group G, n=40) and SA-AQLB combined with general anesthesia group (group SG, n=40) using a random number table method.In group SG, bilateral SA-AQLB was performed under ultrasound guidance before anesthesia induction, and 0.4% ropivacaine 25 ml plus dexamethasone 5 mg was injected into both sides.Combined intravenous-inhalational anesthesia was applied in both groups.Patient-controlled intravenous analgesia (PCIA) with sufentanil 2 μg/kg (in 150 ml of normal saline) was performed after surgery.The PCIA pump was set up to deliver a 2 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h.Visual analogue scale (VAS) scores for abdomen, pelvis and shoulder pain were recorded at 1, 6, 12, 24 and 48 h after operation.Flurbiprofen was used for rescue analgesia when VAS score >4.The occurrence of intraoperative cardiovascular events and amount of sufentanil used during operation were recorded.The time to first pressing the analgesia pump, effective pressing times of PCA, requirement for rescue analgesia and consumption of sufentanil after operation were recorded.The extubation time, time to first flatus after operation, first ambulation time, length of hospital stay and development of postoperative adverse reactions such as nausea and vomiting, urinary retention and respiratory depression within 48 h after operation were recorded. Results:Compared with group G, the incidence of intraoperative hypertension and tachycardia was significantly decreased, the incidence of intraoperative hypotension and bradycardia was increased, the intraoperative consumption of sufentanil was reduced, the extubation time was shortened, the time to first pressing the analgesia pump was prolonged, the effective pressing times of PCA, requirement for rescue analgesia and postoperative consumption of sufentanil were reduced, the time to first flatus, first ambulation time and length of hospital stay were shortened, VAS scores for abdomen, pelvis and shoulder pain were decreased at each time point after operation, and the incidence of nausea and vomiting, urinary retention and respiratory depression after operation was decreased in group SG ( P<0.01). Conclusions:Compared with general anesthesia, the combination of SA-AQLB and general anesthesia can reduce the opioid consumption, inhibit intraoperative stress responses and postoperative hyperalgesia and promote early postoperative recovery when used for the patients undergoing laparoscopic gynecological surgery.
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PurposeArtifacts of metal implantation severely affect image quality of CT or MRI examination, which restricts the display of local soft tissue lesions after orthopaedic surgery. This study aims to explore the application value of ultrasound examination in local soft tissue lesions after metal implant surgery.Materials and Methods Seventy patients with metal implantation after various orthopedic surgeries received US examination, and such sonographic features were recorded as lesion morphology, size, internal echo, edge, with/without capsule and calcification, and blood flow. Moreover, the clinical and radiologic data of patients like X-ray, CT and MRI were compared with the US results so as to determine the sensitivity of ultrasonic examination.Results The peripheral nerve injury might lead to thickened swelling and echo reduction. Ultrasonography revealed 20 cases of hematoma formation, 5 cases of abscess, 5 cases of pseudoaneurysm, 3 cases of myositis ossificans, 15 cases of bone tumor recurrence and 12 cases of peripheral nerve injury in operative region. Compared with the clinical results , the sensitivity, specificity and accuracy of ultrasound diagnosis of the study reached 89.4%, 75.0% and 88.6%, respectively, which were signiifcantly higher than those of X-ray, CT and MRI (χ2=78.642, 46.596 and 61.371,P<0.01). The ultrasonic results showed that most hematomas had clear boundary with homogenous echo inside to echo-free zone. Abscesses mostly displayed cystic or hybrid echo with floatable intracavitary pus spots echo, and no blood flow signal existed in the central area of color Doppler. Pseudoaneurysm in the US showed cystic mass around artery, blood flow rotating in capsule, and the typical two-stage bi-spectrum signal in the neck of capsule. Myositis ossiifcans showed intramuscular irregular hyperecho with acoustic shadow. When bone tumor recurred, US showed hypoechoic soft tissue mass with moth-eaten bone destruction, and blood flow signals within the mass were often detected.Conclusion Ultrasonography has relatively high accuracy in observing soft tissues around metal implantation, which can be used as a premier method.
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Objective To evaluate the diagnostic value of shear wave elastography on deep venous thrombosis in different stage.Methods Models of rabbits'deep venous thrombosis have been established to noninvasively measure Young's moduli of thrombosis in day 1 ,4,7,10 and 14 respectively by shear wave elastography.Results The elastic modulus of thrombosis increased with increment of the stages of thrombosis.Specifically,the mean Young's moduli of thrombosis increased from (4.0±1 .42)kPa (day 1)to (25.71 ±6.09)kPa (day 14),with statistical differences between each two observation time points (P <0.05).Conclusions Shear wave elastography can effectively reflect the elasticity of thrombosis in different stages,and the stage of thrombosis can be estimated judging by quantitative ultrasound elasticity preliminarily.
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lusionsThe CEUS findings are different between benign and malignant gallbladder adenomas. The enhancement pattern and speed are useful for differentiating benign from malignant adenomas.