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Objective To assess the clinical application effect of pocket-sized ultrasound-guided radial artery cannulation.Methods Two hundreds and ten patients undergoing elective surgery,146 males and 64 females,aged 18-70 years,ASA physical status Ⅰ-Ⅲ,were scheduled for radial arterial catheterization.The patients were randomly divided into three groups (n =70 each):control group (group C),pockevsized ultrasound group (group U1) and conventional portable ultrasound group (group U2).In group C,the radial artery catheter placement were performed by traditional palpation method.In group U1,the radial artery cannulation were achieved by GE Vsacn pocket-sized ultrasound guidance.In groups U2,the ultrasound-guided radial artery catheterization were completed by conventional portable ultrasound.Before radial arterial cannulation,the diameter of radial artery and the distance between skin to artery in ultrasound images were measured and recorded.The first attempt success rate,cases that punctured less than 3 times,the number of attempts,successful cannulation time and potential complications were recorded.Results There was no statistic significant difference in the hemodynamic parameters,the diameter and the depth of radial artery among three groups.Compared with group C,patients in the other groups had higher first attempt success rate and greater proportion of cases that punctured less than 3 times,fewer placement attempts,shorter catheterization time,and lower incidence of the complication of hematoma (P＜0.05).There was no significant difference between groups U1 and U2 among these characteristics.Conclusion Ultrasound is a valuable adjunct to radial arterial catheter insertion.The pocket sized ultrasound may be a good alternative option to guide radial artery catheter placement.
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Objective To evaluate the efficacy of "over iliac crest method" for ultrasound-guided posterior lumbar plexus block by comparing with manual palpation and sagittal positioning.Methods A total of 75 patients,aged 25-64 yr,weighing 42-90 kg,with body mass index of 17-32 kg/cm2,of American Society of Anesthesiologists physical status Ⅰ-Ⅲ,scheduled for elective lower extremity surgery under ultrasound-guided posterior lumbar plexus block combined with parasacral sciatic nerve block,were divided into 3 groups (n =25 each) using a random number table method:manual palpation group (group M),sagittal positioning group (group S) and "over iliac crest method" group (group O).Patients received ultrasound-guided posterior lumbar plexus block with in-plane technique using the corresponding positioning method in M,S and O groups.Successful blockade of each level was recorded at 30 min after injection.Time to determine the lumbar intervertebral space,puncture time for lumbar plexus block,the requirement for adjuvant drugs and block efficacy were recorded.The development of complications related to puncture and nerve block was also recorded.Results Compared with group M,the success rates of blockade at levels L1 and L2 were significantly increased,the success rates of blockade at levels L4 and L5 were decreased (P＜0.05),no significant difference was found in the success rate of blockade at level L3 (P＞0.05),the time to determine the lumbar intervertebral space was prolonged,and the requirement for adjuvant drugs was decreased during surgery in O and S groups,and the efficacy of block was significantly enhanced in group O (P＜0.05).Compared with group S,the success rates of blockade at levels L1 and L2 were significantly increased,the success rates of blockade at level L4 were decreased,the time to determine the lumbar intervertebral space was shortened (P＜0.05),and no significant change was found in the efficacy of block in group O (P＞0.05).There was no significant difference in the puncture time for lumbar plexus block between the three groups (P＞0.05).Complications related to puncture and nerve block were not found in three groups.Conclusion "Over iliac crest method" provides higher success rate and better efficacy than manual palpation and sagittal positioning when used for lumbar plexus block.
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Objective To compare the effects of different anesthesia techniques on early prognosis in patients undergoing hip joint replacement. Methods The demographic, preoperative and postoperative data of 478 patients, aged 18-95 yr, of American Society of Anesthesiologists physical statusⅠ-Ⅳ, who underwent elective unilateral hip joint replacement in Tongji Hospital from May 2014 to December 2016, were retrospectively analyzed. Patients were divided into general anesthesia group (group GA, n=197), peripheral nerve block group ( group PNB, n=147) and peripheral nerve block combined with general an-esthesia group ( group PNB+GA, n=134) . The amount of crystalloid solution and colloid solution infused, consumption of sufentanil and requirement for vasoactive agents were recorded during operation. The dura-tion of anesthetic recovery room stay, length of hospital stay before and after operation and total length of hospital stay were recorded. The development of complications within 48 h after operation, therapy after ad-mission to intensive care unit and in-hospital fatality were also recorded. Results Compared with group GA, the intraoperative consumption of sufentanil was significantly decreased in group PNB+GA, and the a-mount of crystalloid solution infused, urine output, consumption of sufentanil, requirement for vasoactive agents and incidence of postoperative hypoxemia, pulmonary infection and acute cerebral infarction were significantly decreased in group PNB+GA ( P<0. 05) . Compared with group PNB+GA, the consumption of sufentanil, requirement for vasoactive agents and incidence of postoperative hypoxemia, pulmonary infec-tion and acute cerebral infarction were significantly decreased in group PNB (P<0. 05). Conclusion Compared with general anesthesia or with peripheral nerve block-general anesthesia, peripheral nerve block is more helpful in improving early prognosis in patients undergoing hip joint replacement.
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Objective To evaluate the efficacy of preoperative transversus abdominis plane block (TAPB)for analgesia after kidney transplantation. Methods Forty American Society of Anesthesiologists physical status ⅡorⅢpatients, aged 18-64 yr, with body mass index of 18-24 kg∕m2, scheduled for e-lective kidney transplantation, were divided into 2 groups(n=20 each)using a random number table:TAPB group and routine analgesia control group(group C). After induction of anesthesia, ultrasound-guided TAPB was performed on the operated side with 0.5% ropivacaine 20 ml in group TAPB. Patient-controlled intravenous analgesia with sufentanil was provided to all the patients after surgery. Tramadol 50 mg was intravenously injected as a rescue analgesic to maintain visual analogue scale score within 24 h after surgery≤3. The consumption of anesthetics during surgery and amount of sufentanil consumed and require-ment for rescue analgesic within 24 h after surgery were recorded. Ramsay sedation scores were recorded at 2, 4, 6, 12 and 24 h after surgery. The occurrence of nausea and vomiting, pruritus and respiratory de-pression within 24 h after surgery were recorded. TAPB-related complications were also recorded in group TAPB. Results Compared with group C, the consumption of remifentanil was significantly reduced during surgery, and the amount of sufentanil consumed within 24 h after surgery was decreased(P<0.05), and no significant change was found in the incidence of Ramsay sedation scores, nausea and vomiting, pruritus or respiratory depression in group TAPB(P>0.05). No patients required rescue analgesic in two groups. TAPB-related complications were not found in group TAPB. Conclusion Preoperative TAPB reduces the perioperative opioid consumption and enhances the efficacy of postoperative analgesia in the patients under-going kidney transplantation.
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Objective To compare the analgesic effect of continuous iliac fasicia block with dif-ferent approaches for patients undergoing total hip arthroplasty (THA).Methods Forty patients,21 males and 9 females,ASA physical status Ⅰ or Ⅱ,scheduled for elective hip arthroplasty surgery in Tongji Hospital from June to December 2016 were enrolled and randomly divided into two groups:parallel group (n =20)or vertical group (n =20).Patients received ultrasound-guided continuous iliac fasicia block with a short-axis in-plane technique in the parallel group and a long-axis in-plane tech-nique in the vertical group after the surgery.All patients had a 10 ml bolus of lidocaine 1% via the catheter followed by an infusion of ropivacaine 0.2% at 4 ml/h for 48 h.The ultrasound imaging time,procedure time and the depth of catheter were recorded.Cumulative frequency of patient-con-trolled nerve blockade analgesia (PCNA),ropivacaine consumption,pain scores at rest,the success rate of block,satisfaction scores and postoperative complications were recorded at every six hours during 48 h after the surgery.Results The ultrasound imaging time and procedure time in the vertical group were longer than in the parallel group (P <0.05).The depth of catheter in the vertical group was significantly greater than in the parallel group (P <0.05).The cumulative frequency of PCNA in the vertical group was significantly less than the parallel group (P <0.05 ).The success rate of the lateral femoral cutaneous nerve block in the vertical group was significantly higher than the parallel group at 6,12,18,24,30,36,42,48 h.The cumulative ropivacaine consumption at 24,30,36 h in the vertical group was significantly less compared with the parallel group (P <0.05).The pain inten-sity at rest was less in the vertical group compared with the parallel group at 24,30,36,42,48 h (P<0.05).There were no significant differences in the success rate of the femoral nerve block,satisfac-tion scores and related complications between the two groups.Conclusion Continuous iliac fasicia block with the short-axis in-plane and long-axis in-plane technique can effectively provide the postop-erative analgesic effects for patients undergoing THA.The long-axis in-plane technique in the vertical group with a higher success rate of the lateral femoral cutaneous nerve block can significantly reduce the ropivacaine consumption and pain scores.