ABSTRACT
Objective To evaluate the effect of dexmedetomidine on the expression of Semaphorin 7A during lung ischemia-reperfusion (I/R) in rats.Methods Thirty healthy clean-grade adult male Sprague-Dawley rats,aged 8-12 weeks,weighing 200-240 g,were divided into 3 groups (n=10 each) using a random number table method:sham operation group (S group),I/R group and dexmedetomidine group (D group).Only sternotomy was performed,and the left hilum of lung was not clamped in S group.The model of lung I/R injury was established by clamping the left hilum of lung for 45 min followed by 120 min of reperfusion in I/R group.Dexmedetomidine 50 μg/kg was intraperitoneally injected at 30 min before ischemia,and then the model was established in D group.The rats were sacrificed at the end of reperfusion,and the lungs were removed for examination of the pathological changes (using haematoxylin and eosin staining) which were scored and for determination of the wet to dry weight ratio (W/D ratio),expression of Semaphorin 7A protein and mRNA (by Western blot or real-time polymerase chain reaction),and contents of tumor necrosis factor-alpha (TNF-α) and interleukin-1beta (IL-1β) in lung tissues (by enzyme-linked immunosorbent assay).Results Compared with S group,W/D ratio and pathological scores were significantly increased,the expression of Semaphorin 7A protein and mRNA was up-regulated,and the contents of TNF-α and IL-1β were increased in I/R and D groups (P＜0.05).Compared with I/R group,W/D ratio and pathological scores were significantly decreased,the expression of Semaphorin 7A protein and mRNA was down-regulated,and the contents of TNF-α and IL-1 β were decreased in D group (P＜0.05).Conclusion The mechanism by which dexmedetomidine reduces lung I/R injury may be related to down-regulating Semaphorin 7A expression,thus inhibiting inflammatory responses of rats.
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Objective To evaluate the efficacy of ultrasound-guided quadratus lumborum block for analgesia after laparoscopic cholecystectomy. Methods Sixty American Society of Anesthesiologists physi-cal statusⅠorⅡ patients, aged 18-64 yr, with body mass index of 20-27 kg∕m2 , scheduled for elective laparoscopic cholecystectomy, were divided into 2 groups ( n=30 each) using a random number table meth-od: ultrasound-guided transversus abdominis plane block group ( group T) and ultrasound-guided quadratus lumborum block group (group Q). In T and Q groups, bilateral ultrasound-guided transversus abdominis plane block and quadratus lumborum block were performed after general anesthesia induction, respectively, with 0. 25％ ropivacaine 20 ml for each side. All the patients received patient-controlled intravenous analge-sia with morphine after surgery, and visual analoge scale scores were maintained≤3 in the two groups. The cumulative consumption of morphine was recorded at 2, 4, 6, 12, 24 and 48 h after surgery. The occur-rence of adverse reactions such as nausea, vomiting, pruritus, over-sedation and respiratory depression was observed and recorded in the analgesic period. The operation time for nerve blocks and nerve blocks-related complications such as bleeding, accidental puncture into the abdominal cavity or intestinal injuries were re-corded. Results Compared with group T, the cumulative consumption of morphine was significantly de-creased at 6, 12, 24 and 48 h after surgery in group Q ( P<0. 05) . There was no significant difference in the operation time for nerve blocks between the two groups ( P>0. 05 ) . There were no adverse reactions such as nausea, vomiting, pruritus, over-sedation and respiratory depression or nerve blocks-related compli-cations in the two groups. Conclusion Ultrasound-guided quadratus lumborum block provides better effica-cy than transversus abdominis plane block when used for analgesia after laparoscopic cholecystectomy.
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Objective To evaluate the effect of ultrasound-guided erector spinae plane block combined with general anesthesia on early postoperative outcome in patients undergoing video-assisted thoracoscopic pulmonary lobectomy.Methods Eighty-five patients of both sexes,aged 18-64 yr,with body mass index of 18-24 kg/m2,of American Society Anesthesiologists physical status Ⅱ or Ⅲ,undergoing elective video-assisted thoracoscopic pulmonary lobectomy,were divided into 2 groups using a random number table method:general anesthesia group (group GA,n =43) and ultrasound-guided erector spinae plane block combined with general anesthesia group (group ESP+GA,n =42).Ultrasound-guided erector spinae plane block was performed after induction of general anesthesia,0.5％ ropivacaine 20 ml was injected in group ESP+GA,and 0.9％ normal saline 20 ml was injected in group GA.Both groups received patient-controlled intravenous analgesia with sufentanil after surgery.Tramadol was intramuscularly injcted as resue analgesic when visual analog scale score＞3.Quality of Recovery-40 questionnaire was used to assess the early postoperative quality of recovery at 1 day before surgery and 1 and 2 days after surgery.The consumption of intraoperative remifentanil and postoperative sufentanil,requirement for rescue analgesics and occurrence of postoperative adverse reactions were recorded.Results Compared with group GA,the Quality of Recovery-40 questionnaire scores were significantly increased at 1 and 2 days after surgery,the consumption of intraoperative remifentanil and postoperative sufentanil was reduced,and the requirement for rescue analgesics and incidence of nausea and vomiting were decreased in group ESP+GA (P＜0.05).Conclusion Ultrasoundguided erector spinae plane block combined with general anesthesia can promote early postoperative outcome in patients undergoing video-assisted thoracoscopic pulmonary lobectomy.
ABSTRACT
Objective To evaluate the efficacy of ultrasound-guided erector spinae plane (ESP) block for postoperative analgesia in the patients undergoing video-assisted thoracoscopic pulmonary lobecto-my by comparing with paravertebral nerve block. Methods Ninety patients of both sexes, aged 18-64 yr, with body mass index of 20- 27 kg∕m2 , of American Society of Anesthesiologists physical statusⅠ-Ⅲ, scheduled for elective video-assisted thoracoscopic pulmonary lobectomy, were divided into 2 groups (n= 45 each) using a random number table: ultrasound-guided paravertebral nerve block ( group P) and ultra-sound-guided ESP block group (group E). Morphine 0. 1 mg∕kg and parecoxib sodium 40 mg were intrave-nously injected at 30 min before surgery. Ultrasound-guided ESP and paravertebral nerve blocks were per-formed with 0. 5％ ropivacaine 20 ml after anesthesia induction in E and P groups, respectively. Both groups received patient-controlled intravenous analgesia with 0. 1％ morphine 100 ml after surgery, and the analgesia pump was set up with a 1 ml bolus dose, 8 min lockout interval and no background infusion. Parecoxib 40 mg was intravenously injected every 8 h. Operation time, anesthesia time and total consumption of intraoperative remifentanil were recorded. The operation time of nerve block and development of pleu-ral puncture and vascular injury during operation were also recorded. The cumulative consumption of mor-phine was recorded at 2, 4, 6, 24 and 48 h after surgery. The development of postoperative nausea and vomiting and respiratory depression was recorded. Tramadol 100 mg was intramuscularly injected as a rescue analgesic when the visual analog scale score was more than 3. Results The operation time of nerve block was significantly shorter in group E than in group P (P<0. 05). There was no significant difference in the total consumption of intraoperative remifentanil, cumulative consumption of morphine, incidence of nausea and vomiting or requirement for rescue analgesia between two groups (P>0. 05). Pleural puncture, vascu-lar injury, pruritus or respiratory depression was not found in two groups. Conclusion Ultrasound-guided ESP block provides better analgesic efficacy after operation than paravertebral nerve block in the patients un-dergoing video-assisted thoracoscopic pulmonary lobectomy.