ABSTRACT
Objective To evaluate the efficacy of ultrasound-guided fascia iliaca compartment block combined with sacral plexus block in elderly patients undergoing posterolateral approach total hip arthroplasty (THA).Methods Sixty patients,24 males and 36 females,aged 65-90 years,ASA physical status Ⅱ or Ⅲ,undergoing THA via posterolateral approach were randomized into two groups with 30 cases in each group.Group SA received unilateral hypobaric spinal anesthesia with 2.0-2.5 ml local anesthetics (2 ml of 0.5% bupivacaine mixed 1 ml of sterile water for injection).Group NB received ultrasound-guided fas-cia iliaca compartment block (50 ml of 0.4% ropivacaine)combined with sacral plexus block (20 ml of 0.5% ropivacaine).The onset time and success time of sensory and motor block were evaluated.The visual analogue scale (VAS)at entring into the operating room (T0 ),1 min before positioning change (T1 ),posi-tioning change (T2 ),skin incision (T3 ),30 min after skin incision (T4 ),end of surgery (T5 ),24 h post-operatively (T6 ).The use of dopamine and atropine and incidence of complications were recorded. Results Compared with group SA,the onset time and success time of sensory and motor nerve block of group NB were longer (P <0.05).The VAS decreased at T1 ,T2 ,T6 and increased at T3 ,T5 in group NB (P <0.05).The use of dopamine in group NB (6.7%)was less than that in group SA (26.7%).Head-ache,nausea, vomiting, urinary retention were significantly decreased in group NB (P < 0.05 ). Conclusion Ultrasound-guided fascia iliaca compartment block combined with sacral plexus block re-lieves the pain caused by positioning changes.This technique may be used in elderly patients undergo-ing THA via posterolateral approach with less use of vasoactive drugs,better postoperative analgesic effects,fewer complications and higher degree of patient satisfaction.
ABSTRACT
Objective To observe the relationship of right internal jugular vein (RIJV)and common carotid artery (CAA)by scanning strictly from the anterior to posterior using ultrasound at different head rotation.Methods Using ultrasonic scanning,the anatomic features of RIJV and CAA both at thyroid cartilage level (prominentia laryngea level)and at the apex of the angle formed by the division of the sternocleidomastoid muscle (triangle level)with 0°,1 5°,30° and 45° right rotation were observed in 131 patients with ASA physical status Ⅰ or Ⅱ (male 55 cases,female 76 cases, aged 18~74 years).Based on the ultrasound images,the safe puncture range,the overlapping ratio, the angle between the horizontal axis and the line from the midpoint of RIJV to that of CAA (αangle) were measured.In addition,the relationship between the RIJV and CAA was defined as anterior-lat-eral, lateral, posterior-lateral or extremely-posterior-lateral position according to α angle. Results The safe puncture range of RIJV augmented as head rotated from 0° to 30° position(P <0.05);The safe puncture range of RIJV at triangle level was significantly higher than at prominentia laryngea level at all the four head positions(P <0.05).The overlapping degree decreased as head rota-ted from 0°to 30°head position at prominentia laryngea level(P <0.05).No siginificant differences of the overlapping degree were found between head positons at triangle level;The overlapping degree at triangle level was less than at prominentia laryngea level when at 0°and 1 5°head positon(P <0.05). At both prominentia laryngea and triangle levels,RIJV located mainly at lateral and posterior-lateral positions.In addition,the part of lateral position increased while the part of posterior-lateral position decreased as the head rotated from 0°to 45°position(P <0.05).Conclusion The puncture conditions for RIJV catheterization were more optimal at 30°to 45°head rotation for a safer puncture range and less overlapping between RIJV and CAA.RIJV located mainly at lateral and posterior-lateral positions at different rotations and RIJV gradually shifted to lateral position while head rotation increasing.It would be much better to select triangle level for central venous catheterization than prominentia laryn-gea level.