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Objective To evaluate the clinical efficacy of portable probe sterile film used for ultrasound-guided central venous cannulation.Methods One hundred emergency patients of both sexes with lower extremity fractures prepared for ultrasound-guided right internal jugular venous cannulation,aged 18-60 yr,weighing 50-85 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,were divided into 2 groups (n=50 each) by using a random number table:portable probe sterile film group (group P) and sterile glove group (group G).In group P,the ultrasound probe was placed in the portable probe sterile film,and then the sealed film was adhered to the scanning surface without fold or bubble after emptying gas by syringe.In group G,the ultrasound probe was wrapped by disposable medical sterile gloves with the scanning surface coated by coupling agents.The microbiological detection of probe was performed after aseptic processing,and relative sterility was defined as the total number of colonies less than or equal to 5 cfu/cm2.The probe aseptic processing time,puncture and cannulation time and total operation time were recorded.The aseptic qualification of scanning surface and handle was recorded.The clarity (equal to 3 point) of ultrasonic image was assessed and recorded using a 4-point scale.The success of first puncture,first cannulation and total cannulation was recorded.Complications such as bleeding,hematoma and dyspnea were observed simultaneously.Results The aseptic qualification rate of scanning surface was all 100％ in both groups.Compared with group G,the probe aseptic processing time was significantly prolonged,the puncture and cannulation time and total operation time were shortened,the aseptic qualification rate of handle was increased,and the clarity rate of ultrasonic image and success rates of first cannulation and total cannulation were all increased,the incidence of bleeding and hematoma was decreased (P＜0.05 or 0.01),and no significant change was found in the success rate of first puncture in group P (P＞0.05).Conclusion The portable probe sterile film is easy to operate,easy to realize an aseptic condition,has limited influence on the ultrasonic imaging,also can assure successful cannulation and reduce complications,so it is suitable for aseptic processing when used for ultrasound-guided central venous cannulation.
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Objective To evaluate the effects of magnesium sulphate on the analgestic efficacy of nerve block analgesia with ropivacaine. Methods Sixty cases who used femoral nerve block analgesia after unilateral total knee arthroplasty under the general anesthesia were selected,and according to digital table they were randomly divided into two groups( n=30 each):magnesium sulfate plus ropivacaine( group M) and ropivacaine( group C) . The solution (20mL) of 0. 2% ropivacaine and 0. 15% magnesium sulphate were administered to group M,and 20mL solution of 0.2% ropivacaine was given to the group C. The pain score was measured by visual analogue scale(VAS). The supplementary usage and cumulative dosage of morphine were recorded and the analgesia relevant complications were observed. Results The results of this study indicated that 4h,8h,12h and 24h after the operation,the VAS scores had no statistically significant difference ( all P > 0. 05 ) at rest, which in group M was significantly decreased compared with group C at 12h(t=2. 800,P=0. 009) and 24h(t=2. 934,P=0. 012) after treated with continuous passive motion ( CPM) postoperatively. The cumulative dosages of morphine when patients undergo CPM of knee joint in group M were (2.78 ±0.32)mg,(2.05 ±0.16)mg,respectively,which were significantly lower than those in the groupC[(4.10±0.85)mg,(2.44±0.25)mg](t=7.960,2.632,all P<0.05).No obvious analgesia relevant complications occurred in both two groups. Conclusion Magnesium sulphate can enhance the efficacy of postopera-tive femoral nerve block analgesia with ropivacaine, reduce the usage of morphine without increasing the analgesia relevant complications.
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Objective To evaluate the effects of magnesium sulphate on the analgestic efficacy of nerve block analgesia with ropivacaine. Methods Sixty cases who used femoral nerve block analgesia after unilateral total knee arthroplasty under the general anesthesia were selected,and according to digital table they were randomly divided into two groups( n=30 each):magnesium sulfate plus ropivacaine( group M) and ropivacaine( group C) . The solution (20mL) of 0. 2% ropivacaine and 0. 15% magnesium sulphate were administered to group M,and 20mL solution of 0.2% ropivacaine was given to the group C. The pain score was measured by visual analogue scale(VAS). The supplementary usage and cumulative dosage of morphine were recorded and the analgesia relevant complications were observed. Results The results of this study indicated that 4h,8h,12h and 24h after the operation,the VAS scores had no statistically significant difference ( all P > 0. 05 ) at rest, which in group M was significantly decreased compared with group C at 12h(t=2. 800,P=0. 009) and 24h(t=2. 934,P=0. 012) after treated with continuous passive motion ( CPM) postoperatively. The cumulative dosages of morphine when patients undergo CPM of knee joint in group M were (2.78 ±0.32)mg,(2.05 ±0.16)mg,respectively,which were significantly lower than those in the groupC[(4.10±0.85)mg,(2.44±0.25)mg](t=7.960,2.632,all P<0.05).No obvious analgesia relevant complications occurred in both two groups. Conclusion Magnesium sulphate can enhance the efficacy of postopera-tive femoral nerve block analgesia with ropivacaine, reduce the usage of morphine without increasing the analgesia relevant complications.
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Objective To evaluate the value of probe sterile protective film when applied to ultrasound-guided peripheral nerve block.Methods Ninety American Society of Anesthesiologists physical status Ⅰ or Ⅱpatients who required ultrasound-guided lumbar plexus block,aged 18-60 yr,weighing 55-85 kg,were randomly divided into 3 groups (n=30 each):sterile protective film group (group F),traditional physical method group (group TP) and traditional chemical method group (group TC).The probe was sterilized using a sterile protective film in group F,using a sterile glove in group TP,and using 70%-80% alcohol in group TC.Microbiological detection of probe was carried out subsequently,and the relative sterility was defined as the total number of colonies was less than or equal to 5 cfu/cm2.The time spent in sterilizing probe and in performing lumbar plexus block was recorded.The sterile qualified rates of scanning surface and handle of probe were calculated.The ultrasonic image quality was assessed by using a 4-point scale,and the number of display areas was recorded by Moro method.Results Compared with group TP,the time spent in sterilizing probe and in performing lumbar plexus block was significantly prolonged,the sterile qualified rate of probe handle and ultrasonic image quality were increased,and the number of display areas was increased in group F (P<0.05).Compared with group TC,the time spent in sterilizing probe was significantly shortened,and the sterile qualified rates of scanning surface and handle were increased in group F (P<0.05 or 0.01).Conclusion The probe sterile protective film exerts simple operation,strict sterile effect and little influence on ultrasonic image,the efficacy is superior to that of traditional methods,and it is more suitable for probe sterilization when applied to ultrasound-guided peripheral nerve block.
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Objective To investigate the efficacy of adductor canal block (ACB) under the guidance of ultrasound for postoperative analgesia in the pediatric patients undergoing knee operation.Methods Sixty pediatric patients,aged 3-12 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,weighing 12-35 kg,scheduled for elective unilateral knee operation,were selected and randomly divided into 2 equal groups using a random number table:ultrasound-guided ACB group (group ACB) and ultrasound-guided femoral nerve block (FNB) group (group FNB).After induction of general anesthesia,ACB or FNB was performed under the guidance of ultrasound,and 0.3％ ropivacaine 1 ml/kg was injected.Anesthesia was maintained with intravenous infusion of remifentanil combined with propofol,and bispectral index value was maintained at 40-60.Immediately after injection of local anesthetics (T0),and at 4,8,12 and 24 h after injection (T1-4),analgesic efficacy was assessed using the FLACC pain scale,and quadriceps strength was assessed by manual muscle testing.Satisfactory analgesia was defined as FLACC score ≤ 3,and obvious quadriceps weakness was defined as manual muscle testing grade 0-2.The complications associated with nerve block (such as local anesthetic toxicity,bleeding at the puncture site,hematoma),and occurrence of postoperative nausea and vomiting and delayed emergence were recorded.Results There was no significant difference between two groups in the rate of satisfactory analgesia at T1-T4 (P＞ 0.05).Compared with group FNB,the incidence of obvious quadriceps weakness was significantly lower at T1-T3 (P＜0.05),and no significant change was found at T4 in group ACB (P＞0.05).There was no significant difference in the incidence of nausea or retching between two groups (P＞0.05).Complications associated with nerve block,vomiting and delayed emergence were not observed in the two groups.Conclusion Ultrasound-guided ACB can be safely and effectively used for postoperative analgesia in the pediatric patients undergoing knee operation,and it has less influence on the quadriceps strength than FNB.
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Objective To evaluate the value of ultrasound-measured quantification of anterior neck soft tissue in predicting the difficult laryngoscopy in the obese patients.Methods Ninety-six patients,with body mass index ≥ 28 kg/m2,aged 22-60 yr,of ASA physical status Ⅰ or Ⅱ,scheduled for elective surgery under general anesthesia with endotracheal intubation,were selected.Assessment methods of modified Mallampati grade (method M) and anterior neck soft tissue quantification measured by ultrasound (method U) were performed before anesthesia.The level of vocal cords was selected using ultrasound scanning for anterior neck.The positive result was greater than 20 mm in method U,and was grade Ⅲ or Ⅳ in method M.Direct laryngoscope was placed after induction of anesthesia.Difficult laryngoscopy was defined as Cormack-Lehane grade Ⅲ or Ⅳ,or in whom laryngoscope could not be placed.The sensitivity,specificity and accuracy of the two assessment methods for predicting the difficult laryngoscopy were calculated.Results Twenty-two patients were found to have difficult laryngoscopy,and the anterior neck soft tissue quantification was (23.0±3.0) mm,which was significantly thicker than that in the patients of non-difficult laryngoscopy ((1.9±2.2) mm).The sensitivity,specificity and accuracy of method U were 91％,92％ and 92％,respectively,and of method M were 77％,81％ and 80％,respectively,and there was significant difference between the two methods.There was no significant difference in the parameters of difficult laryngoscopy which were predicted using method U between the patients of different ages or gender.Conclusion It can accurately predict the difficult laryngoscopy in the obese patients when the ultrasound-measured quantification of anterior neck soft tissue is greater than 20 mm.
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Objective To evaluate the efficacy of patient-controlled infraclavicular brachial plexus block for analgesia after elbow arthrolysis.Methods Eighty patients with elbow stiffness of both sexes, aged 18-64 yr, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, scheduled for elective elbow arthrolysis, were equally and randomly assigned to receive either the infraclavicular (Ⅰ group) or axillary (A group) brachial plexus block.All catheters were placed using ultrasound visualization preoperatively.When patients complained of pain in the recovery room after regaining consciousness, 0.2％ ropivacaine was injected via the catheter, 15 min later patient-controlled infraclavicular brachial plexus block was performed with 0.2％ ropivacaine (400 ml), and an electronic pump was set up with a 5 ml bolus dose, a 30 min lockout interval and background infusion at a rate of 5 ml/h.The patients underwent rehabilitation exercise everyday for 3 consecutive days starting from 24 h after operation.The catheter insertion time, successful block, and occurrence of moderate or severe pain (numeric rating scale [NRS] score ＞ 4) and greater inserting resistance (inserting resistance score＞ 1) during insertion, and the occurrence of paresthesia and vascular damage during insertion were recorded.NRS score was recorded at 24, 48 and 72 h after operation during rehabilitation exercise.The elbow articular range of motion was recorded at 72 h after operation, and the improvement in articular range of motion was calculated.The satisfaction with the improvement in articular range of motion (improvement ≥ 80％) and occurrence of complete improvement in articular range of motion (improvement=100％) were recorded.Catheter-related adverse reactions (such as oozing from the insertion site, obstruction, prolapse) and local anesthetics-related adverse reactions (nausea and vomiting, central nervous system toxicity) were recorded.Results The success rate of blockade was 100％ during insertion in both groups.Compared with group A, the catheter insertion time was significantly shortened, the incidence of moderate or severe pain and greater inserting resistance during insertion was decreased, the incidence of paresthesia and vascular damage during insertion was decreased, NRS score at 24 h after operation durig rehabilitation exercise was decreased, the incidence of complete improvement was increased (P＜0.05), and no significant change was found in the improvement in articular range of motion and satisfaction with the improvement in group I (P＞0.05).Conclusion Patient-controlled infraclavicular brachial plexus block can be safely and effectively used for analgesia after elbow arthrolysis, and it provides better efficacy than patient-controlled axillary brachial plexus block.
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Objective To evaluate the reliability of ultrasound for rapid identification of esophageal intubation in the patients with difficult airway.Methods Twenty-one patients requiring orotracheal intubation, aged 20-75 yr, with body mass index of 25-32 kg/m2, of ASA physical status Ⅰ or Ⅱ , Cormack-Lehane grade Ⅲ or Ⅳ under direct laryngoscope, undergoing elective general anesthesia, were selected.The carotid artery, trachea and esophagus were identified by ultrasonic scanning at suprasternal notch before induction of anesthesia.After induction of anesthesia, tracheal intubation was performed.During intubation, ultrasound was performed to detect esophageal intubation.After intubation, mechanical ventilation was performed.Auscultation of bilateral breath sounds was carried out to evaluate the tube position.The position of the tube was subsequendy determined through partial pressure of end-tidal CO2 monitoring.Results The sensitivity and specificity of ultrasound in identifying esophageal intubation were both 100％ in the patients with difficult airway.Conclusion Ultrasound can rapidly and effectively identify esophageal intubation in the patients with difficult airway.
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BACKGROUND:Previously, serious thoracolumbar burst fractures with spinal cord injury were mainly treated by anterior surgery. The superiority of conventional posterior repair lies in strong reduction and fixation effects. However, it is difficult to fuly decompression. The anterior and central cylinders of the injured vertebra cannot receive good reconstruction. Loss of correction and internal fixation failure always appear. It remains controversial which repair method is more ideal. OBJECTIVE:To comparatively analyze the effect of posterior and anterior approaches with subtotal vertebrectomy, decompression, reconstruction of spine, and internal fixation for patients with thoracolumbar burst fractures. METHODS: The data of 42 patients with thoracolumbar burst fracture treated by anterior and posterior approaches with subtotal vertebrectomy, decompression, and reconstruction of spine from May 2006 to December 2012 was retrospectively analyzed. They were divided into two groups according to the surgical procedures: anterior approach group (n=23) and posterior approach group (n=19). They were folowed up for at least 24 months. Repair results and imaging results were compared in patients of both groups. RESULTS AND CONCLUSION:None patients in the two groups affected fixator loosing or breakage, and obtained good bone fusion. The intraoperative blood loss was more and operative time was longer in the anterior approach group than in the posterior approach group, showing significant difference (P 0.05). No significant difference in the anterior vertebral height and kyphosis Cobb angle was detected before treatment, at 1 week after treatment and during final folow-up (P > 0.05). The incidence of postoperative complications was significantly higher in the anterior approach group than in the posterior approach group (P < 0.05). These findings confirm that subtotal vertebrectomy through anterior approach and posterior approach can effectively repair thoracolumbar burst fractures. However, the complications of posterior approach are less, and posterior approach has few impacts on the pulmonary function, is safe, and has good biocompatibility with the host.
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Objective To evaluate the effects of continuous femoral nerve block combined with in?filtration anesthesia on postoperative analgesia in the patients undergoing total knee arthroplasty. Methods Ninety patients, aged 50-80 yr, weighing 45-90 kg, of ASA physical status Ⅰ-Ⅲ, scheduled for elective unilateral total knee arthroplasty, were randomly divided into 3 groups ( n=30 each) using a ran?dom number table: continuous femoral nerve block + infiltration anesthesia group ( group A); continuous femoral nerve block group ( group B); continuous femoral nerve block + single sciatic nerve block group ( group C) . The femoral nerve was catheterized for block before induction of general anesthesia in the three groups, and then a single sciatic nerve block was performed in group C. In group A, 20 ml mixture was in?jected into the posterior part of the joint capsule before prosthesis implantation, and 20 ml mixture was in?jected around the collateral ligaments and incision sites after prosthesis implantation and before closing. The mixture included ropivacaine 2?5 mg∕ml, fentanyl 2?5 μg∕ml, and methylprednisolone 1 mg∕ml. In group B, 40 ml of normal saline was given as the method previously described in group A. Patient?controlled anal?gesia with 0?2% ropivacaine 250 ml was used for postoperative analgesia, lasting for 48 h. The patient?con?trolled analgesia pump was set up with a 5 ml bolus dose, a 30 min lockout interval and background infusion at a rate of 5 ml∕h. Tramadol was used as rescue analgesic and was given orally to maintain the VAS score ≤ 5. VAS scores at rest were recorded at 4, 8, 12, 24 and 48 h after surgery, and VAS scores during activity were recorded at 8, 12, 24 and 48 h after surgery. The total consumption of tramadol within 48 h after surgery was recorded. The motor function of the affected extremity was assessed and scored at 12, 24 and 48 h after surgery, and the sensory and motor function was evaluated at 72 h after removal of the catheter. The occurrence of bleeding or exudates from the site of catheterization and adverse effects were recorded. Results Compared with group B or C, VAS scores at rest at 4-24 h after operation, VAS scores during activity at 8-24 h after operation, and the total consumption of tramadol were significantly de?creased in group A. Compared with group B, no significant changes were found in motor block score of the affected extremity in group A. Compared with group C, the motor block score of the affected extremity was significantly decreased in A and B groups. There were no significant differences in the incidence of bleeding or exudates from the site of catheterization and nausea and vomiting between the three groups. Conclusion Continuous femoral nerve block combined with infiltration anesthesia can provide sufficient analgesia with?out influencing the recovery of sensory and motor function, and the safety is good for the patients undergoing total knee arthroplasty.
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Objective To determine the minimum effective local anesthetic dose (ED50 ) of spinal ropivacaine for arthroscopic meniscecto-my .Methods Twenty-five patients undergoing arthroscopic meniscectomy under combined spinal-epidural anesthesia received intrathecal ropivacaine .ED50 of ropivacaine was determined by the sequence method .The effective criteria were as follows :the level of sensory block reaching at least T12 within 20 min after injection of the local anesthetic ;the motion block reaching the Bromage Scale score ≥2 within 20 min after injection of the local anesthetic ;no supplemental epidural anesthetic at least 1 h after injection of the local anesthetic .The initial dose was 15mg and according to the effective or ineffective results in previous patient ,a dose of ropivacaine 1 mg was decreased or increased . Results ED50 of ropivacaine for the arthroscopic meniscectomy was 12 .24 mg(95% CI 12 .09-12 .39) .Conclusion The dose of ropiva-caine more than 12 .24 mg for arthroscopic meniscectomy is the best .But the anesthetic effect may be related with the specific gravity of the local anesthetic and the patients′factors(height ,weight ,age) .
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Background Replase of uveitis is a primary cause of vision damage.To predict recurrentassociated factors for uveitis is very critical for the prevention and management of uveitis.Objective This study was to explore the risk factors of recurrent uveitis and establish the prediction model of recurrent uveitis.Methods Clinical data of recurrent uveitis patients who were diagnosed in Renhe Hospital of Three Gorges University from July 1,2010 to June 30,2011 were retrospectively reviewed.The demography characteristics of the patients were collected and the disease was followed-up under the informed consent.Kaplan-Meier method was used to estimate the disease recurrence rate and to plot relapse-free survival curve at different levels of predictive factors.Multivariate Cox proportional hazards model was used to select independent risk factors of relapse and establish the prediction model for recurrent uveitis.Results Total 825 cases of recurrent uveitis were included and followed up for 1 month to 38 months,with a median following-up time of 16 months.Relapse of uveitis was identified in 149 cases (18.1％)during the following-up duration.The relapse-free survival time was from 1 month to 38 months,and the 1-,2-and 3-year cumulative recurrence-free survival rates were 87.3％,82.8％ and 80.9％.Multivariate Cox proportional hazards regression analysis showed that immunosuppression withdrawal(X1) (β =0.940,Waldx2 =12.018,P =0.001),oral steroid withdrawal (X2) (β =1.334,Wald x2 =18.450,P ＜ 0.001),colds (X3) (β =0.642,Wald x2 =11.988,P =0.001),work and study stress(X4) (β=0.285,Wald x2 =4.925,P=0.026) and excessive alcohol and tobacco(X5) (3--0.541,Wald x2 =4.718,P =0.030) were the independent risk factors for recurrence of uveitis.The risk of recurrence in patients with uveitis function model expression was h (t)=h0 exp (2.559 X1 +3.797 X2 + 1.901 X3 + 1.331 X4 +1.719 X5).Conclusions Replase of uveitis is an interaction of many factors,and immunosuppression withdrawal,oral steroid withdrawal,colds,work and study stress,excessive alcohol and tobacco are independent risk factors for recurrence of uveitis.An intervention according to the controllable factors is one of the important ways to prevent the recurrence of uveitis.
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Objective To evaluate the efficacy of dexmedetomidine injected into axillary sheath in alleviating the tourniquet pain during brachial plexus block with ropivacaine.Methods Sixty ASA physical status Ⅰ or Ⅱ patients,aged 18-60 yr,weighing 52-85 kg,scheduled for the replantation of amputated finger,were randomly divided into 2 equal groups (n =30 each):ropivacaine group (group R) and dexmedetomidine mixed with ropivacaine group (group DR).All patients underwent axillary brachial plexus block guided by a nerve stimulator.When the intensity of electric stimulation ≤ 0.4 mA,flexion of fingers or wrist still existed,and the local anesthetic was injected into the axillary sheath.0.5％ ropivacaine 40ml was injected in group R.0.5％ ropivacaine mixed with 100μg dexmedetomidine 40ml was injected in group DR.The pressure of inflation was set at 200-250mmHg,and the stress duration was 120 min.Tourniquet pain and the level that the patients could tolerate was evaluated using visual analog scale (VAS) at 120 min of stress status.The patient' s satisfaction with anesthesia was rated and the development of adverse cadiovascular events and local and systemic adverse reactions were recorded.Excessive sedation was measured with Ramsay score in group DR.Results Compared with group R,the tourniquet pain that the patients could tolerate was significantly increased,the severity of tourniquet pain was reduced and the incidence of adverse cadiovascular events was decreased in group DR (P ＜ 0.01).No serious tourniquet-related complications were observed in both groups.No patients developed excessive sedation in group DR.Conclusion Dexmedetomidine 100μg injected into the axillary sheath can safely and effectively alleviate the tourniquet pain when used during brachial plexus block with ropivacaine.
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Objective To evaluate the relationship between the optimum preoperative fasting time and in tervals between eating and trauma in pediatric patients undergoing emergency orthopedic surgery by measuring the gastric antral cross-sectional area (CSA) using ultrasound.Methods Fifty ASA physical status Ⅰ or Ⅱ pediatric patients,aged 2-7 yr,weighing 10-25 kg,undergoing elective orthopedic surgery,were randomly divided into 2 groups (n =25 each) using a random number table:6-h fast group (group CA) and 8-h fast group (group CB).Seventy-five ASA physical status Ⅰ or Ⅱ pediatric patients,aged 2-7 yr,weighing 10-25 kg,undergoing the emergency orthopedic surgery,were randomly divided into 3 groups according to the interval between eating and trauma:interval ≤ 1 h group (TA group,n =22),1 h ＜ interval ≤ 4 h group (TB group,n =26) and interval ＞ 4 h group (TC group,n =27).CSA was measured at 6 h after the last eating (T1) in group CA,8 h after the last eating (T2) in group CB and T1 and T2 in TA,TB and TC groups.Results There was no significant difference in CSA between group CA and group CB (P ＞ 0.05).Compared with group CA,CSA was significantly enlarged in TA and TB groups (P ＜ 0.05) and no significant change was found in group TC (P ＞ 0.05).Compared with group CB,CSA was significantly enlarged in TA group (P ＜ 0.05),and no significant change was found in TB and TC groups (P ＞ 0.05).Compared with group TA,CSA was significantly decreased at T1 in TC group and T2 in TB and TC groups (P ＜ 0.05),and no significant change was found at T1 in TB group (P ＞ 0.05).Compared with group TB,CSA was significantly decreased at T1 (P ＜ 0.05),and no significant change was found at T2 in TC group (P ＞ 0.05).Compared with the CSA measured at T1,CSA was significantly decreased at T2 in TB group (P ＜ 0.05),and no significant change was found at T2 in TA and TC groups (P ＞0.05).Conclusion For the pediatric patients undergoing emergency orthopedic surgery,when the interval between eating and trauma is within the period of 1-4 h,an 8-h preoperative fast is recommended; when the interval ＜ 1 h,an 8-h preoperative fast is still not able to achieve the aim of fasting and measures should be taken to avoid regurgitation of gastric contents; when the interval ＞ 4 h,the preoperative fasting time can be properly shortened to 6h.
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Objective The evaluate the accuracy of loss of resistance technique for location of fascia iliaca compartment using ultrasound technique.Methods One hundred and seventy-five patients undergoing hip surgery were enrolled in the study.A line was drawn on the skin from the pubic tubercle to the anterior superior iliac spine and divided in three equal parts.The site of puncture was marked 2 cm distal to the point at which the lateral met the middle third of the line.The needle was inserted until a loss of resistance was felt twice (fascia lata and fascia iliaca),at which point 0.5 ％ ropivacaine 30 ml was infused.Correct puncture was identified by visualized spread of local anesthetic solution under the guidance of ultrasound technique.The effective sensory block was recorded within 20 min after administration.Results The accuracy of loss of resistance method for locating the fascia iliac compartment was 56.6 ％ using ultrasound technique.There were 80 patients in whom fault site of puncture occurred:25 cases in the superficial layer of the fascia iliac and 51 cases in the iliopsoas muscle.The rate of effective block was 98.0 ％ for correct location and 82.9 ％ for fault location.Conclusion Loss of resistance technique cannot accurately locate the fascia iliac compartment.
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Objective To assess the accuracy of ultrasonographic measurement of gastric fluid volume in predicting the occurrence of nausea and vomiting during and after emergency cesarean section.Methods Seventyseven ASA Ⅰ-Ⅲ patients aged 18-35 yr weighing 66-87 kg undergoing emergency cesarean section were divided into 3 groups according to the preoperative gastric fluid volume:group A ≤ 0.4 ml/kg (n =21); group B 0.4-0.8ml/kg (n =34) and group C ＞ 0.8 ml/kg (n =22).Gastric fluid volume was calculated by Bouvet regression equation,based on antral area of the stomach measured with M-Turbo ultrasonography system (Somo Site Co.USA).Cesarean section was performed under combined spinal-epidural anesthesia with 0.4％ ropivacaine.BP,HR and SpO2 were measured and recorded after entering the operating room,at skin incision and at the end of operation.The occurrence of nausea and vomiting was recorded during operation and within 1 h after operation.Results There was no significant difference in hemodynamic variables among the 3 groups.The incidence of nausea was comparable among the 3 groups:33％ in group A,35％ in group B and 46％ in group C,while the incidence of vomiting was significantly higher in group C (46％) than in group A (10％) and group B (15％).Conclusion The incidence of vomiting is significantly higher during and within 1 h after emergency cesarean section in patients with preoperative gastric fluid volume ＞ 0.8 ml/kg,but the incidence of nausea is not related to preoperative gastric fluid volume.
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Objective To compare the efficacy of ultrasound-guided continuous fascia iliac compartment block (cFICB) and neurostimulator-guided continuous femoral nerve block (cFNB) for postoperative analgesia in patients undergoing total knee arthroplasty.Methods Sixty-six ASA Ⅰ or Ⅱ patients,aged 46-78 yr,weighing 45-88 kg,scheduled for unilateral total knee arthroplasty,were randomly divided into 2 groups (n =33 each):cFNB group (group Ⅰ) and cFICB group (group Ⅱ).At 30 min before surgery,the patients received FNB guided by neurostimulator in group Ⅰ and FICB guided by ultrasound in group Ⅱ.A bolus of 0.5％ ropivacaine 20 ml was injected and a catheter for continuous nerve block was inserted in both groups.At 0.5 h after surgery,the catheter was connected to a patient-controlled analgesia (PCA) pump.PCA with 0.2％ ropivaeaine was used for postoperative analgesia (48 h).The PCA pump was set up to deliver a 5 ml bolus dose with a 30-min lockout interval and background infusion at 5 ml/h.VAS score was maintained ≤ 3.The distribution of sensory block was assessed at 10 min after the first administration,and at 0.5,4 and 24 h after surgery.The effective rate of sensory block was calculated.When VAS score ＞ 4,tramadol 50 mg was given intravenously or orally every 12 h as a rescue analgesic.When VAS score ＞ 5,pethidine 50 mg was injected intramuscularly as a rescue analgesic.The number of attempts was recorded during 0-4 h,4-12 h and 12-24 h after surgery.The consumption of tramadol and pethidine was also recorded during 0-24 h and 24-48 h after surgery.The sleep quality score during the nighttime was also recorded during 0-24 h and 24-48 h after surgery.Vascular puncture and parasthesia during nerve block were recorded.The toxic reaction,severe nausea and vomiting (lasting for more than 1 day) and nerve damage were recorded after surgery.Results Compared with group Ⅰ,the effective rate of sensory block in the medial aspect of the thigh was significantly decreased at 10 min after the first administration,and the effective rate of sensory block in the lateral aspect of the thigh was significantly increased at 0.5 h after surgery in group Ⅱ (P ＜0.05).There was no significant difference in the number of attempts,consumption of tramadol and pethidine,and sleep quality score during the nighttime during different time periods between the two groups (P ＞ 0.05).No vascular puncture or parasthesia was found during nerve block in the two groups.No toxic reaction,severe nausea and vomiting or nerve damage was found after surge,y in the two groups.Conclusion Ultrasound-guided cFICB has the similar analgesic efficacy with neurostimulator-guided cFNB after operation,but it can provide a wider distribution of sensory blockade in patients undergoing total knee arthroplasty.
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Objective To investigate the effects of femoral nerve block combined with celecoxib on postoperative analgesia in elderly patients with hip fracture. Methods Two hundreds ASA -Ⅲ patients aged 65-89 yrweighing 35-90 kg undergoing hip fracture surgery were randomly divided into 4 groups ( n = 50 each):control group (group Ⅰ ), femoral nerve block group ( group Ⅱ ), celecoxib group (group Ⅲ ) and femoral nerve block +celecoxib group (group Ⅳ ). Operations were performed under combined spinal-epidural anesthesia. Groups Ⅲand Ⅳ were given oral celecoxib 400 mg at 1 h before operation, and 200 mg at 1 and 2 days after operation twice a day. Groups Ⅰ and Ⅲ received iv injection of sufentanil 0.06 μg/kg before the patients were placed in the position, while in groups Ⅱ and Ⅳ femoral nerve block was performed using a nerve stimulation with 20 ml of 0.5%ropivacaine and 10 min later the patients were placed in the position. All the patients received postoperative patient-controlled intravenous analgesia with sufentanil to maintain visual analogue scale score ≤ 3. The condition of satisfactory analgesia and sufentanil consumption within 24, 48 and 72 h were recorded. The coagulation function was measured on the day of admission to the hospital, at 1 day before operation and at 4 days after operation. Cardiac troponin Ⅰ (cTnI) concentrations were measured before operation, at the end of operation and at 1 day after operation. Postoperative complications was observed and recorded. Results Compared with group Ⅰ , the consumption of sufentanil was significantly reduced during each period in group Ⅳ ( P ＜ 0.01 ). Compared with group Ⅱ , the consumption of sufentanil was significantly reduced within 48 and 72 h after operation (P ＜ 0.05), while no significant change was found within 24 h after operation in group Ⅳ ( P ＞ 0.05). Compared with group Ⅲ , the consumption of sufentanil was significantly reduced within 24 h after operation ( P ＜ 0.05 ), while no significant change was found within 48 and 72 h in group Ⅳ ( P ＞ 0.05). The level of satisfactory analgesia was significantly higher in group Ⅳ than in the other three groups, and in groups Ⅱ and Ⅲ than in group Ⅰ ( P ＜ 0.05). The 4 groups were comparable with respect to the increased rate of cTnI concentrations at the end of operation and after operation, and perioperative blood coagulation. No postoperative complications were found in the 4 groups. Conclusion Femoral nerve block combined with celecoxib can reduce postoperative opioid consumption and enhance postoperative analgesia in elderly patients with hip fracture.