ABSTRACT
Objective To evaluate the effect of ultrasound-guided continuous anterior quadratus lumborum block (QLB) on postoperative analgesia in total hip arthroplasty.Methods Fifty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes,aged 65-80 yr,weighing 45-80 kg,scheduled for elective total hip arthroplasty under subarachnoid block,were divided into 2 groups (n =25 each) using a random number table method:ultrasound-guided continuous anterior quadratus lumborum block group (group Q) and routine analgesia group (group R).Anterior QLB was performed at the end of operation in group Q.Patient-controlled intravenous analgesia was performed with sufentanil after operation in two groups.Dezocine was given as rescue analgesic.Ramsay sedation score and the maximum angle for hip flexion and abduction of hip joint were recorded after operation,and the total consumption of sufentanil,requirement for dezocine and occurrence of adverse reactions were recorded within 72 h after operation.The occurrence of QLB-related complications was also recorded.Results Compared with group R,Ramsay sedation score was significantly decreased and the maximum angle for hip flexion and abduction of hip joint were increased at each time point after operation,and the total consumption of sufentanil,requirement for dezocine and incidence of nausea and vomiting were decreased in group Q (P ＜ 0.05).No QLB-related complications were found in group Q.Conclusion Ultrasound-guided continuous anterior QLB can produce better postoperative analgesia and reduce postoperative consumption of opioids with fewer adverse reactions in the patients undergoing total hip arthroplasty.
ABSTRACT
Objective To evaluate the effect of ultrasound-guided quadratus lumborum block (QLB) on the efficacy of postoperative analgesia after caesarean section.Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ parturients,aged 20-39 yr,weighing 50-80 kg,scheduled for elective cesarean section under subarachnoid block,were divided into 2 groups (n =30 each) using a random number table:QLB group (group Q) and control group (group C).Ultrasound-guided bilateral QLBs were performed at the end of surgery,the solution was injected into the compartment between quadratus muscle and psoas major muscles,and 0.25％ ropivacaine 1.25 mg/kg was injected to each side in group Q.The parturients in both groups received patient-controlled intravenous analgesia after surgery to maintain the visual analog scale score ≤ 3,and dezocine 5 mg was intramuscularly injected as a rescue analgesic when the visual analog scale score≥4.Bruggrmann comfort scale (BCS) and Ramsay sedation scores were evaluated at 2,4,6,12,24 and 48 h after operation.The consumption of sufentanil during patient-controlled intravenous analgesia,requirement for rescue analgesia,satisfaction score of analgesia,the number of successfully delivered doses (D1) and the number of attempts (D2) were recorded within 24 h after surgery.D1/D2 was calculated.The development of respiratory depression and over-sedation was recorded.The development of QLB-related adverse reactions and postoperative nausea,vomiting,chest tightness and pruritus was also recorded.Results Compared with group C,BCS scores were significantly increased,the consumption of sufentanil was reduced,D1/D2 was increased,the requirement for rescue analgesia was decreased,and the satisfaction score of analgesia was increased (P＜0.05),and no significant change was found in Ramsay sedation score in group Q (P＞0.05).Adverse reactions such as respiratory depression,over-sedation,nausea,vomiting,chest tightness and pruritus were not found in two groups.Adverse reactions such as hematoma and infection at the puncture site or local anesthetic intoxication were not observed after surgery in group Q.Conclusion Ultrasound-guided QLB can enhance the efficacy of postoperative analgesia after caesarean section,reduce postoperative consumption of opioids and raise the comfort degree for parturients.
ABSTRACT
Objective To investigate the expression of Toll-like receptor 4 (TLR4)in peripheral blood monocytes and its correlation with TNF-α and IL-6 in type 2 diabetes (T2DM)patients with neuropathy. Methods Healthy volunteers (NC,n=44),T2DM without neuropathy (n=44)and T2DM with neuropathy (n=44)were recruited in the present study.The expression of TLR4 mRNA and protein in peripheral blood monocytes was detected by RT-PCR and flow cytometry. ELISA was undertaken to measure the plasma concentration of TNF-αand IL-6. Results The levels of HbA1 c[(9.09±1.62)%vs(8.36±1.10)% vs (5.30±0.89)%],the protein expression of TLR4[(42.02±9.69)% vs (31.27± 6.87)% vs (11.96±5.54)%],the mRNA expression of TLR4[(2.98±1.06)vs (1.74±0.47)vs (1.12 ±0.52)],TNF-α[(8.75±3.14 )vs (6.27±3.64)vs(3.19±1.17)pg/ml]and IL-6[(3.63±1.81)vs(2.60 ±1.14)vs(1.54±0.58)pg/ml]in patients with diabetic neuropathy significantly increased compared with T2DM and NC group;TLR4 showed a positive correlation with TNF-αand IL-6(r=0.631,P <0.0001;r=0.447,P =0.0023). Conclusion TLR4 of monocytes may take part in the occurrence of systemic inflammation and has a close relationship with the development of diabetic neuropathy.