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Objective:To investigate the analgesic effect of ultrasound-guided pericapsular nerve group (PENG) block combined with laryngeal mask general anesthesia and internal fixation of proximal femoral nail antirotation (PFNA) under ERAS concept in elderly patients.Methods:A total of 50 elderly patients with femoral trochanteric fractures treated with PFNA internal fixation who were admitted to Changsha Central Hospital from January 2021 to March 2022 were selected and according to the random number table method, they were divided into groups P and F, with 26 cases in group P (ultrasound-guided PENG block combined with laryngeal mask general anesthesia group) and 24 cases in group F [ultrasound-guided fascia iliaca compartment block (FICB)] combined with laryngeal mask general anesthesia group]. The bispectral index (BIS) of the two groups of patients was maintained within the range of 40-60, and the dosage of cyclopofol and remifentanil was adjusted according to the BIS and hemodynamic changes. Postoperative oxycodone was used for patient controlled intravenous analgesia (PCIA). When the Visual Analogue Scale (VAS) score ≥4, 1 mg intravenous oxycodone was administered as rescue analgesia. The VAS score was observed and recorded before nerve block (T 0), 10 minutes after nerve block (T 1), 20 minutes after nerve block (T 2), when the patients were placed in body position after bed (T 3), after laryngeal mask removal (T 4), 12 h after operation (T 5), 24 h after operation (T 6) and 48 h after operation (T 7). The mean arterial pressure (MAP), heart rate (HR) and blood oxygen saturation (SpO 2) at each time point from T 0 to T 4 were observed and recorded; the intraoperative dose of remifentanil, the rescue dose of oxycodone at postoperative T 6 and T 7, Lovett muscle strength score, anesthesia operation time, anesthesia recovery time and postoperative anesthesia-related complications were recorded. Results:There was no significant difference between the two groups in VAS scores at T 0, T 4, T 5 and T 6, MAP, HR and SpO 2 at T 0, T 1, T 2 and T 4, the dosage of remifentanil during operation, the remedial dosage of oxycodone at T 6 after operation, anesthesia operation time and anesthesia recovery time (all P>0.05). Compared with group F, the VAS scores of group P at T 1, T 2, T 3 and T 7 were lower than those of group F (all P<0.05); At T 3, there was no significant difference in SpO 2 between the two groups ( P>0.05), but the MAP and HR in group P was lower than that in group F (all P<0.05); The remedial dose of oxycodone at T 7 in group P was lower than that in group F ( P<0.05), and the analgesic effect was longer; Lovett muscle strength score at T 6 and T 7 in group P was better than that in group F (all P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups ( P>0.05). Conclusions:Compared with FICB, ultrasound-guided PENG block used in PFNA internal fixation in elderly patients has faster effect, lower dosage of opioid analgesics, longer duration of analgesia, and less impact on postoperative lower limb muscle strength.
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Objective:To study on the effect of ultrasound-guided thoracic paravertebral nerve (TPVB) block on quality of recovery from general anesthesia in tuberculosis patients with fiberboard exfoliation in post anesthesia recovery unit (PACU).Methods:From May 2018 to December 2019, 40 tuberculosis patients in Changsha Central Hospital with pulmonary fibreboard exfoliation and focal abscess lesions cleaning were randomly divided into two groups, with 20 patients in each group. The patients in group A received endobronchial general anesthesia and in group B received ultrasound-guided TPVB combined with endobronchial general anesthesia. Patients in the two groups were maintained under anesthesia by propofol, and the bispectral index (BIS) was maintained within the range of 40-50. The dosage of propofol and sufentanil was adjusted according to changes in BIS and hemodynamics. The mean arterial pressure (MAP), heart rate (HR) in two groups of patients were recorded at before anesthesia induction (T 0), before cutting leather (T 1), cut skin after (T 2), the end of operation (T 3), extubation time (T 4), and T 5 (time of leaving PACU). The visual analogue scale (VAS) of all patients in resting and cough state was recorded at 5, 30 min after extubation and the time of leaving PACU. The dosage of propofol and sufentanil in the operation and the additional dosage of sufentanil in PACU were recorded in both two groups. And the respiratory recovery time, consciousness recovery time, extubation time and sedation agitation scale(SAS) were observed. The adverse reactions such as nausea, vomiting, drowsiness and hypotension were observed in PACU. Results:Compared with group A, MAP and HR of patients at T 2, T 3, T 4, T 5 in group B were more stable during anesthesia, and VAS of patients in group B were lower than that in group A at each time point after extubation ( P<0.05). The dosage of sufentanil and propofol in group B were (35.92±8.12)μg and (749.56±95.30)mg respectively, which were significantly lower than those in group A [(45.74±4.42)μg and (862.83±105.34)mg, P<0.05]; the dosage of sufentanil in postoperative anesthesia recovery room of group B was (5.26±2.10)μg, significantly less than that of group A (10.35±5.86)μg ( P<0.05). The respiratory recovery time, consciousness recovery time and extubation time in group B were (12.92±5.12) min, (20.56±5.10) min and (26.87 ± 6.16) min, which were shorter than those in group A [(15.74±4.72)min, (25.83±5.34)min and (35.35±5.80)min, P<0.05]. The incidence of postoperative nausea, vomiting, lethargy and hypotension in group B were 10%, 10%, 35% and 20%, which were significantly lower than those in group A (30%, 20%, 75% and 45%, P<0.05). Conclusions:Ultrasound-guided paravertebral nerve block may significantly reduce the dosage of opioid analgesics for general anesthesia in tuberculosis patients with fiberboard exfoliation, accelerate the speed of anesthesia recovery, reduce the agitation during recovery, and improve the quality of anesthesia recovery.
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Objective To investigate the value and advantage of ultrasound guided intermuscular groove and suprascapular nerve block combined with general anesthesia in shoulder arthroscopy.Methods 40 American Society of Anesthesiologists (ASA) Ⅰ-Ⅱ patients undergoing elective arthroscopic shoulder surgery were randomly divided into two groups.Patients in group A were treated with general anesthesia,while patients in group B were treated with brachial plexus and suprascapular nerve block combined with general anesthesia.Mean arterial pressure (MAP),heart rate (HR) and visual analogy score (VAS) were measured at preoperative (To),5 min after the beginning of the surgey (T1),30 min after the beginning of the surgey (T2),at the end of the surgery (T3),and 30 min after removing laryngeal mask (T4).Bispectral index (BIS) was recorded at T1 and T2.The operation time,extubation time,dosage of opioids (sufentanyl),dosage of propofol,visual analogue scale (VAS) scores at awake time in post anesthesia care unit (PACU),and 6 h,12 h,24 h after surgery.Results There were no significant differences in the BIS between two groups at T1 and T2 (P ＞ 0.05).Both the MAP and HR had no statistical significance at T0 (P ＞ 0.05).MAP and HR in group B were significantly lower than those in group A from T1 to T4 (P ＜ 0.05).Compared with group A,patients in group B had significantly shorter extubation time (P ＜ 0.05),smaller dosages of sufentanyl and propofol (P ＜ 0.05),lower VAS scores at awake time 6 h and 12 h after surgery (P ＜ 0.05).Conclusions Brachial plexus and suprascapular nerve block combined with general anesthesia can offer better anesthesia status,reduce dosage of opioids and propofol,and can provide effective analgesia in shoulder arthroscopy.
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Objective To evaluate the influence of ultrasound-guided transverse abdominis plane (us-TAP) block on intraoperative and postoperative analgesia at different time points in total abdominal hysterectomy.Methods 46 patients undergoing total hysterectomy under general anesthesia were selected,randomly divided into two groups,group A and group B,with 23 cases in each group.Group A received bilateral us-TAP block after induction of general anesthesia and before operation;Group B received bilateral us-TAP block after operation and before anesthesia recovery.In both groups,the anesthesia was adjusted according to the bispect ral index (BIS) and hemodynamics.Sufentanil was used for patient-controlled intravenous analgesia (PCIA) after operation.The mean blood pressure (MBP),heart rate (HR) at T0(preanesthesia),T1 (skin incision),T2 (postoperation),T3 (tracheal extubation),T4 [leave the post anesthesia care unit (PACU)] in both two groups were recorded.The dosage of anesthetics during operation and the recovery time after operation were recorded.Visual analogue scores (VAS) at 2 h,6 h,12 h and 24 h after operation were observed in the resting and coughing state of the patients in the two groups.The total consumption of analgesics 24-h after surgery and the side effects of nausea and vomiting were recorded.Results MAP and HR in group A were significantly lower than that in group B at T1 (P ＜ 0.05),but there was no statistical difference at other time points (P ＜ 0.05).The dose of sufentanil used in group A was less than that in group B (P ＜ 0.05).The recovery time in group A was shorter than that in group B (P ＜ 0.05).At 2 h,6 h,12 h and 24 h post operation,there was no significant difference at rest and coughing VAS between the two groups (P ＜ 0.05).There was no difference in the consumption of analgesics 24 hours after operation between the two groups (P ＜ 0.05).The incidence of postoperative nausea and vomiting in group A was lower than that in group B (P ＜ 0.05).Conclusions In open hysterectomy,although the analgesic effect of us-TAP blockade before and after operation is not significantly different,preoperative TAP blockade under ultrasound can effectively reduce the amount of intraoperative general anesthetics and accelerate the recovery of patients,effectively reducing the incidence of postoperative nausea and vomiting.
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Objective To evaluate the safety,efficacy and comfort of dexmedetomidine sedation combined with ultrasound-guided ilioinguinal and ilioinguinal nerve block in open inguinal hernia surgery for elderly patients with underlying diseases.Methods 40 elderly patients for open inguinal hernia surgery with underlying diseases were selected and randomly divided into group A and group B.Group A recived simple nerve block,while group B recived dextropyrimidine sedation combined with nerve block.The heart rate (HR),mean arterial pressure (MAP),SpO2,Ramsay sedation score and visual analogue score (VAS) at T0 (entering operating room),T1 (anesthesia puncture),T2 (15 min after anesthesia),T3 (surgical incision),T4 (hernia sac free),T5 (operation ending) in both two groups were recorded,and the intraoperative anesthesia effect were evaluated.The satisfaction rate,incidence of bradycardia,bradycardia and respiratory depression were compared between the two groups;and observed the sufentanil using,lidocaine using and the occurrence of adverse reactions.Results There was no significant difference of SpO2 at each time point between the two groups (P ＞ 0.05);HR,MAP and Ramsay sedation scores at T0 between the two groups had no significant difference (P ＞ 0.05);compared with group A,HR,MAP and Ramsay scores at T1-T5 in group B decreased and Ramsay scores increased,while VAS at T1,T3,T4 and T5 in group B were lower (P ＜ 0.05);in group B,local anesthesia with lidocaine at puncture point,intraoperative sufentanil and body movement were significantly reduced,and the overall satisfaction rate of patients was high (P ＜ 0.05).There were no obvious adverse reactions in both groups.Conclusions Dexmedetomidine sedation combined with ilioinguinal/iliohypogastric nerve block is safe and effective in elderly patients with open hernia surgery combined with basic diseases,and it can improve the comfort of patients during anesthesia puncture and operation more than simple nerve block.
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Objective To investigate influence of different usage of dyclonine hydrochloride mucilage on hemodynamics and postoperative throat pain of laryngeal mask anesthesia patients.Methods Sixty patients in flexible ureteroscopic holmium laser lithotripsy with laryngeal mask anesthesia were randomly divided into three groups according to different usage of dyclonine hydrochloride mucilage (n =20).Group A was coated laryngeal mask with paraffin oil.Group B was coated laryngeal mask with dyclonine hydrochloride mucilage.Group C was coated laryngeal mask with dyclonine hydrochloride mucilage and dyclonine hydrochloride mucilage gargle.The indwelling time of laryngeal mask, postoperative recovery time of spontaneous breathing, time of hearing the call to open eyes, and the time of pulling out the laryngeal mask were recorded.Heart rate (HR), mean blood pressure (MBP) index at T1 (pre-anesthesia induction), T2 (1 min before pulling out the laryngeal mask), T3 (pulling out the laryngeal mask), T4 (5 min after removing the laryngeal mask), and T5 (10 min after removing the laryngeal mask) were recorded.The complications of throat after removing laryngeal mask were observed.The pain degree of sore-throat at the time of 30 minutes after removing the laryngeal mask was observed.The adverse reactions of the usage of dyclonine hydrochloride were observed in three groups.Results There were no statistically significant differences in indwelling time of laryngeal mask, postoperative recovery time of spontaneous breathing, time of hearing the call to open eyes, and the time of pulling out the laryngeal mask among three groups (P ＞ 0.05).There were no statistically significant differences in HR, MBP at T1 , and T5 (P ＞ 0.05).HR and MBP were higher in group A than in groups B and C at T2 ～ T4, and HR and MBP were higher in group B than in group C at T2 ～ T4, with statistically significant difference (P ＜ 0.05).The incidences of sore throat and swallowing discomfort were significantly lower in groups B and C than in group A (P ＜ 0.05).The incidences of sore throat and swallowing discomfort were significantly lower in group C than in group B (P ＜0.05).No statistically significant difference were found in incidence of hoarseness among three groups (P＞ 0.05).The pain degree of sore-throat in group C were significantly lower than in group B, and the pain degree of sore-throat in groups B and C was significantly lower than in group A (P ＜ 0.05).There were no allergic reactions and local anesthetic poisoning for three groups.Conclusions Dyclonine hydrochloride mucilage can reduce hemodynamic fluctuations during recovery period, and prevent or relieve effectively the patient's throat pain after laryngeal mask anesthesia.At the same time, dyclonine hydrochloride mucilage can improve the patient's postoperative physical comfort without adverse reactions, especially coated laryngeal mask with dyclonine hydrochloride mucilage and dyclonine hydrochloride mucilage gargle.
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Objective To investigate the clinical value of the optical microscope on the quality control of the coagulation specimen microscopic examination before the coagulation test.Methods 92 patients with coagulation specimens agglutination occurs which taken were selected as the experimental group,92 patients re-blood microscopy to ensure that no agglutination phenomenon was set to control,observed differences in coagulation indexes of the two groups.Results The PT,APTT,TT and Fg were statistically significant(P ＜ 0.05) between experimental group and control group by the q test.Different agglutination specimens group in the experimental group by analysis of variance,PT,APTT.TT and Fg were statistically significant(P ＜ 0.05) between groups comparison of the q test analysis,PT,APTT,TT and Fg were significant differences (P ＜ 0.05).With the aggravation of blood specimens agglutination,PT,APTT and TT time extension and Fg concentration reduce more serious.Conclusion Optical microscope before the introduction of clotting function tests experimental quality control a large extent,to enhance the accuracy of laboratory coagulation test results,clinical diagnosis and preoperative preparation has important clinical value.