Effects of patient-controlled infraclavicular brachial plexus block for postoperative pain and surgical efficacy in patients with terrible tyriad of the elbow / 中国骨伤

<p><b>OBJECTIVE</b>To study the effects of ultrasound guided inter-scalene brachial plexus block and patient-controlled infraclavicular brachial plexus block for postoperative pain and surgical efficacy in patients with terrible tyriad of the elbow.</p><p><b>METHODS</b>From March 2015 to August 2016, 60 patients with terrible tyriad of the elbows were treated in Ningbo No.6 Hospital with ASA I to II internal fixation. There were 32 males and 28 females, ranging in age from 16 to 70 years old, with a mean age of (55.6±18.2) years old. All the patients were divided into two groups(30 cases in each group): controlled intermuscular groove brachial plexus block (group C), infraclavicular brachial plexus block(group I). All catheters were placed using ultra-sound visualization and injected 0.33% ropivacaine 30 ml preoperatively. After regaining consciousness, all patients connected the electronic pump. The solution contained 0.2% ropiva-caine and the pump was setup to deliver a 5 ml bolus dose, with a 15 min lock out interval and background infusion at 5 ml/h. Both analgesia lasted until 5 d after operation. The patients underwent rehabilitation exercise everyday for 5 consecutive days starting from 24 h after operation.VAS score was recorded at 24 h, 48 h, 72 h and 4 d, 5 d after operation during rest and rehabilitation exercise time. The elbow articular range of motion and Mayo elbow performance score (MEPS) were recorded at 6 d after operation. Catheter-related adversereactions (such as oozing from the insertion site, obstruction, prolapse) were recorded.</p><p><b>RESULTS</b>The success rate of blockade was 100% during insertion in both groups. Compared with group C, the VAS score at 3 d during rest time and 3, 4, 5 d after operation during rehabili-tation exercise were decreased(2.5±0.5 vs. 3.8±1.1, 3.0±0.4 vs. 5.0±0.9, 2.5±0.4 vs. 4.5±1.2, 2.1±0.3 vs. 4.1±1.0,<0.05). The elbow articular range of motion and MEPS were increased(-2.19±18.01)° vs.(-8.19±12.16)°, (45.15±11.20)° vs. (22.15±7.02)°, (19.06±6.75)° vs. (9.10±2.48)°, (17.08±5.18)° vs. (10.12±3.15)°, (80.80±9.50) points vs. (64.90±11.21) points. The incidence of insertion site, obstruction, prolapse was 15, 5 and 10 cases respectively in group C, but without any catheter-related adverse reactions happened in group I (<0.05).</p><p><b>CONCLUSIONS</b>Patient-controlled infraclavieular brachial plexus block can be effectively used for postoperative pain after fixation for terrible tyriad of the elbows, and it can increase surgical outcome.</p>

Case-control study on the effect of ulinastatin on postoperative complications in elderly patients undergoing hip joint replacement / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the preventive effects of ulinastatin (Uti) on postoperative complications in elderly patients undergoing hip joint replacement.</p><p><b>METHODS</b>From Angust 2009 to June 2010, 160 elderly patients undergoing selective hip joint replacement with ASA I to II were assessed according to American Society of Anesthesiologists classification, including 81 males and 79 females ranging in age from 65 to 83 years (mean 73.9 years). All the patients were divided into 2 groups according to random number table (80 patients in each group): control group (group C) and ulinastatin group (group U). The patients in Group U received intravenous injection of ulinastatin with a dose of 10,000 U/kg before skin incision,and then with dose of 5000 U/kg respectively at 1, 2 and 3 days after operatio. The patients in Group C received the same volume of normal saline instead of ulinastatin. Blood samples were taken preoperatively,at the end of surgery and 1, 2, 3 days after operation for determination of ALT, AST, Scr, BUN and Plasma D-dimer. Deep vein thrombosis and postoperative cognitive dysfunction (POCD) were also examined through color Doppler ultrasonography and neuroeognirive assessment on the postoperative 3 days respectively.</p><p><b>RESULTS</b>Compared with the preoperative values, the contents of ALT, AST, Scr, BUN and plasma D-dimer in each group all increased. Compared with group C,the values of ALT, AST, Scr, BUN and plasma D-dimer decreased markedly (P < 0.05). The incidence rate of DVT and POCD was 0 and 3.75% in group U, which were lower than those of patients in the group C (40%, 27.5%) respectively.</p><p><b>CONCLUSION</b>Intravenous infusion of ulinastatin during operation can protect important organ function, correct blood hypercoagulability, lower the occurrence of DVT and POCD, and prevent the postoperative complications in some degree.</p>

Effects of ulinastatin on coagulation function and deep vein thrombosis in patients undergoing hip joint replacement / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effects of ulinastatin (Uti) and low-molecular-weight heparin (Lmwh) on coagulation function and deep vein thrombosis (DVT) in patients undergoing hip joint replacement.</p><p><b>METHODS</b>From March to December 2010 150 ASAI-II patients with average age of 72.5 (65 - 85) years undergoing hip joint replacement were randomly divided into 3 groups (n = 50 each): normal saline (NS) control group (Group C), Uti group (Group U) and Lmwh group (Group L). Group U received intravenous infusion of ulinastatin (10 000 U/kg) at preoperative, perioperative and after operation 1, 2 and 3 d, respectively. Group C received the same volume of NS instead of Uti. Group L were injected Lmwh subcutaneously (3200 U/d) at preoperative, after operation 1, 2 and 3 d. Blood samples were taken before operation (T(0)), at the end of surgery (T(1)), 1 d (T(2)), 2 d (T(3)) and 3 d (T(4)) after operation for determination the values of R, K, α angle, MA and CI, using thromboelastography, and the DVT were also examined through color Doppler ultrasonography at 3 d after operation.</p><p><b>RESULTS</b>Compared with T(0), R, K were shorter, α angle, MA and CI were larger in group C, the values at T(2) were up to the peak then declined at T(4). Compared with group C, the value of R, K were larger, the value of α angle, MA and CI were shorter in group U and group L. The DVT checked by ultrasonography were found in 20 cases in group C, 1 case in group U, and zero case in group L. The differences were no statistically significant between group U and group L.</p><p><b>CONCLUSION</b>Intravenous infusion of Uti during the period of operation can correct the hypercoagulability of blood and decrease the incidence of DVT after operation.</p>

Effect of ulinastatin on post-operative cognition disorders in elderly patients undergoing hip joint replacement / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the effect of ulinastatin on post-operative Cognition disorders in elderly patients undergoing hip joint replacement.</p><p><b>METHODS</b>Forty ASA I or II elderly patients undergoing selective hip joint replacement, aged > or = 65 years, were randomly divided into 2 groups (n = 40 each): control group and ulinastatin group. Ulinastatin group received iv infusion of ulinastatin (10,000 u/kg) after skin incision, (5,000 U/kg) after operation 1, 2, 3 d respectively, included 21 males and 19 females with an average age of (75.00 +/- 7.81) years old. Control group received the same volume of normal saline instead of ulinastatin, included 20 males and 20 females with an average age of (72.80 +/- 7.25) years old. Neuroeognitive testing was performed on the preoperative day and on the 3th postoperative day and post-operative cognition disorders was defined as 1 SD decline from baseline on neurocognitive assessment. Serum S100beta protein were measured before operation, at the end of surgery, 3, 24 h and 3 d after operation.</p><p><b>RESULTS</b>The incidence rate of postoperative cognition disorders was 2.5% in ulinastatin group, there were lower than those of patients in the control group (25%) (P < 0.05); In control group, the scales for MMSE before and after operation were (25.2 +/- 2.1), (22.6 +/-2.5) scores and the level of serum S100beta protein at T0-4 were (0.041 +/- 0.012), (0.125 +/- 0.031), (0.178 +/- 0.036), (0.142 +/- 0.038), (0.048 +/- 0.015) microg/L. As well in ulinastatin group, above date were (25.9 +/- 2.4), (24.8 +/- 2.1), (0.040 +/- 0.013), (0.095 +/- 0.021), (0.116 +/- 0.017), (0.087 +/- 0.019) and (0.043 +/- 0.012) respectively. Compared with preoperative, MMSE evaluation scale was decreased on the 3th postoperative day and the S100beta was increased markedly at T1-3 in control group (P < 0.05); Compared with control group, MMSE evaluation scale was increased and the S100beta was decreased markedly at T1-3 in ulinastatin group (P < 0.05 ).</p><p><b>CONCLUSION</b>Intravenous infusion of ulinastatin during operation can prevent the occurrence of POCD in elderly patients.</p>