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Objective:To explore the effects of general anesthesia and combined spinal and epidural anesthesia on inflammatory factors and pain in patients with osteoarthritis after total knee arthroplasty.Methods:A total of 84 patients with osteoarthritis who underwent unilateral total knee arthroplasty in Hulunbuir People's Hospital from January 2020 to May 2021 were selected as the research subjects. They were randomly divided into general anesthesia group (40 cases) and combined spinal and epidural anesthesia group (44 cases). Venous blood samples of 5 ml were collected before operation and 6, 24, 48 hours after operation, and the contents of inflammatory factors [tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6] in serum were determined by enzyme-linked immunosorbent assay (ELISA). The visual analogue pain scale (VAS) of the two groups at 30 min, 6, 24 and 48 hours after operation was compared.Results:At 6 and 24 hours after operation, TNF-α, IL-1β and IL-6 levels in the combined spinal and epidural anesthesia group were lower than those in the general anesthesia group ( t = 4.17, 3.85, 8.95, 10.98, 10.04, 9.87, P < 0.05). There were significant differences in the levels of TNF-α, IL-1β and IL-6 at different time points between the general anesthesia group and combined spinal and epidural anesthesia group ( F = 271.67, 149.26, 81.70, 189.36, 102.44, 157.32, P < 0.001). At 6 and 24 hours after operation, the VAS scores of patients in the combined spinal and epidural anesthesia group were significantly lower than those in the general anesthesia group ( t = 6.60, 3.66, P < 0.05). There were statistically significant differences in VSA scores between the two groups at different time points ( F = 67.47, 52.37, P < 0.05). Conclusion:The effect of combined spinal and epidural anesthesia is significantly higher than general anesthesia in inhibiting the expression of TNF-α, IL-1β and IL-6 in patients with osteoarthritis after operation, and the effect of analgesia is obvious.
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OBJECTIVE@#To explore the effect of electroacupuncture on the improvement of insulin resistance after knee joint replacement based on the combined spinal and epidural anesthesia and postoperative epidural analgesia.@*METHODS@#Eighty patients with insulin resistance but normal blood glucose were randomly divided into a control group and an observation group, 40 cases in each group.Both groups of patients underwent combined spinal and epidural anesthesia and postoperative epidural analgesia for knee arthroplasty. On the basis of the treatment,electroacupuncture (EA) was applied during the operation and within 1 month after the operation in the observation group, and EA was used at Hegu (LI 4), Qihai (CV 6), Zhongwan (CV 12), Pishu (BL 20), Shenshu (BL 23), etc. once every other day. The control group was not treated with electroacupuncture. Fasting blood glucose and fasting insulin were recorded 30 min before surgery (T), immediately (T), 1 d (T), 3 d (T), 7 d (T) and 1 month (T) after surgery, and the insulin resistance (IR) index was calculated.@*RESULTS@#Compared with those at T time point, the IR index of the control group at T, T, T and T time points and the observation group at T, T, T time points were lower (all <0.05). Compared with the control group at the same time point, the IR index of the T and T time points in the observation group was significantly lower (both <0.05), and it was lower than the insulin resistance standard.@*CONCLUSION@#Combined spinal and epidural anesthesia and postoperative epidural analgesia can improve short-term insulin resistance. Combined with EA, the improvement of insulin resistance is more obviously and longer.
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Humans , Acupuncture Points , Anesthesia, Epidural , Arthroplasty, Replacement, Knee , Electroacupuncture , Insulin , Insulin ResistanceABSTRACT
Objective To investigate the effects of sciatic nerve combined with anesthesia and lumbar spinal combined anesthesia on the vital signs of knee replacement surgery.Methods 112 cases of knee joint replacement surgery with different anesthesia,in The second people's Hospital of Quzhou from August 2013 to August 2015,were selected and randomly divided into experimental group one and experimental group two,56 cases in each group.Experimental group one was treated with sciatic nerve combined with anesthesia,and experimental group two underwent combined spinal-epidural anesthesia,comparison of changes in vital signs,blood pressure and other vital signs after 2 groups.Results After anesthesia,the changes of vital signs such as heart rate and blood pressure of experimental group one was significantly higher than that of experimental group two,the difference was statistically significant(P<0.05).The incidence of adverse events in the experimental group one was significantly lower than that in the experimental group two(26.8％),the difference was statistically significant(P<0.05).The MMSE score in the experimental group one(26.44±0.76)was significantly lower than that of the experimental group two(27.18±0.72),the difference was statistically significant(P<0.05).However,there was no significant difference in MMSE score between the two groups before anesthesia,6 hours,24 hours and 72 hours after operation.Conclusion Patients with knee replacement surgery were treated with sciatic nerve combined with anesthesia after treatment to stabilize the vital signs of patients,and less adverse reactions,more suitable for knee replacement surgery anesthesia treatment.
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Objective To observe the influence of combined spinal and epidural anesthesia( CSEA) of different po-sitions on the anesthesia effect, anesthesia operation and hemodynamic index during cesarean section of obese par-turients. Methods Eighty obese parturients[BMI≥30] undergoing cesarean section were randomly divided into two groups, that was group A and B, with 40 cases each. In group A, the parturients were required to undergo lat-eral decubitus position with 0.5% ropivacaine hydrochloride of 2. 4 ml. In group B, the parturients were required to undergo sitting position with the same ropivacaine hydrochloride as group A. The following data was recorded, which were the percentage of one-attempt's successful epidural needle placement, the anesthesia level,the anesthe-sia effect and the hemodynamic change. All the complications were also observed,such as the supine hypotension syndrome during operation,headache after spinal anesthesia and postoperative spinal nerve stimulation. ResultsThe difference of anesthetic effect between the two groups was insignificant in statistics while group B's rate of one-attempt successful puncture was higher than gruop A ( P <0.05 ) . The difference of hemodynamic index between them was significant in statistics ( P<0.05 ) with group B's rate of supine hypotension syndrome lower than group A. Conclusion Both body positions have the same anesthtic effect for obese parturients during cesarean section while the puncture operation of sitting positon is easier than lateral decubitus position and the hemodynamic change is also more stable.
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BACKGROUND: Currently, combined spinal-epidural anesthesia (CSE) is frequently administered, especially in obstetrics and orthopedic surgery. The aim of this study is to determine the appropriate concentration of bupivacaine to use with epidural volume extension that is suitable for total knee replacement during CSE. METHODS: Eighty patients (ASA physical status I and II) scheduled for totalknee replacement were randomly allocated to four groups of 20 patients each: All patients intrathecally received 2 ml of 0.5% hyperbaric bupivacaine. After fixation of spinal anesthesia, the groups received the following treatments. Group S patients received a 10 ml administration of normal saline for 15 min followed by a continuous 10 ml/hr epidural infusion. Group B1 patients received a 10 ml administration of 0.125% bupivacaine for 15 min followed by a continuous 10 ml/hr epidural infusion. Group B2 patients received a 10 ml administration of 0.25% bupivacaine for 15 min followed by a continuous 10 ml/hr epidural infusion. Group B3 patients received a 10 ml administration of 0.5% bupivacaine for 15 min followed by a continuous 10 ml/hr epidural infusion. RESULTS: The incidence of intraoperative movement in group S and group B1 patients were significantly greater than the incidence for group B2 and B3 patients. The incidence of intraoperative pain in group S patients was significantly greater than for patients in any of the other groups. CONCLUSIONS: We conclude that it is necessary to administer more than a 0.25% concentration of epidural bupivacaine load and provide continuous administration after a spinal block during total knee replacement.
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Humans , Anesthesia , Anesthesia, Spinal , Arthroplasty, Replacement, Knee , Bupivacaine , Incidence , Obstetrics , OrthopedicsABSTRACT
OBJECTIVE:To compare the efficacy and safety of different density of Levobupivacaine for combined spinal and epidural anesthesia (CSEA) in elder patients. METHODS: Sixty elder patients undergoing transurethral prostatectomy (TURP) were randomly assigned to 1 of the 3 groups: Group Ⅰ(n=20,hypobaric group) received 0.75% Levobupivacaine 1 mL+ 0.5 mL 0.9% Sodium Chloride Injection,Group Ⅱ(n=20,isobaric group) received 0.75% Levobupivacaine 1 mL+0.5 mL cerebrospinal fluid,and Group Ⅲ(n=20,hyperbaric group) received 1 mL 0.75% Levobupivacaine+0.5 mL 10% Glucose. RESULTS: All the 3 groups achieved satisfactory anesthetic efficacy. The incidences of hypotension,nausea,vomiting and shivering were significantly lower in Group Ⅲ than in other two groups (Group Ⅰ and Group Ⅱ)(P
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Objective: To observe the effect and safety of application of combined spinal and epidural anesthesia to hip surgery on the elderly.Methods: 47 patients aged over 70 years underwent hip surgery;All patients were given combined spinal and epidural anesthesia with 7.5mg~10mg of 0.5% bupivacaine(1~1.4ml of 0.75% bupivacaine was attenuated with 0.5~1ml of cerebrospinal fluid;density: 1.010).The time to anesthesia?sensory block levels and the effect of analgesia and muscle relaxation were recorded;BP?HR and SPO2 were monitored.Results: Foot febrile and lower limb numbness appeared in 40 patients immediately after drug administration;foot febrile appeared in 7 patients 3min after drug administration.There were 3 patients at the highest sensory block levels(T6)?40 patients at T10~12 and 7 patients at T7~9.Combined spinal and epidural anesthesia could provide 100% satisfactory analgesia and muscle relaxation during operation.BP and HR had no obvious variation after anesthesia.Conclusion: The application of combined spinal and epidural anesthesia has the advantage of low-dosage?fast-acting?consummate analgesia?satisfactory muscle relaxation and small interference with recirculating and respiratory system;etc,and so it is safe and effective for hip surgery on the elderly.