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Se realiza estudio prospectivo para demostrar que la nucleolisis percutánea, más el bloqueo peridural y foraminal con ozonoterapia es efectiva y muy segura para disminuir el dolor producido por síndrome de espalda fallida. Material y método: previo consentimiento informado, a 45 pacientes con síndrome de espalda fallida, se les realizó un total de 45 nucleolisis percutáneas, más bloqueo peridural y foraminal con ozonoterapia, durante un periodo comprendido entre mayo 2012 a mayo del 2013. Todas las nucleolisis se realizaron bajo control fluoroscopio con medidas de asepsia y antisepsia estrictas, y sedación consciente. A todos los pacientes, se les administró ozono en disco, peridural y foraminal (5-10 ml) a 10ug/ml, más procaina al 2% y 1cc de 40mg de cristales esteroideos; en todos los casos se administró 1gr. de cefacidal como profilaxis. Discusión: La eficacia del tratamiento, se basa en el control del dolor según la escala visual analógica basal (EVA 0), a los 30 días (EVA 1), a los seis meses (EVA 3) y a los 12 meses (EVA 6). Se aplicó el test de oswestry, antes del tratamiento y al final del estudio; a todos los pacientes se les realizo encuesta en la primera consulta, y luego al final del tratamiento con una respuesta satisfactoria(AU)
This prospective study is to demonstrate that percutaneous nucleolisys and epidural, foraminal block with oxygen-ozone is effective and very safe to decrease the pain from failed back syndrome. Materials and Methods: previous reported 45 patients with failed back syndrome consent to a total of 45 percutaneous nucleolisys more and foraminal Epidural blockade with ozone therapy was conducted over a period from May 2012 to May 2013 all nucleolisys were performed under fluoroscopic control measures strict asepsis and antisepsis, conscious sedation. All patients were administered ozone in disk, epidural and foraminal (5-10 ml) at 10 ug / ml over 2% procaine more steroidal 1cc 40mg of crystals, in all cases of cefaolin sodium 1grs administered prophylactically. Discution: The effectiveness of treatment is based on pain control by baseline visual analog scale (EVA 0), 30 days (EVA 1), six (EVA 3) and 12 months (EVA 6). By oswestry test evaluated before treatment and at study end; all patients were conducted survey in the first query and then at the end of treatment with satisfactory response
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Low Back Pain/physiopathology , Back Injuries/complications , Hernia/diagnosis , Intervertebral Disc/surgery , Ozone , TherapeuticsABSTRACT
Objective To explore the two different anesthesia methods on hemodynamics and inflammatory cytokines in elderly patients during peroperative period.MethodsFifty elderly patients with Knee Replacement( ASA Ⅰ,Ⅱ )were randomly divided into general anesthesia group( group A,n =25 ) and combined general and epidural anesthesia group( group B,n =25 ).The changes of mean arterial pressure(MAP) and heart rate ( HR ) were monitored before induction of anesthesia ( T1 ),at intubation ( T2 ),during skin incision ( T3 ) and at the time of extubation ( T4 ),at 30 min after extubation ( T5 ).Blood samples were taken from artery for determination of plasma TNF-α,IL-6,IL-10 concentrations before tourniquet inflation ( T5 ),10 min after tourniquet deflation(T6),30 min after tourniquet deflation (T7)and 30 min after operation (T8)by enzymelinked immunosorbent assay(ELISA).ResultsThe MAP and HR of patients in two groups at T2,T3,T4 were all increased when compared with T1 [ group A:HR:( 94.3 ± 10.4 ) bpm,( 96.4 ± 12.7 ) bpm,(93.3 ± 11.1 )bpm vs(62.6 ±7.3)bpm;MAP:( 18.8 ±3.4)kPa,( 19.6 ±3.4)kPa,( 17.8 ±2.0)kPa vs ( 14.5 ± 1.5)kPa,P＜0.05;group B:HR(76.2 ±6.5)bpm,(70.1 ± 9.7) bpm,(71.5 ± 8.3) bpm vs(64.6 ± 8.4) bpm;MAP:( 16.3 ± 2.5 ) kPa,( 15.3 ± 1.2) kPa,( 14.8 ± 1.4) kPa vs ( 14.1 ± 1.3 ) kPa,P ＜ 0.05 ].There was significant difference on MAP and H R between group A and group B( F =11.957,9.745;P ＜ 0.05 ).The level of plasma TNF-α,IL-6 and IL-10 were significantly increased at T6 to T8 compared with T5 in both groups[ groupA:TNF-α:(4.36 ±0.18) ng/L,(7.54 ± 1.23) ng/L,(10.35 ±2.21 )ng/L vs (2.26 ±0.16) ng/L; groupA:IL-6:(4.32 ±0.21 ) ng/L,( 8.35 ± 1.26 ) ng/L,( 10.23 ± 2.23 ) ng/L vs ( 1.36 ± 0.08 ) ng/L; groupA:IL-10:(5.32±1.10) ng/L,(7.56 ± 1.36) ng/L,(8.63 ± 2.21) ng/L vs (1.25 ± 0.03) ng/L; groupB:TNF-α:(3.43 ±0.06)ng/L,(5.24 ±2.10) ng/L,(7.68 ± 1.43) ng/L vs(2.22 ±0.15) ng/L;groupB:IL-6:(3.41 ±0.08 ) ng/L,(5.34 ± 1.34 ) ng/L,( 8.54 ± 2.03 ) ng/L vs ( 1.28 ± 0.04 ) ng/L; groupB:IL-10:( 7.28 ± 1.22 )ng/L,( 10.53 ± 2.14)ng/L,( 12.45 ± 2.03 )ng/L vs( 1.31 ± 0.04)ng/L,P ＜ 0.05 ].And there was significant difference on TNF-α,IL-6 and IL-10 between group A and group B( F =7.889,3.554,5.443,respectively,P ＜0.05).ConclusionCompared with general anesthesia group,combined general and epidural anesthesia group can ensure hemodynamic stability of elderly patients during peroperative period very well and can reduce the releasing of inflammatory cytokins,it is a viable and an ideal method.
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ObjectiveTo explore two different anesthesia methods on hemodynamics and the quality of palinesthesia in elderly patients during peroperative period.Methods Sixty elderly patients with Hip Replacement( ASA,Ⅰ,Ⅱ ) were randomly divided into general anesthesia group ( group A,n =30 ) and combined general and epidural anesthesia group( group B,n =30).The changes of mean arterial pressure(MAP)and heart rate( HR ) were monitored before induction of anesthesia( T1 ),at intubation( T2 ),during skin incision (T3) and at the time of extubation ( T4 ),at 30 min after extubation ( T5 ) and at the same time,the dosage of general anesthetics and each index's time after operation to awake were recorded of the patients in both groups.ResultsThe MAP and HR of patients in two groups at T2,T3,T4,T5 were all increased when compared with T1.And the increasing degree of MAP and HR in group A were higher than that in group B ( MAP:within group F =17.352,interaction F =4.326,between groups F =8.652; HR:within group F =11.561,interaction F =5.241 between groups F =7.248; P ＜ 0.05 ).The dosage of general anesthetics was significantly different between two groups[ sevoflurane:(1.40 ± 0.30)MAC vs (1.00 ± 0.12 )MAC,t =0.37,P＜0.05 ; fentanyl:(0.34 ±0.08)mg vs(0.18 ±0.03) mg,t =0.21,P ＜0.05 ; vecuronium:(6.20 ±0.32) mg vs(4.10 ±0.31 ) mg,t =1.24,P ＜0.05 ; propofol:(448 ±24) mg vs(393 ±26) mg,t =3.46,P ＜0.05].There was significant difference on gag reflex time [ ( 18.00 ± 1.27 ) min vs ( 12.31 ± 2.54 ) min,t =2.74,P ＜ 0.05 ],time to extubation [ ( 24.03 ± 2.42 ) min vs ( 16.05 ± 1.20 ) min,t =3.68,P ＜ 0.05 ],fully awake time [(29.54±5.24)min vs(19.25±2.64)min,t=1.35,P＜0.05] between these two groups.ConclusionThe two different anesthesia methods can ensure haemodynamic stability of elderly patients undergoing hip replacement during peroperative period.But compared with general anesthesia group,combined general and epidural anesthesia group can reduce the dosage of general anesthetics and shorten the time of extubation significantly,it is a viable and an ideal method.
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BACKGROUND: This study was conducted to investigate risk factors for perioperative periods between general anesthesia (GA group) and thoracic epidural blockade combined with general anesthesia (CEA group) for consecutive hepatic resections. METHODS: A retrospective chart review was carried out regarding 85 patients who had undergone hepatic resections. We compared the effects of postoperative pain control in the two groups, including pulmonary complications and durations of hospital stay. RESULTS: There was no significant difference in demographic data between the two groups. The perioperative fluid requirement and transfusions were lower in the CEA group. Supplemental analgesics requirement was significantly lower in the CEA group than the GA group in the 3 days postoperatively. There were no statistical difference between the two groups in nausea, vomiting, urticaria, constipation or urinary retention, but hypotension was more pronounced in the CEA group than the GA group. Postoperative pulmonary and surgical complications were similar between the two groups, but the duration of hospital stay was longer in the GA group than the CEA group. CONCLUSIONS: We conclude that the thoracic epidural blockade combined with general anesthesia provided lower surgical blood loss and better postoperative analgesia and hospital stay than general anesthesia for hepatic resections.
Subject(s)
Humans , Analgesia , Analgesics , Anesthesia, General , Blood Loss, Surgical , Constipation , Hepatectomy , Hypotension , Length of Stay , Nausea , Pain, Postoperative , Perioperative Period , Retrospective Studies , Risk Factors , Urinary Retention , Urticaria , VomitingABSTRACT
Objective To investigate the effect of various adjunctive drugs in patients undergoing abdominal surgery under epidural anesthesia. Methods 60 ASA Ⅱ～Ⅲ patients scheduled for elective abdominal surgery were randomly divided into four groups: Group PP, promethazine 50mg + ephedrine 100mg as one unit; Group DF, droperidol 5mg + fantanyl 0.1mg as one unit; Group MP, midazolam 5mg + pethidine 100mg as one unit; Group MF, midazolam 5mg + fantanyl 0.1mg as one unit. All the drugs were intravenously administered 10 min after the first dose of epidural block. The dose of various combinations was selected to reach sedation degree of Ramsay 4. The blood pressure, heart rate and SpO_2 were monitored, the degree of sedation and the side-effects were recorded during the operation. The patients were postoperatively surveyed to evaluate the degree of amnesia and satisfaction of anesthesia. Results No significant differences in hears rate and SpO_2 were found among the four groups. In group DF there was marked influence on the blood pressure. The time needed to reaching Ramsay 4 degree of sedation in MP group (1.49?1.13min) and MF group (1.64?0.96min) was significantly shorter than that in group PP (4.36?2.11min) and group DF (4.97?2.65min) (P≤0.01). An obvious difference was found in the incidence of responses to surgical exploration. There was a higher risk of glossoptosis in groups MP and MF than in other groups. Conclusion Midazolam combined with fentanyl or ephedrine is the most effective combination to supplement epidural anesthesia for abdominal operations.
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BACKGROUND: The C7-T1 interspinous space is commonly chosen for cervical epidural blockade, usually regarding the vertebral prominence as C7. But determining the vertebral prominence itself is confusing and unreliable because of individual variances. For this reason, we decided to look into the accuracy of estimating segmental level from palpating the surface anatomy. METHODS: 1. When the neck was flexed in the sitting position, cervical spinous processes were palpated and the first and most prominent spinous processes were marked. 2. In the same position, the estimated location of the C7 vertebral spinous process was marked, counting cephalads from the lower end of scapular (known to be at the T7 level, customarily). 3. By using the radiologic imaging method, actual cervical vertebral levels were confirmed and the results were compared with the vertebral spinous processes palpated and marked by the above methods. RESULTS: The first prominent spinous process was most commonly the C6 spinous process in both male and female subjects. The most prominent spinous processes palpated were C7 in males and C6 in females in the largest number of subjects. Estimates from the lower end of the scapular were correct in only 47.2% of cases. CONCLUSIONS: Because of considerable individual variances, estimates from the surface references can be incorrect in many circumstances, and radiologic imaging methods are suggested for the correct determination of the cervical vertebral levels.
Subject(s)
Female , Humans , Male , Neck , PalpationABSTRACT
BACKGROUND: The C7-T1 interspinous space is commonly chosen for cervical epidural blockade, usually regarding the vertebral prominence as C7. But determining the vertebral prominence itself is confusing and unreliable because of individual variances. For this reason, we decided to look into the accuracy of estimating segmental level from palpating the surface anatomy. METHODS: 1. When the neck was flexed in the sitting position, cervical spinous processes were palpated and the first and most prominent spinous processes were marked. 2. In the same position, the estimated location of the C7 vertebral spinous process was marked, counting cephalads from the lower end of scapular (known to be at the T7 level, customarily). 3. By using the radiologic imaging method, actual cervical vertebral levels were confirmed and the results were compared with the vertebral spinous processes palpated and marked by the above methods. RESULTS: The first prominent spinous process was most commonly the C6 spinous process in both male and female subjects. The most prominent spinous processes palpated were C7 in males and C6 in females in the largest number of subjects. Estimates from the lower end of the scapular were correct in only 47.2% of cases. CONCLUSIONS: Because of considerable individual variances, estimates from the surface references can be incorrect in many circumstances, and radiologic imaging methods are suggested for the correct determination of the cervical vertebral levels.
Subject(s)
Female , Humans , Male , Neck , PalpationABSTRACT
BACKGROUND: Postherpetic neuralgia is usually defined as pain persisting for more than one month after the onset of the eruption of herpes zoster, although there is a overlap between this and the pain of the acute zoster. Many approaches have been proposed to treat postherpetic neuralgia, however, it remains a source of frustration for both patients and physicians. OBJECTIVE: The purpose of this study was to determine more precisely the relationship between the effects of continuous epidural blockade and the time of treatment on postherpetic neuralgia. METHODS: We analyzed the results of 5 patients with postherpetic neuralgia for whom continuous epidural blockade was performed within 1 month after the onset of postherpetic neuralgia, and compared them with the results of 5 patients for whom continuous epidural blockade was performed after 1 month after the onset of postherpetic neuralgia. RESULTS: Continuous epidural blockade performed within 1 month after the onset of postherpetic neuralgia reduced pain significantly, compared to the results of continuous epidural blockade performed after 1 month after the onset of postherpetic neuralgia. CONCLUSION: Continuous epidural blockade performed within 1 month after the onset of postherpetic neuralgia may be the treatment of choice for the pain.