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Objective To analyze the influence of topographic anatomy on brachial plexus block anesthesia, and to provide reference for clinical research and application. Methods Total of 20 cadavers were selected and located through the modified method of inferior brachial plexus block of the coracoid process. The nerve blocking points were marked with blue dye, and the nerve concentration sites and marking points were dissected and exposed at the same time. The anatomical relationship between nerve concentration points and body surface markers were explored. Results The distances from the upper margin of the left centralization to the midpoint of the subclavian border, the inferior margin of the sternoclavicular joint, the shoulder peak and the inferior edge of the coracoid process were (3. 62±0. 24) cm, ( 10. 39± 0.25) cm, (6. 67 ±0.18) cm and (2. 80±0.19) cm, respectively. The distances from the upper edge of the right centralization to the midpoint of the subclavian border, the inferior margin of the sternoclavicular joint, the shoulder peak and the inferior edge of the coracoid process were (4. 24±0. 27) cm, (11. 10±0. 28) cm, (6. 35±0. 19) cm and (3. 03± 0. 15) cm, respectively. Conclusion The application of anatomy improves the accuracy of brachial plexus block, thus improves the effect of brachial plexus block anesthesia, and provides a powerful reference for clinical research and application.
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Objective To investigate the effect of B-guided brachial plexus block anesthesia on postoperative cognitive function and serum neurotrophic factor (NGF) and transforming growth factor-β (TGF-β) levels in children with ulnar and radius fractures.Methods From February 2014 to January 2017,we selected 78 children with ulnar radius fractures in our hospital randomly and divided them into observation group and control group,each group 39 cases.The control group was given brachial plexus block anesthesia under the position of nerve stimulation,and the observation group was subjected to B-guided brachial plexus block anesthesia.Anesthesia-related indicators,anesthetic effects and complications were observed and analyzed between the two groups,and hemodynamics parameters of brachial plexus block after 0.5h,cognitive function and serum NGF and TGF-β levels before and after operation were compared.Results Compared with the control group,anesthesia onset,recovery room stay time in the observation group were shorter and the duration of analgesia was longer (P ＜ 0.05).The excellent and good rate of anesthesia in the observation group 97.44％ (38/39) was higher than that in the control group (76.92％,30/39).The incidence of complications in the observation group 5.12％ (2/39) was much lower than that of the control group (23.08％,9/39,P ＜ 0.05).There was no significant difference in systolic peak velocity between the two groups (P ＞ 0.05).Compared with the control group,the end of the diastolic velocity and blood flow of brachial plexus block after 0.5h were higher,resistance and pulsatility index were lower (P ＜ 0.05).There was no significant difference in preoperative cognitive function,serum NGF and TGF-β levels between the two groups before operation (P ＞ 0.05).After operation,compared with the control group,the cognitive function,serum NGF and TGF-β levels were higher in the observation group (P ＜ 0.05).Conclusion Anesthesia effect of B-guided brachial plexus block anesthesia is significant in children with ulnar radius fractures.The incidence of complications is low,which can significantly improve the ulnar arterial hemodynamics,significantly increased serum NGF,TGF-β levels,contribute to postoperative fracture healing,and will not affect the cognitive function of children after surgery.
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Objective To explore the effect of dexmedetomidine on upper limb surgery during brachial plexus block anesthesia and its influence on cognitive function.MethodsFrom May 2015 to May 2016, 60 cases of elbow joint operation patients were studied.The patients were randomly divided into control group (local anesthesia combined with physiological saline) and observation group (using local anesthesia drugs with dexmedetomidine).The mean arterial pressure and heart rate before and after anesthesia in two groups were compared.The changes of anesthesia and cognitive function, and the incidence of adverse reactions were compared between the two groups.ResultsCompared with before anesthesia, the mean arterial pressure and heart rate were significantly lower in the two groups (P<0.05).The mean arterial pressure and heart rate in the observation group were significantly lower than those in the control group (P<0.05).There was no significant difference between the two groups in the onset time of motor block sensory block, while the observation group was significantly longer than the control group (P<0.05).The control group patients with Ramsay score below 3 points, a total of 4 cases, accounting for the observation group of patients with Ramsay score of less than 3 points, a total of 24 cases, accounting for 80%, the observation group was significantly better than the control group (P<0.05) sedative effect.Compared with before anesthesia, two groups of patients with postoperative 20min MMSE score were lower, but the observation group MMSE score was significantly higher than that of the control group (P<0.05).There was no significant difference in adverse reactions between the two groups.ConclusionIn the following surgery, the use of local anesthesia combined with dexmedetomidine anesthesia can prolong the time of nerve tissue, and can obtain better sedation and pain, and has little effect on the cognitive function of patients.
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OBJECTIVE:To observe the effects of praeruptorin A for brachial plexus block anesthesia in patients receiving up-per extremity fractures surgery. METHODS:68 patients receiving upper extremity fracture surgery were randomly divided into trial group and control group with 34 cases in each group. Trial group was given praeruptorin A 0.2 mg/kg intravenously before brachial plexus block anesthesia,and control group was given equivalent volume of 0.9% sodium chloride injection. The anesthesia induc-tion time,the pain reflex disappearance time and postoperative recovery time were compared between 2 groups,and hemodynamic parameters and RPP were recorded in 2 groups before anesthesia (T0),immediately after anesthesia (T1),5 min after anesthesia (T2),10 min after anesthesia (T3),20 min after anesthesia (T4) . RESULTS:Anesthesia induction time,pain reflex disappear-ance time and postoperative respiratory recovery time in trial group were all significantly shorter than in control group,with statisti-cal significance(P<0.05). SBP,DBP,HR and MAP of trial group were lower than those of control group at T2,T3,T4,with sta-tistical significance(P<0.05). RPP of trial group was significantly lower than that of control group at T1,T2,T3 and T4,with sta-tistical significance (P<0.05). CONCLUSIONS:For brachial plexus anesthesia of upper extremity fractures surgery,preoperative application of praeruptorin A can shorten anesthesia induction time,pain reflex disappearance time and postoperative respiratory re-covery time,and reduce the fluctuation of hemodynamics.
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Objective To explore the application effect and safety of ultrasonic location in interscalene bra-chial plexus block anesthesia.Methods 100 cases with upper extremity orthopedic surgery patients were selected, according to the brachial plexus between the different positioning methods,they were divided into control group and observation group,50 cases in each group,the control group chose the traditional anatomical localization techniques, observation group interscalene under ultrasound guidance brachial plexus block,two groups of anesthesia were com-pared,block success rates and complications were observed.Results The block operation time,anesthesia onset time,duration of analgesia and anesthesia drug dosage of the observation group were (185.5 ±24.86)s,(11.55 ± 2.89)min,(11.42 ±2.39)min,(17.25 ±2.54)mL while the control group were (228.75 ±26.20)s,(16.05 ±4.66)min,(10.95 ±2.83)min,(19.50 ±2.79)mL,there was significant difference between two groups(t =18.34, 10.28,9.72,10.68,all P <0.05).the anesthesia success rate of the observation group was 98%,significantly higher than 88% of the control group,the difference between the two groups was statistically significant(χ2 =9.12,P <0.05).The incidence rate of complications in the observation group was 0,while the control group was 8%,two groups had significant difference in complication rate(χ2 =8.34,P <0.05).Conclusion Ultrasonic location in in-terscalene brachial plexus block anesthesia has a good clinical effect,with high safety,which is worthy of populariza-tion and application.