RESUMEN
Objective To compare the analgesic effect and motor function of epidural analgesia and continuous adductor canal block in the elderly patients with internal malleolus fracture,in order to provide a reference for the choice of postoperative analgesia.Methods A total of 80 patients aged 65-74 years were enrolled in this study.They were randomly divided into adductor canal block group (T group,n =40) and epidural block group (C group,n =40) by computer random software.The T group underwent laryngeal mask intubation with general anesthesia + ultrasound guided transnasal saphenous nerve block.The C group underwent epidural anesthesia.The systolic blood pressure (SBP),diastolic blood pressure (DBP) and heart rate (HR) were measured before anesthesia (T0),10 minutes after anesthesia (T1),30 minutes after operation (T2),before leaving OR (T3).Visual analogue (VAS) was recorded immediately before leaving OR,2h,6h,12h,24h and 48h after operation.The incidence of complications such as hypotension,ephedrine use,postoperative urinary retention and other anesthesia-related complications were also recorded.Results The SBP and DBP were significantly higher in the T group at T1,T2 and T3 than those in group C (t =5.069,3.087,3.019,5.659,2.744,2.254,all P ＜ O.05).The HR was lower in the T group at T1 and T2 than those in the C group (t =4.138,3.797,all P ＜ 0.05).There were no statistically significant differences in VAS between the two groups at 2h,6h,12h,24h and 48h postoperatively (all P ＞ 0.05).The incidence of intraoperative hypotension (7 cases),ephedrine use (6 cases) and postoperative urina-ry retention (12 cases) were significantly higher in the C group than those in the T group (0 cases,O cases,1 cases,x2 =11.11,P ＜0.05).Conclusion Compared with epidural anesthesia,ultrasound-guided adductor canal block anesthesia can maintain hemodynamics stability in elderly patients with internal malleolus fracture,it can provide the same analgesic effect as epidural analgesia,and has no effect on the motor function of the contra lateral limbs and can reduce the risk of postoperative complications.
RESUMEN
Complications related to tracheal intuation are many, but intubation granuloma is a rare complication. The authors experienced a case of recurrent intubation granulomas in spite of removal of granuloma with CO2 LASER under suspension laryngosoopy. We used neuroleptic analgesia for the third operation in order to avoid tracheal intubation. The result was excellent after the third operation, and there was no recurrence noted for 8 months.