The regional nerve block technique for anesthesia in elderly patients with traumatic tibia and fibula fractures / 中华老年医学杂志

Objective:To explore the effect of regional nerve block anesthesia for elderly patients with traumatic tibia and fibula fractures.Methods:Ninety-three elderly patients with tibia and fibula fractures undergone surgical treatment were randomly divided into an observation group and a control group, with 47 and 46 patients, respectively, in each group.The control group received general anesthesia and the observation group received a regional nerve block.Results:There was no difference in operative time between the two groups[(42.2±5.4)min and(43.3±5.7)min, t=0.953, P=0.343].The time to recovery of consciousness[(11.2±2.6)min and(14.5±2.8)min, t=5.714, P<0.001]and the volume of intraoperative infusion[(415.6±27.5)ml/L and(686.6±36.3)ml/L, t=40.626, P<0.001]were lower and patients' blood pressure and respiratory rate were also lower at skin incision, fracture fixation, end of surgery and 30 min after surgery in the observation group than in the control group.The levels of Glu, IL-6 and COR were higher than those in the control group(all P<0.05).The incidence of complications was 2.13% in the observation group and 15.22% in the control group( χ2=5.07, P<0.05). Conclusions:Elderly patients with traumatic tibia and fibula fractures receive beneficial anesthetic effects with the regional nerve block technique, with stable hemodynamics, mild stress response and minor adverse reactions.

Iliocostalis Plane Block in Analgesia for Video-assisted Thoractomy:Report of One Case / 中国医学科学院学报

Interfascial plane block is a quick,safe and simple technique that offers effective analgesia for video-assisted thoracotomy.However,the currently described methods still have certain limitations.We explored the application of a novel interfascial plane block method-iliocostal plane block in video-assisted thoracotomy,along with the use of stained cadaveric anatomy,with an attempt to shed new light on the analgesia for video-assisted thoracotomy.

Effect of Regional Nerve Block in Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: The goal of this study is to evaluate the efficacy of femoral, obturator, and sciatic nerve regional blocks with using ropivacaine during total knee arthroplasty. MATERIALS AND METHODS: As a prospective study, we performed total knee arthroplasty for 383 patients from Oct. 2004 to Feb. 2009. There was 139 cases of femoral and obturator nerve regional block, 123 cases of femoral, obturator, and sciatic nerve regional block, and 121 cases of lidocaine local anesthesia at the synovium and subcutaneous tissue during wound closure. All the femoral nerve block cases used a femoral catheter for an additional ropivacaine injection at 10 hours after surgery. The pain was examined using a visual analogue scale (VAS). The VAS scores were checked on the day of surgery and at post operative 24 hours, 48 hours and 6 days. The pain control effects among the 3 groups were compared with one-way ANOVA test and Scheffe`s multiple comparison test. RESULTS: The mean postoperative VAS score on the day of surgery and at post operative 24 hours, 48 hours and 6 days in the femoral and obturator nerve block group, were 6.3, 5.6, 5.3, and 4.7, respectively. For the cases of femoral, obturator and sciatic nerve block, the VAS scores were 3.9, 4.3, 3.5 and 1.9, respectively, and the VAS scores in the lidocaine local anesthetic group were 7.1, 6.1, 5.8 and 5.2, respectively. There was a statistical significance in all three groups (p<.0001), and the additional sciatic nerve block groups had significant effectiveness. CONCLUSION: Pain control with the ropivacaine regional nerve block is more effective than the lidocaine local anesthesia, and additional sciatic nerve block is a important factor for decreasing the postoperative pain after total knee arthroplasty.

Anesthetic Management for Awake Craniotomy with Scalp Nerve Block and Propofol/Fentanyl Infusion / 대한마취과학회지

BACKGROUND: If epileptogenic foci are close to eloquent areas of the brain, awakening is needed for functional mapping during seizure surgery. In these cases adequate analgesia and sedation are needed. However sufficient dosage of intravenous anesthetics leads to many side effects. The authors used propofol and fentanyl infusion combined with scalp nerve block to reduce the severity of side effects from overdose of anesthetics. METHODS: The subjects were adult patients who would undergo awake craniotomy. After administering fentanyl 50~100 mcg intravenously, scalp nerve block was done to supraorbital, supratrochlear, auriculotemporal and lesser and greater occipital nerves of the surgical side with 0.25% bupivacaine containing 1 : 200,000 epinephrine. The anterior temporal region was infiltrated with the same local anesthetics. Oxygen was given by nasal cannula. During operation fentanyl was infused. Propofol was infused except during the awake period. Invasive arterial blood pressure, end-tidal CO2 and respiratory rate were monitored throughout the operation and arterial blood gas analysis was done intermittently. RESULTS: During total anesthesia time (410.3 39.9 min) propofol 16.2 6.3 mg/kg and fentanyl 11.9 3.7 mcg/kg were administered. The results of scalp nerve block were satisfactory. Brain swelling and transient decrease in respiratory rate were noticed in six patients and oxygen desaturation to 94% in one patient. All the patients were cooperative and the above problems were solved by reducing drug infusion rates. CONCLUSIONS: Propofol and fentanyl infusion with scalp nerve block may be an adequate method of anesthetic management for awake craniotomy.