Effects of ultrasound-guided erector spinae plane block on analgesic dosage, lumbar function and pain in patients undergoing percutaneous kyphoplasty / 中国基层医药

Objective:To investigate the effects of ultrasound-guided erector spinae plane block on analgesic dosage, lumbar function and pain in patients undergoing percutaneous kyphoplasty.Methods:A total of 100 patients who underwent percutaneous kyphoplasty in Hangzhou Cancer Hospital from November 2018 to October 2021 were included in this study. They were randomly assigned to undergo either local infiltration anesthesia (control group, n = 50) or ultrasound-guided erector spinae plane block (observation group, n = 50). Analgesic dosages, pain status at different phases (Visual Analogue Scale score) and lumbar function (Oswestry Disability Index score), intraoperative and postoperative conditions (operative time, time to get out of bed, time to first exhaust), and the incidence of adverse reactions were compared between the two groups. Results:At 24 and 48 hours after surgery, the amount of analgesics infused in the observation group was (24.54 ± 2.52) mL and (55.68 ± 5.61) mL, respectively, and the number of analgesic pump pressings was (1.01 ± 0.26) times and (3.15 ± 1.02) times, which were significantly lower than those in the control group [amount of analgesics infused at 24 and 48 hours after surgery: (32.78 ± 3.31) mL, (62.57 ± 6.42) mL; the number of analgesic pump pressings at 24 and 48 hours after surgery: (6.42 ± 1.53) times, (10.78 ± 2.45) times, t = 14.00, 5.71, 24.65, 20.33, all P < 0.001]. Visual Analogue Scale score at the time at which the balloon was pressurized and expanded in the observation group was significantly lower than that in the control group [(4.10 ± 0.87) points vs. (4.65 ± 1.01) points, t = 2.92, P < 0.05]. At 1 day and 1 month after surgery, Oswestry Disability Index score in the observation group was (18.37 ± 2.78) points and (12.15 ± 2.02) points, respectively, which were lower than (23.56 ± 3.42) points and (17.53 ± 2.34) points in the control group ( t = 8.33, 12.31, both P < 0.05). The time to get out of bed and the time to first exhaust in the observation group were (9.12 ± 2.54) days and (23.56 ± 4.56) hours, respectively, which were significantly shorter than those in the control group [(11.64 ± 3.12) days, (28.14 ± 5.12) hours, t = 4.43, 4.72, both P < 0.001). There was no significant difference in the incidence of adverse reactions between the two groups ( P > 0.05). Conclusion:Ultrasound-guided erector spinae plane block for percutaneous kyphoplasty can effectively ameliorate lumbar spine function, reduce postoperative pain, and facilitate postoperative recovery, without affecting the dosage of narcotics and analgesics. The method is safe and effective.

Influence of apical preparation size and final irrigation protocol on the debridement of oval root canals

Abstract This study assessed the influence of apical preparation size and final irrigation protocol on the debridement of the apical third of oval root canals of mandibular molars. Seventy-seven distal roots were divided into 7 groups (n = 11): Control: without instrumentation or irrigation; Group 30CI: ProTaper Next (up to size 30; PTN) + conventional irrigation (CI); Group 30UAI: PTN + ultrasonically activated irrigation (UAI); Group 30XPF: PTN + XP-endo Finisher (XPF); Group 40CI: PTN + ProDesign Logic (up to size 40; PDL) + CI; Group 40UAI: PTN + PDL + UAI; and Group 40XPF: PTN + PDL + XPF. The total volume of irrigating solutions used per root canal in all the experimental groups was 33 mL of 2.5% sodium hypochlorite (NaOCl) and 6 mL of 17% ethylenediaminetetraacetic acid (EDTA). After specimen processing and histological analysis under a digital microscope (100x), the percentages of untouched canal walls (UCW) and remaining debris (RD) were assessed using Image J software. A descriptive and exploratory analysis was conducted, indicating that the data failed to meet the assumptions of an analysis of variance. Therefore, generalized linear models were used to assess the effects of the different instrumentation and irrigation protocols, as well as the interaction among them, on the percentage of UCW and RD. No significant difference was found among the irrigation protocols regarding the percentage of UCW, irrespective of apical preparation size (p>0.05). However, UCW and RD were significantly lower in groups 40CI, 40UAI and 40XPF than in groups 30CI, 30UAI and 30XPF (p<0.05). The percentage of RD was significantly lower in the UAI and XPF groups than in the CI groups, irrespective of apical preparation size (p<0.05). The difference between preparation sizes 30 and 40, with respect to RD, was higher when CI was used (p<0.05). In conclusion, instrumentation up to apical preparation size 40 resulted in lower percentages of UCW and RD than up to apical preparation size 30. Use of UAI or XPF resulted in lower percentages of RD than CI.

Resumo Este estudo avaliou a influência do tamanho do preparo apical e do protocolo de irrigação final sobre o debridamento do terço apical de canais radiculares ovais de molares inferiores. Setenta e sete raízes distais foram selecionadas e divididas em 7 grupos (n = 11): Grupo controle: sem instrumentação nem irrigação; Grupo 30IC, ProTaper Next (até o tamanho 30; PTN) + irrigação convencional (IC); Grupo 30IAU, PTN + irrigação ativada ultrassonicamente (IAU); Grupo 30XPF, PTN + XP-endo Finisher (XPF); Grupo 40IC, PTN + ProDesign Logic (até o tamanho 40; PDL) + IC; Grupo 40IAU, PTN + PDL + IAU; e Grupo 40XPF, PTN + PDL + XPF. Os volumes totais dos irrigantes utilizados por canal radicular em todos os grupos experimentais foram 33 mL de hipoclorito de sódio (NaOCl) a 2,5% e 6 mL de ácido etilenodiamino tetracético (EDTA) a 17%. Após o processamento dos espécimes e a análise das secções histológicas sob um microscópio digital (100x), as porcentagens de paredes não instrumentadas (PNI) e detritos remanescentes (DR) foram avaliadas utilizando-se o software Image J. Uma análise descritiva e exploratória foi realizada, indicando que os dados não atenderam aos pressupostos de uma análise de variância. Modelos lineares generalizados foram, portanto, utilizados para avaliar os efeitos dos diferentes protocolos de instrumentação e irrigação, bem como da interação entre eles, sobre as porcentagens de PNI e DR. Não houve diferença significativa entre os protocolos de irrigação final quanto à porcentagem de PNI, independentemente do tamanho do preparo apical (p>0,05). Entretanto, as porcentagens de PNI e DR foram significativamente menores nos grupos 40IC, 40IAU e 40XPF do que nos grupos 30IC, 30IAU e 30XPF (p<0,05). A porcentagem de DR foi significativamente menor nos grupos em que se utilizou a IAU ou o XPF do que naqueles em que se utilizou a IC, independentemente do tamanho do preparo apical (p<0,05). A diferença entre os tamanhos de preparo apical 30 e 40 com relação aos DR foi maior quando se utilizou a IC (p<0,05). Concluiu-se que a instrumentação até um preparo apical de tamanho 40 resultou em menores porcentagens de PNI e DR do que até um preparo apical de tamanho 30. A utilização da IAU ou do XPF resultou em uma menor porcentagem de DR do que a utilização da IC.

Ultrasound-guided reduction and percutaneous crossed pin fixation for the treatment of displaced supracondylar fracture of the humerus in children / 中国骨伤

OBJECTIVE@#To investigate the effect of ultrasound guided reduction and exploration of ulnar nerve position and percutaneous crossed pin fixation for the treatment of displaced supracondylar fracture of the humerus in children.@*METHODS@#The clinical data of 45 patients with displaced supracondylar fracture of humerus from December 2017 to December 2018 were analyzed retrospectively, including 26 boys and 19 girls, ranging in age from 1 year and 3 months to 11 years and 4 months, with an average of 7.6 years old;44 cases of crashing injury, 1 case of falling injury;29 cases on the left side, 16 cases on the right side;12 patients classified to Gartland typeⅡand 33 patients classified to Gartlandtype Ⅲ. The operation was performed from 4 h to 7 d after injury, with an average of 2.5 d. There were no neurological and vascular injuries occurred in the children. Ultrasound was used to guide the fracture reduction of the child, and the cross-needle was fixed. In the medial needle insertion, the ulnar nerve position was detected by ultrasound to avoid damage to the ulnar nerve. The ulnar nerve state was observed during operation. The clinical function evaluation criteria of Flynn was used at the latest follow-up. The evaluation criteria was used to evaluate the functional and aesthetic characteristics of the elbow joints of the children, and to observe the complications such as ulnar nerve injury after operation.@*RESULTS@#Ultrasound was used to detect the fracture from the medial side of the elbow, the lateral aspect of the elbow and the sagittal plane of the elbow. The position of the ulnar nerve could be clearly explored to avoid ulnar nerve injury when the needle was inserted inside. All children were followed up, and the duration ranged from 6 to 12 months, with an average of 9 months. None of the patients had a loss of repositioning and the fractures healed. The healing time ranged from 4 to 6 weeks, with an average of 5 weeks. At the latest follow-up, according to Flynn's evaluation criteria:compared with the healthy side, 41 patients with flexion and extension limitation were 0° to 5°, clinically evaluated as excellent;3 patients with flexion and extension limitation were 6° to 10°, clinically evaluated as good;1 patient with flexion and extension limitation was 11° to 15°, clinically evaluated as acceptable. Compared with the healthy side, 40 patients lost 0° to 5°of the angle, and 5 patients lost 6° to 10°of the angle. There were no complications such as ulnar nerve injury and cubitus varus.@*CONCLUSION@#Although ultrasound-guided treatment of displaced supracondylar fracture of the humerus in children has higher requirements for the operator at present, because of its advantages of clear development, portability, effectiveness and no impact on health, it could clearly explorethe fracture situation during the operation, guide the reduction of the fracture, and accurately show the position of the ulnar nerve, effectively improve the safety of the medial puncture, so as to minimize the complications The occurrence of the disease. Therefore, the treatment of displaced supracondylar fracture of humerus with ultrasound-guided manual reduction and percutaneous cross needle fixation is effective and worthy of further promotion.

Effectiveness of harmonic scalpel in patients submitted to total thyroidectomy: systematic review with meta-analysis

SUMMARY OBJECTIVE: The objective of this study was to evaluate the efficacy and safety of the harmonic scalpel compared to the conventional technique in patients submitted to total thyroidectomy. METHOD: This is a systematic review with inclusion of randomized controlled trials (RCTs) that compared both techniques. An electronic search was carried out in the Medline and Lilacs databases until June 2017. The outcomes analysed were operation time, intraoperative bleeding, surgical morbidity, and costs. RESULTS: Data from 31 primary studies were included. The use of the harmonic scalpel correlates to a shorter operation time (p <0.001) and a lower volume of intraoperative bleeding (p <0.001). There were no differences in the risk of transient (p = 0.53) and permanent (p = 0.70) hypocalcaemia, transient (p = 0.61) and permanent (p = 0.50) dysfunctions of the inferior laryngeal nerve and hematoma (p = 0.14). CONCLUSION: Total thyroidectomy using a harmonic scalpel is effective and safe compared to the conventional technique.

Laparoscopic ultrasonography in difficult place right laparoscopic hepatectomy / 中华普通外科杂志

Objective To evaluate the role of laparoscopic ultrasonography (LUS) in difficult place laparoscopic hepatectomy of the right liver.Methods The data of 7 patients undergoing laparoscopic hepatectomy with tumor in the difficult location of the right liver in our hospital between Jun 2015 and Aug 2017 were retrospectively analyzed.LUS was used during all the operations in order to investigate the anatomy of the operations,determine the tumor stage and guide the incision margin of tumor.It was conventionally used to detect the relationship between the lesions and peripheral intrahepatic vessels and ducts.Results Seven cases underwent successful laparoscopic hepatectomy.The mean operative time was (121 ± 50) min,average intraoperative blood loss was (301 ± 122) ml,and there was no operative mortality.Mean hospital stay was (7.1 ± 1.2) d.One suffered biliary leakage and was cured by conservative treatment.Conclusions Laparoscopic ultrasound can determine tumor location and guide the operative route,increasing safety of laparoscopic hepatectomy.