Résumé
Objective:To compare the efficacy of superior trunk block (STB) versus interscalene brachial plexus block (ISB) in the patients undergoing arthroscopic shoulder surgery with general anesthesia.Methods:Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 18-70 yr, undergoing elective arthroscopic shoulder surgery, were divided into 2 groups ( n=30 each) using a random number table method: ISB plus general anesthesia group (group IG) and STB plus general anesthesia group (group SG). In group IG and group SG, 0.375% ropiacaine 15 ml was injected around C 5-C 6 nerve roots and superior trunk, respectively.SpO 2, diaphragmatic excursion, diaphragmatic paralysis, dyspnea and Horner syndrome were recorded at 30 min after injection.General anesthesia with tracheal intubation was then performed in all the patients, and remifentanil or phenylephrine was used to maintain hemodynamics stable.The use of remifentanil was recorded at the end of operation, the visual analogue scale score was performed after patients regained consciousness, and the duration of sensory and motor blockade was recorded at 24 h after operation. Results:Compared with group IG, the decrease in the amplitude of SpO 2 was significantly decreased, and diaphragmatic excursion was increased, the incidence and degree of diaphragmatic paralysis were decreased, duration of sensory blockade was prolonged, the incidence of Horner syndrome and dyspnea was decreased ( P<0.05), and no significant change was found in the requirement for remifentanil, postoperative visual analogue scale score, and duration of motor blockade in group SG ( P>0.05). Conclusion:STB not only provides better perioperative analgesia, but also reduces the incidence of diaphragmatic paralysis when compared with ISB in the patients undergoing arthroscopic shoulder surgery with general anesthesia.
Résumé
Objective@#To investigate the anesthetic effect of the iliac fascia gap block in patients with senile femoral intertrochanteric fractures and its effect on stress indicators.@*Methods@#A total of 100 elderly patients with intertrochanteric fractures were selected and randomly divided into control group(n=50) and observation group(n=50) by digital table.The control group was treated with general anesthesia.The observation group was anesthetized with iliac fascia gap block on the basis of the control group.The levels of norepinephrine(NE), epinephrine(E) and cortisol(Cor) were measured by double antibody radioimmunoassay.The effects of anesthesia and stress indicators of the patients were compared.@*Results@#The dosages of propofol and remifentanil in the observation group were (721.21±21.24)mg and (421.25±8.94)μg, respectively, which were less than those in the control group [(946.46±24.35)mg and (545.42±9.13)μg, t=18.832, 19.231, P<0.05]. The time of extubation, the recovery time of anesthesia and agitation score in the observation group were (12.31±0.94)min, (16.43±1.21)min and (1.64±0.39)points, which were significantly lower than those in the control group[(18.43±1.21)min, (24.34±1.43)min, (2.54±0.64)points, t=21.124, 18.432, 19.831, all P<0.05]. Before anesthesia, there were no statistically significant differences in stress indicators and VAS score between the two groups (all P>0.05). The NE, E, Cor levels at 24h after operation had no statistically significant differences between the two groups (all P>0.05). The postoperative 24h VAS scores in the two groups were lower than those after extubation and before anesthesia(t=14.395, 13.882, 19.662, 12.501, all P<0.05). After anesthesia, the levels of NE, E Cor and VAS score in the observation group were (0.61±0.08)μg/L, (0.07±0.02)μg/L, (112.5±20.51)μg/L and (5.64±0.46)points, respectively, which were significantly lower than those in the control group [(0.84±0.12)μg/L, (0.98±0.06)μg/L, (178.42±29.49)μg/L, (6.75±0.49)points, t=10.773, 12.507, 11.295, 15.774, all P<0.05]. The incidence rate of adverse reaction of the observation group was 8.00%, which was lower than 6.00% of the control group, but the difference was not statistically significant(P>0.05).@*Conclusion@#The use of iliac fascia gap blockage in elderly patients with intertrochanteric fractures is effective and can reduce the dose of anesthetic drugs, reduce perioperative stress response, and does not increase the incidence of adverse reactions, it is worthy of application.
Résumé
Objective To compare adductor canal block(ACB)with topical anesthesia for postoperative analgesia in the patients undergoing arthroscopic knee surgery.Methods Sixty patients of both sexes,aged 18-64 yr,with body mass index of 18-30 kg/m2,of American Society of Anesthesiologists physical status ⅠorⅡ,scheduled for elective arthroscopic meniscectomy,were divided into 2 groups (n=30 each) using a random number table:ACB group and topical anesthesia group(TA group).In group ACB,0.2% ropivacaine 20 ml was injected into the adductor canal under the guidance of ultrasound at 30 min before operation to perform ACB.In group TA,0.25% ropivacaine 20 ml was injected into the articular cavity at 5 min before the end of operation.The development of effective analgesia (VAS scores ≤4)and weakened quadriceps femoris muscle strength(muscle strength 0-2 grade,post-operative muscle strength was assessed by using manual muscle testing),related complications(local anesthetic intoxication,bleeding at the puncture site and hematoma) and occurrence of postoperative nausea,vomiting and delayed emergence were recorded.Results Compared with group TA,the rate of effective analgesia within 12 h after surgery was significantly increased (P0.05).Local anesthetic intoxication,bleeding at the puncture site,hematoma or delayed emergence was not observed in the two groups.Conclusion ACB produces better efficacy for postoperative analgesia than topical anesthesia in the patients undergoing arthroscopic knee surgery.