RESUMO
Objective:To compare the effects of ultrasound-guided dynamic needle tip positioning (DNTP) and long axis in-plane (LAX-IP) techniques for axillary vein puncture and catheterization.Methods:One hundred Society of Anesthesiologists physical statusⅠ-Ⅲ patients of both sexes, aged 18-64 yr, with body mass index of 20-28 kg/m 2, scheduled for elective axillary vein cannulation, were divided into 2 groups ( n=49 each) using the random number table method: DNTP group and LAX-IP group.Axillary vein puncture was performed using DNTP technique and LAX-IP technique under ultrasound guidance in DNTP group and LAX-IP group, respectively.Successful puncture at first attempt, overall successful catheterization, the number of needle tip redirection, and axillary vein puncture time and catheterization time were recorded.The occurrence of complications such as axillary artery puncture, posterior wall penetration of axillary vein, hematoma formation, pneumothorax, and nerve injury was recorded. Results:Compared with group LAX-IP, the success rate of puncture at first attempt was significantly increased, the number of cases required needle redirection was decreased, and the puncture time was shortened ( P<0.05), and no significant change was found in the logarithm of the posterior wall penetration of axillary vein in group DNTP ( P>0.05). No complications such as arterial puncture, hematoma, pneumothorax, or nerve injury occurred in two groups. Conclusions:Compared with LAX-IP technique, ultrasound-guided DNTP technique can dynamically observe the position of the needle tip, the operation is simple and safe, and it is worthy of clinical promotion when used for axillary vein puncture and cannulation.
RESUMO
Objective:To evaluate the analgesic efficacy of pericapsular nerve group (PENG) block in elderly patients undergoing hip replacement under subarachnoid block.Methods:Fifty patients of both sexes, aged 65-89 yr, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with body mass index 20-30 kg/m 2, undergoing unilateral hip arthroplasty, were divided into 2 groups ( n=25 each) by a random number table method: PENG group and fascia iliaca compartment block (FICB) group.In PENG group, 0.4% ropivacaine hydrochloride 20 ml was injected around the nerve innervating the hip joint capsule under ultrasound guidance.In FICB group, 0.4% ropivacaine 30 ml was injected around the nerve innervating the fascia iliaca compartment under ultrasound guidance.Subarachnoid block was performed in both groups.Visual analog scale scores and scores for satisfaction with analgesia at rest and during activity were recorded before blockade (T 0), at 10, 20 and 30 min after blockade (T 1-3) and when placed in the position for spinal anesthesia (T 4). The cumulative consumption of sufentanil, effective pressing times of analgesic pump, and development of related complications were recorded at 6, 12, 24 and 48 h after operation (T 5-8). Results:Compared with FICB group, the VAS scores at rest and during activity were significantly decreased at T 1-4, and scores for satisfaction with analgesia during activity were increased in PENG group ( P<0.05). There was no significant difference between the two groups in the cumulative consumption of sufentanil and effective pressing times of analgesic pump ( P>0.05). One patient developed postoperative delirium in group FICB, and no patients developed puncture site infection and nerve damage after operation in two groups. Conclusion:PENG block produces better analgesic efficacy than FICB when used for elderly patients undergoing hip replacement under subarachnoid block.