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Objective To compare the effect of continuous saphenous nerve block (SNB)with femoral nerve block (FNB)under multimodal analgesia for early analgesic effect and rehabilitation af-ter total knee replacement (TKA).Methods Sixty patients scheduled to undergo TKA,23 males and 37 females,were randomly divided into two groups:group A (continuous SNB)and group B (contin-uous FNB ).The patients received PCA after surgery by the catheter placed near nerve with ultrasound-guided.The loading dose was 0.5% ropivacaine 25 ml and 0.1 mg epinephrine,back-ground dose was 5 ml/h,bolus dose was 5 ml and the locking time was 20 min.The first time to walk and total steps,the knee joint range of motion,postoperative hospital stay,general anesthetics and additional analgesics dose and the side effects were also recorded.Results The first time to walkand walking distancein group A were better than group B [(25.4±2.1)h vs (34.0±2.7)h,(7.6±1.8) steps vs (3.7±1.3)steps,(P<0.05)].The range of motion in group A was bigger than in group B [12 h:(75.8±4.3)°vs (65.4±4.7)°,24 h:(93.3±4.2)°vs (81.8±4.3)°,48 h:(102.1±4.1)° vs (95.1±2.6)°,P<0.05].The average length of postoperative hospital stay was shorter in group A than in group B [(5.3±1.2)d vs (7.4±1.4)d,P<0.05].The additional analgesics and the side effects were similar between the two groups.Conclusion The continuous SNB combined with multi-modal analgesia was more beneficial to patients with the early postoperative rehabilitation for TKA.
RESUMO
Objective To compare the efficacy of different target concentrations of sufentanil target-controlled infusion used to supplement topical anesthesia for fiber-optic bronchoscopy (FOB)-assisted awake nasotracheal intubation in patients with obstructive sleep apnea syndrome (OSAS).Methods Forty-five ASA physical status Ⅱ or Ⅲ patients with OSAS,aged 28-60 yr,with body mass index of 30-40 kg/m2,scheduled for elective surgery,were randomly assigned into 3 groups (n =15 each):control group (group C) and sufentanil with the target plasma concentration of 0.4 ng/ml (group S1) and 0.6 ng/ml groups (group S2).Naso-pharyngeal and laryngeal mucous membrane was sprayed with 2％ lidocaine mixed with 1％ ephedrine for topical anesthesia in both groups.In addition 1％ tetracaine 3 ml was injected into trachea through cricothyroid membrane.FOB-assisted awake nasotracheal intubation was performed after the target concentration was achieved.The degree of airway obstruction was scored during intubation.The highest values of MAP and HR,rate-pressure product ＞ 12 000,decreased respiratory rate and hyoxemia were recorded during the period between induction of anesthesia and 3 min after intubation was completed.The changes in MAP and HR as percent of baseline values were calculated.Before topical anesthesia (T0),when target concentrations were reached (T1),and at 1 and 3 min after intubation (T2,3),blood samples were taken to determine the plasma concentrations of epinephrine (E),norepinephrine (NE) and cortisol.Results Compared with group C,the airway obstruction score was significantly decreased in group S1,the incidence of changes in MAP and HR ＞ 30％ of baseline values and rate-pressure product ＞ 12 000 was decreased,the plasma concentrations of E,NE and cortisol were decreased in S1 and S2 groups,and the incidence of the respiratory rate was decreased and hypoxemia was increased in group S2 (P ＜ 0.05).Compared with group S1,the airway obstruction score were significantly decreased,and the incidence of respiratory rate was decreased and hypoxemia was increased in group S2 (P ＜ 0.05).Compared with the baseline value at T0,the plasma concentrations of E,NE and cortisol were significantly increased at T2,3 in group C,while decreased at T1 in S1 and S2 groups (P ＜ 0.05).Conclusion Compared with pure topical anesthesia,sufentanil with the target plasma concentration of 0.4 ng/ml does not induce respiratory depression,maintains hemodynamics stable,attenuates the stress responses and provides better intubation conditions when used to supplement topical anesthesia for FOB-assisted awake nasotracheal intubation in patients with OSAS.