Effects of bilateral erector spinae plane block for posterior lumbar spine surgery in elderly patients / 中南大学学报(医学版)

OBJECTIVES@#With the rapid development of aging population, the number of elderly patients undergoing posterior lumbar spine surgery continues to increase. Lumbar spine surgery could cause moderate to severe postoperative pain, and the conventional opioid-based analgesia techniques have many side effects, which are barriers to the recovery after surgery of the elderly. Previous studies have demonstrated that erector spinae plane block (ESPB) could bring about favorable analgesia in spinal surgery. As far as the elderly are concerned, the analgesic and recovery effects of ESPB on posterior lumbar spine surgery are not completely clear. This study aims to observe the effects of bilateral ESPB on elderly patients undergoing posterior lumbar spine surgery, and to improve the anesthesia techniques.@*METHODS@#A total of 70 elderly patients of both sex, who were selected from May 2020 to November 2021, scheduled for elective posterior lumbar spine surgery, and in the age of 60-79 years, with American Society of Anesthesiologists class Ⅱ-Ⅲ, were divided into a ESPB group and a control (C) group using a random number table method, with 35 patients each. Before general anesthesia induction, 20 mL 0.4% ropivacaine was injected to the transverse process of L3 or L4 bilaterally in the ESPB group and only saline in the C group. The score of Numerical Rating Scale (NRS) indicating pain at rest and on movement within 48 h after operation, time of first patient control analgesia (PCA), cumulative consumptions of sufentanil within 48 hours, Leeds Sleep Evaluation Questionnaire (LSEQ) scores on the morning of day 1 and day 2 after operation, Quality of Recovery-15 (QoR-15) scores at 24 and 48 h after operation, full diet intake times, perioperative adverse reactions such as intraoperative hypotension, postoperative dizziness, nausea, vomiting, and constipation were compared between the 2 groups.@*RESULTS@#A total of 70 patients were enrolled and 62 subjects completed the study, including 32 in the ESPB group and 30 in the C group. Compared with the C group, the postoperative NRS scores at rest at 2, 4, 6, and 12 h and on movementat at 2, 4, and 6 h were lower, time of first PCA was later, sufentanil consumptions were significantly decreased during 0-12 h and 12-24 h after operation, LSEQ scores on the morning of day 1 and QoR-15 scores at 24 and 48 h after operation were higher, full diet intakes achieved earlier in the ESPB group (all P<0.05). There were no significant differences in the incidences of intraoperative hypotension, postoperative dizziness, nausea, vomiting, and constipation between the 2 groups (all P>0.05).@*CONCLUSIONS@#Providing favorable analgesic effects with reduced opioids consumption, bilateral ESPB for posterior lumbar spine surgery in the elderly patients could also improve postoperative sleep quality, promote gastrointestinal functional restoration, and enhance recovery with few adverse reactions.

Application of staged modular theory and practice lectures in laparoscopic training / 中华医学教育探索杂志

Objective:To evaluate the effectiveness of staged modular theory and practice lectures in laparoscopic training.Methods:In this study, a large group of medical students and a large group of residents were selected, and each of the two groups was divided into an experimental group and a control group respectively. The experimental group received staged modular theory and practice lectures based on the conventional trainings, and the control group only underwent conventional laparoscopic skills training and instruction. Before and after the training, the completion time of 6 basic laparoscopic operations, laparoscopic suture time, suture quality and the number of accidental injuries were recorded and scored in each group according to the assessment criteria. SPSS 26.0 was used for statistical analysis of the assessment data. Independent samples t-test or Mann-Whitney U test was used for inter-group comparison between the two large groups, and paired samples t-test or Wilcoxon sign rank sum test was used for intra-group comparison before and after the training. Results:Compared with the control group, the experimental group of medical students that had undergone staged modular theory and practice lectures had a shorter time to complete basic laparoscopic operations, faster speed of suturing ( t=6.18, P<0.001) and higher quality of suturing ( t=4.17, P<0.001) and fewer accidental injuries ( Z=-2.03, P=0.043); the experimental group of residents that had undergone staged modular theoretical and practical lectures had a shorter time to complete basic laparoscopic operations, faster speed of suturing ( t=3.31, P=0.002) and higher quality of suturing ( t=3.68, P=0.001) and fewer accidental injuries ( Z=-2.44, P=0.015). Conclusion:The staged modular theory and practice lectures are able to further improve the quality of basic laparoscopic skills training.

Effect of dexmedetomidine pretreatment on TLR4/NF-κB signaling pathway during intestinal ischemia-reperfusion in rats / 中华麻醉学杂志

Objective To evaluate the effect of dexmedetomidine pretreatment on Toll-like receptor 4 (TLR4)/nuclear factor kappa B (NF-κB) signaling pathway during intestinal ischemia-reperfusion (I/R) in rats.Methods Twenty-four male Spragne-Dawley rats,weighing 180-220 g,were divided into 3 groups (n =8 each) using a random number table method:sham operation group (S group),intestinal I/R group (I group) and dexmedetomidine pretreatment group (DP group).Intestinal I/R model was established by occlusion of the superior mesenteric artery for 1 h followed by 2-h reperfusion in anesthetized rats.Dexmedetomidine 100 μg/kg was intraperitoneally injected at 30 min before ischemia in DP group.Blood samples were collected from hearts at the end of reperfusion for determination of the serum intestinal fatty acid binding protein (I-FABP) level by enzyme-linked immunosorbent assay.The intestinal tissues were obtained at the end of reperfusion for examination of pathologic changes and for determination of tumor necrosis factor-alpha (TNF-α) and interleukin-1beta (IL-1β) contents (by enzyme-linked immunosorbent assay) and expression of TLR4,MyD88,phosphorylated NF-κB p65 (p-NF-κB p65) in total protein and NF-κB p65 in nucleoprotein (by Western blot).The degree of intestinal tissue damage was graded using Chiu's scoring system.Results Compared with S group,the Chiu's score and concentrations of IFABP in serum and contents of TNF-α and IL-1β in intestinal tissues were significantly increased,and the expression of TLR4,MyD88 and p-NF-κB p65 in total protein and NF-κB p65 in nucleoprotein was up-regulated in I/R group,and the Chiu's score was significantly increased,the expression of MyD88 and p-NF-κB p65 was up-regulated (P＜0.05),and no significant change was found in serum I-FABP concentration,contents of TNF-α and IL-1β,or expression of TLR4 in total protein and NF-κB p65 in nucleoprotein in DP group (P＞0.05).Compared with I/R group,the Chiu's score,serum I-FABP concentration,and contents of TNF-α and IL-1β were significantly decreased,and the expression of TLR4,MyD88 and p-NF-κB p65 in total protein and NF-κB p65 in nucleoprotein was down-regulated in DP group (P＜0.05).Conclusion The mechanism by which dexmedetomidine pretreatement mitigates intestinal I/R injury may be related to inhibiting activation of TLR4/NF-κB signaling pathway in rats.

Protective effect of parecoxib on intestinal barrier function of septic mice / 临床麻醉学杂志

Objective To observe the effect of parecoxib on intestinal barrier function of septic mice.Methods Sepsis was induced by cecal ligation and puncture (CLP) model.Twenty-one male C57BL/6 mice were randomly divided into three groups (n =7 in each group):group Sham,group CLP,group P (parecoxib 2 mg/kg was administered via gastric tube 2 h after CLP).In vivo intestinal permeability was measured using an in vivo ligated loop model 24 h after surgery.Twenty-one male C57BL/6 mice were randomly divided into three groups as before.The small intestine tissue sample was harvested 24 h after surgery.The intestinal pathological changes were observed under light microscope.The expression of tight junction proteins ZO-1,Occludin,and Claudin-1 in the ileum were measured by Western blot.IL-6 and PGE2 level in the ileum were measured by ELISA.Results Compared with group Sham,the intestinal permeability was significantly increased and there was a significant intestinal pathological injury in group CLP.IL-6 and PGE2 level in the ileum was sig nificantly increased and the expression of tight junction protein ZO-1,Occludin,and Claudin-1 in the ileum were reduced in the group CLP (P＜0.05).Compared with the group CLP,intestinal permeability and pathological injury was significantly reduced in the group P.The levels of IL-6 and PGE2 were significantly decreased (P＜0.05),the expression of ZO-1,Occludin,and Claudin 1 were upregulated in group P (P＜0.05).Conclusion Parecoxib can decrease the levels of proinflammatory factors and up-regulate the expression of tight junction to reverse intestinal barrier dysfunction caused by sepsis in mice.

Preconditioning of ulinastatin alleviates GES-1 cell injury induced by oxygen and glucose deprivation / 实用医学杂志

Objective To observe the effects of the preconditioning of ulinastatin on GES-1 cell injury induced by oxygen and glucose deprivation (OGD). Methods GES-1 cells were cultured in vitro and divided into three groups: normal control group (group N), oxygen and glucose deprivation group (group O), and ulinastatin preconditioning group (group U). The OGD model of GES-1 cells were established by glucose-free medium and three-gas incubator for 6h. Ulinastatin was added to group U 12h before the deprivation of oxygen and glucose. The cell viability and apoptosis were determined by cck-8 and flow cytometry respectively. Western Blot was used to examine the protein expression of Caspase-3 and Cleaved Caspase-3. The TRPV1 mRNA expression was measured by quantitative real-time PCR. Results As compared with group N, the viability of GES-1 was decreased, the apoptotic rate and the expression of Caspase-3 and Cleaved Caspase-3 were increased, and the TRPV1 mRNA expression decreased greatly in group O (P < 0.05). As compared with group O, the aforementioned changes were significantly inhibited in group U. Conclusions Ulinastatin preconditioning could effectively inhibit GES-1 cell injury induced by OGD, which may be related to the inhibition of apoptosis and the upregulation of TRPV1 mRNA expression.

Effects of general anesthesia combined thoracic paravertebral block on postoperative pain and fast track in single-port video-assisted thoracoscopic surgery / 临床麻醉学杂志

Objective To explore the effects of general anesthesia combined thoracic paraverte-bral block on postoperative pain and fast track single-port video-assisted thoracoscopic surgery (VATS).Methods Thirty patients,including male 20 and female 10,received single-port VATS were randomly and equally divided into two groups:group C received general anesthesia only,and group T received ultrasound-guided thoracic paravertebral nerve block combined with general anesthe-sia.Both groups did not use the patient-controlled analgesia,if insufficient analgesia happened (rest-ing VAS scores>4),than used dezocine intravenously as additional analgesia (a single-dose 5-20 mg, no more than 120 mg per day).The Ramsay scores at 1,4,8,12 h after the surgery and the mechani-cal withdrawal threshold on the day before the surgery,at 4,8,12,24 h after the surgery were recor-ded.The first time of post-operation pain feedback,the consumption of dezocine in the first 24 h after surgery,the incidence rates of side effects,the first time off-bed and the hospital stays were also re-corded.Results Compared with group C,the Ramsay scores at 8,12 h postoperatively in group T significantly decreased (P <0.05),and the mechanical withdrawal threshold at 4,8 h postoperatively significantly increased (P <0.05).The first time of post-operation pain feedback in group T was sig-nificantly longer than group C (P <0.05).The consumption of dezocine in the first 24 h after surgery significantly decreased in group T (P <0.05).The first time off-bed and the hospital stays in group T were shorter than group C (P <0.05).Also,the incidence rates of nausea,vomiting in the first 24 h postoperatively were lower in group T (P < 0.05 ).Conclusion General anesthesia combined with single-injected thoracic paravertebral nerve block can effectively relieve the postoperative pain in pa-tients undergoing single-port VATS,reduce the consumption of opioids in the first 24 h postopera-tively,cutting down the occurring rates of adverse reactions,which was beneficial to early ambulate and shortened the hospital stays.